COMPLAINT FOR PARENTAGE, ALLOCATION OF PARENTAL …...you are filing a poverty affidavit, you must...

COMPLAINT FOR PARENTAGE, ALLOCATION OF PARENTAL RIGHTS AND RESPONSIBILITIES (CUSTODY), AND PARENTING TIME (COMPANIONSHIP AND VISITATION)

SCIOTO COUNTY, OHIO

This form is used to be legally recognized as the parent of a child, be named the residential parent, or obtain visitation with the child(ren). If you are filing a Complaint for Parentage, Allocation of Parental Rights and Responsibilities and Parenting Time, the following forms must be filed:

FORMS YOU MUST COMPLETE:

Form Form Name Purpose and Instructions

Domestic Relations Classification Form Required by the Court when filing an affirmative action for parentage and custody or visitation. Put an “X” by DO and option J if need paternity established or K if paternity already established. Fill out the bottom of the form.

Ohio Sup. Ct. Form 20

Complaint for Parentage, Allocation of Parental Rights and Responsibilities (Custody) and Parenting Time (Companionship and Visitation)

Required to ask the court to find that you are legally the father of the child(ren) and/or for custody or visitation with the child(ren)

Ohio Sup. Ct. Affidavit 1/

Local Form 5

Affidavit of Income and Expenses* Required to allow Courts to address child support and other child-related expenses.

Ohio Sup. Ct. Affidavit 3

Parenting Proceeding Affidavit* Required to advise the Court where the children have lived for the last five years and the names of the adults responsible for their care during this five year period. (or since birth if under age 5).

Local Form 4 Application for Child Support Services (IV-D Application)

Required to allow Court to address child support.

Local Form 12 Poverty Affidavit and

Financial Disclosure/Affidavit of Indigency

Tells the Court that you cannot afford to prepay the filing fee.


Request for Service IF you do not know your spouse’s address AND you are filing a poverty affidavit, you must check the box for “Other” on this form and write in “posting” so the clerk will serve by posting.

Required because the other party must be served with the Complaint. This form tells the Court where to send the copies to the other party.


Waiver of Service of Summons Complete this form IF the other party agrees to waive service of the Complaint by signing this form.

Affidavit for Service* Use this ONLY if you do not know the other party’s current address.

*Affidavits must be signed in front of a Notary who will administer an Oath

INSTRUCTIONS

• All forms must either be typed or printed in ink. You must fill out the forms completely before filing them with the court. The court staff will not help you complete the forms.

• Make (1) copy of the following documents: o Domestic Classification form o Poverty Affidavit and Financial Disclosure/Affidavit of Indigency

• Make three (3) copies of all other forms • Take the original and all copies to the Clerk of the Scioto County Common Pleas Court (2nd

floor Courthouse on 6th street) • NOTE: If you did not complete the poverty affidavit, the filing fee is $_________ • Once you file the forms, the Clerk will send you notice of any court dates. You must attend

all of these court dates. • NOTE: If you move, call the Clerk with your new address

IF YOU ARE FILING THE COMPLAINT FOR PARENTAGE AND CUSTODY OR

VISITATION, THEN YOU MUST ATTEND THE COURT HEARING.

IN THE COURT OF COMMON PLEAS DOMESTIC RELATIONS DIVISION, SCIOTO COUNTY

PORTSMOUTH OHIO

CLASSIFICATION FORM Case No. Style: Please check the appropriate box(es):

DR = Divorce

A: Termination of Marriage with Children

B: Termination of Marriage without Children

DM = Dissolution

C: Dissolution of Marriage with Children

D: Dissolution of Marriage without Children

DV = Domestic Violence DO = Other Domestic Relations Matters

E: Change of Custody F: Visitation Enforcement/Modification G: Child Support Enforcement/Modification I: U.I.F.S.A. J: Parentage K: All Others

Submitted By: Address: Telephone:

IN THE COURT OF COMMON PLEAS Division COUNTY, OHIO IN THE MATTER OF: A Minor : Plaintiff : Case No. : Street Address : : Judge City, State and Zip Code : : : Magistrate vs. : : : Defendant : : Street Address : : City, State and Zip Code : Instructions: This form is used to be legally recognized as the parent of the child, be named as the residential parent, or obtain visitation with the child(ren). The Parenting Proceeding Affidavit (Uniform Domestic Relations Form - Affidavit 3) and the Affidavit of Income and Expenses (Uniform Domestic Relations Form - Affidavit 1) must be filed with this Complaint.

COMPLAINT FOR PARENTAGE, ALLOCATION OF PARENTAL RIGHTS AND RESPONSIBILITIES (CUSTODY), AND

PARENTING TIME (COMPANIONSHIP AND VISITATION)

1. I, (name), am the Plaintiff and biological Father Mother (select one) of the following child(ren): Name of Child Date of Birth

2. Defendant, is the biological Father Mother (select one) of the child(ren).

Supreme Court of Ohio Uniform Domestic Relations Form – 20 Page 1 of 2 Uniform Juvenile Form – 2 COMPLAINT FOR PARENTAGE, ALLOCATION OF PARENTAL RIGHTS AND RESPONSIBILITIES AND PARENTING TIME Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46 Effective Date: 7/1/2013

3. The child(ren) has/have resided in County, Ohio since (date residence established) as set out in the Parenting Proceeding Affidavit (Uniform Domestic Relations Form - Affidavit 3).

4. The father-child relationship has has not (select one) been established. If it has been established, a copy of the order establishing the father-child relationship is attached. A copy of the child(ren)’s birth certificate is also attached.

5. No court has issued an order about the following child(ren): The following Court has issued an order about the following child(ren):

6. I request that the Court (check all that apply): Name (Father’s name) as the Father of the child(ren) (child(ren)’s name). Correct the child(ren)’s birth certificate to indicate the child(ren)’s father. Order genetic testing and determine the father of the child(ren). Name the Plaintiff Defendant (select one) as the residential parent and legal custodian of the child(ren). Grant reasonable parenting time (visitation) to the Mother Father (select one). Change the child(ren)’s name to Adopt the proposed Shared Parenting Plan for the child(ren) which is attached. Order the appropriate amount of child support for the child(ren), allocate the income tax dependency exemption for the child(ren), and determine who should provide health insurance coverage for the child(ren). Other (specify):

Your Signature

Telephone number at which the Court may reach you or at which messages may be left for you

Supreme Court of Ohio Uniform Domestic Relations Form – 20 Page 2 of 2 Uniform Juvenile Form – 2 COMPLAINT FOR PARENTAGE, ALLOCATION OF PARENTAL RIGHTS AND RESPONSIBILITIES AND PARENTING TIME Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46 Effective Date: 7/1/2013

COURT OF COMMON PLEAS COUNTY, OHIO

Case No. Plaintiff/Petitioner

Judge

v./and Magistrate

Defendant/Petitioner

Instructions: Check local court rules to determine when this form must be filed. This affidavit is used to make complete disclosure of income, expenses and money owed. It is used to determine child and spousal support amounts. Do not leave any category blank. Write “none” where appropriate. If you do not know exact figures for any item, give your best estimate, and put “EST.” If you need more space, add additional pages.

AFFIDAVIT OF INCOME AND EXPENSES

Affidavit of (Print Your Name)

Date of marriage Date of separation

SECTION I - INCOME Husband Wife

Employed Yes No Yes No

Employer

Payroll address

Payroll city, state, zip

Scheduled paychecks per year 12 24 26 52 12 24 26 52

A. YEARLY INCOME, OVERTIME, COMMISSIONS AND BONUSES FOR PAST THREE YEARS

Husband Wife

Base yearly income $ 3 years ago 20 $

$ 2 years ago 20 $

$ Last year 20 $

Yearly overtime, commissions and/or bonuses

$ 3 years ago 20 $

$ 2 years ago 20 $

$ Last year 20 $

Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 1 Affidavit of Income and Expenses Approved under Ohio Civil Rule 84 Effective Date: July 1, 2010 Page 1 of 7

B. COMPUTATION OF CURRENT INCOME

Husband Wife Base yearly income $ $ Average yearly overtime, commissions and/or bonuses over last 3 years (from part A) $ $ Unemployment compensation $ $ Disability benefits

$ $

Workers’ Compensation

Social Security

Other: Retirement benefits

$ $

Social Security

Other: Spousal support received $ $ Interest and dividend income (source)

$ $

Other income (type and source)

$ $

TOTAL YEARLY INCOME $ $

Supplemental Security Income (SSI) or public assistance $ $ Court-ordered child support that you receive for minor and/or dependent child(ren) not of the marriage or relationship $ $

SECTION II – CHILDREN AND HOUSEHOLD RESIDENTS Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 1 Affidavit of Income and Expenses Approved under Ohio Civil Rule 84 Effective Date: July 1, 2010 Page 2 of 7

Minor and/or dependent child(ren) who are adopted or born of this marriage or relationship:

Name Date of birth Living with

In addition to the above children there is/are in your household:

adult(s)

other minor and/or dependent child(ren). SECTION III – EXPENSES List monthly expenses below for your present household. A. MONTHLY HOUSING EXPENSES

Rent or first mortgage (including taxes and insurance) $

Real estate taxes (if not included above) $

Real estate/homeowner’s insurance (if not included above) $

Second mortgage/equity line of credit $

Utilities

o Electric $

o Gas, fuel oil, propane $

o Water and sewer $

o Telephone $

o Trash collection $

o Cable/satellite television $

Cleaning, maintenance, repair $

Lawn service, snow removal $

Other: $ $

TOTAL MONTHLY : $


B. OTHER MONTHLY LIVING EXPENSES

Food

o Groceries (including food, paper, cleaning products, toiletries, other) $

o Restaurant $

Transportation

o Vehicle loans, leases $

o Vehicle maintenance (oil, repair, license) $

o Gasoline $

o Parking, public transportation $

Clothing

o Clothes (other than children’s) $

o Dry cleaning, laundry $

Personal grooming

o Hair, nail care $

o Other $

Cell phone $

Internet (if not included elsewhere) $

Other $

TOTAL MONTHLY $

C. Monthly child related expenses (for children of the marriage or relationship)

Work/education-related child care $

Other child care $

Unusual parenting time travel $

Special and unusual needs of child(ren) (not included elsewhere) $

Clothing $

School supplies $

Child(ren)’s allowances $

Extracurricular activities, lessons $

School lunches $

Other $

TOTAL MONTHLY $


D. INSURANCE PREMIUMS

Life $

Auto $

Health $

Disability $

Renters/personal property (if not included in part A above) $

Other $

TOTAL MONTHLY $

E. MONTHLY EDUCATION EXPENSES

Tuition

o Self $

o Child(ren) $

Books, fees, other $

College loan repayment $

Other $

$

TOTAL MONTHLY: $

F. MONTHLY HEALTH CARE EXPENSES (not covered by insurance)

Physicians $

Dentists $

Optometrists/opticians $

Prescriptions $

Other $

$

TOTAL MONTHLY: $

G. MISCELLANEOUS MONTHLY EXPENSES

Extraordinary obligations for other minor/handicapped child(ren) (not stepchildren) $

Child support for children who were not born of this marriage or relationship and were not adopted of this marriage $

Spousal support paid to former spouse(s) $

Subscriptions, books $

Entertainment $


Charitable contributions $

Memberships (associations, clubs) $

Travel, vacations $

Pets $

Gifts $

Bankruptcy payments $

Attorney fees $

Required deductions from wages (excluding taxes, Social Security and Medicare) (type) $

Additional taxes paid (not deducted from wages) (type) $

Other $

$

TOTAL MONTHLY: $

H. MONTHLY INSTALLMENT PAYMENTS (Do not repeat expenses already listed.) Examples: car, credit card, rent-to-own, cash advance payments

To whom paid Purpose Balance due Monthly payment

$ $

$ $

$ $

$ $

$ $

$ $

$ $

$ $

$ $

$ $

$ $

$ $

$ $

$ $

$ $ TOTAL MONTHLY: $

GRAND TOTAL MONTHLY EXPENSES (Sum of A through H): $


OATH (Do not sign until notary is present.)

I, (print name)

, swear or affirm that I have read this document and, to the best of my knowledge and belief, the facts and information stated in this document are true, accurate and complete. I understand that if I do not tell the truth, I may be subject to penalties for perjury.

Your Signature

Sworn before me and signed in my presence this day of , .

Notary Public

My Commission Expires:


COURT OF COMMON PLEAS

COUNTY, OHIO

Case No. Plaintiff/Petitioner

Judge

v./and Magistrate

Defendant/Petitioner/Respondent

Instructions: Check local court rules to determine when this form must be filed. By law, an affidavit must be filed and served with the first pleading filed by each party in every parenting (custody/visitation) proceeding in this Court, including Dissolutions, Divorces and Domestic Violence Petitions. Each party has a continuing duty while this case is pending to inform the Court of any parenting proceeding concerning the child(ren) in any other court in this or any other state. If more space is needed, add additional pages.

PARENTING PROCEEDING AFFIDAVIT (R.C. 3127.23(A)) Affidavit of

(Print Your Name) Check and complete ALL THAT APPLY: 1. I request that the court not disclose my current address or that of the child(ren). My address is

confidential pursuant to R.C. 3127.23(D) and should be placed under seal to protect the health, safety, or liberty of myself and/or the child(ren).

2. Minor child(ren) are subject to this case as follows:

Insert the information requested below for all minor or dependent children of this marriage. You must list the residences for all places where the children have lived for the last FIVE years.

a. Child’s Name: Place of Birth:

Date of Birth: Sex: Male Female

Period of Residence Check if Confidential Person(s) With Whom Child Lived

(name & address) Relationship

to present Address Confidential?

to

Address

Confidential?

to

Address

Confidential?

to

Address

Confidential?

Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 3 Parenting Proceeding Affidavit Approved under Ohio Civil Rule 84 Effective Date: July 1, 2010

Page 1 of 4

b. Child’s Name: Place of Birth:


Check this box if the information requested below would be the same as in subsection 2a and skip to the next question.




to

Address

Confidential?

to

Address

Confidential?

to

Address

Confidential?

c. Child’s Name: Place of Birth:


Check this box if the information requested below would be the same as in subsection 2a and skip to the next question.




to

Address

Confidential?

to

Address

Confidential?

to

Address

Confidential?

IF MORE SPACE IS NEEDED FOR ADDITIONAL CHILDREN, ATTACH A SEPARATE PAGE AND CHECK THIS BOX .

3. Participation in custody case(s): (Check only one box.) I HAVE NOT participated as a party, witness, or in any capacity in any other case, in this or any other

state, concerning the custody of, or visitation (parenting time), with any child subject to this case.

I HAVE participated as a party, witness, or in any capacity in any other case, in this or any other state, concerning the custody of, or visitation (parenting time), with any child subject to this case. For each case in which you participated, give the following information:

Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 3 Page 2 of 4 Parenting Proceeding Affidavit Approved under Ohio Civil Rule 84 Effective Date: July 1, 2010

a. Name of each child: b. Type of case: c. Court and State: d. Date and court order or judgment (if any): IF MORE SPACE IS NEEDED FOR ADDITIONAL CUSTODY CASES, ATTACH A SEPARATE PAGE AND CHECK THIS BOX .

4. Information about other civil case(s) that could affect this case: (Check only one box.) I HAVE NO INFORMATION about any other civil cases that could affect the current case, including

any cases relating to custody, domestic violence or protection orders, dependency, neglect or abuse allegations or adoptions concerning any child subject to this case.

I HAVE THE FOLLOWING INFORMATION concerning other civil cases that could affect the current case, including any cases relating to custody, domestic violence or protection orders, dependency, neglect or abuse allegations or adoptions concerning a child subject to this case. Do not repeat cases already listed in Paragraph 3. Explain:

a. Name of each child: b. Type of case: c. Court and State: d. Date and court order or judgment (if any): IF MORE SPACE IS NEEDED FOR ADDITIONAL CASES, ATTACH A SEPARATE PAGE AND CHECK THIS BOX . 5. Information about criminal case(s): List all of the criminal convictions, including guilty pleas, for you and the members of your household for the following offenses: any criminal offense involving acts that resulted in a child being abused or neglected; any domestic violence offense that is a violation of R.C. 2919.25; any sexually oriented offense as defined in R.C. 2950.01; and any offense involving a victim who was a family or household member at the time of the offense and caused physical harm to the victim during the commission of the offense.

Name Case Number Court/State/County Convicted of What Crime?

IF MORE SPACE IS NEEDED FOR ADDITIONAL CASES, ATTACH A SEPARATE PAGE AND CHECK THIS BOX .


6. Persons not a party to this case who has physical custody or claims to have custody or visitation rights to children subject to this case: (Check only one box.)

I DO NOT KNOW OF ANY PERSON(S) not a party to this case who has/have physical custody or claim(s) to have custody or visitation rights with respect to any child subject to this case.

I KNOW THAT THE FOLLOWING NAMED PERSON(S) not a party to this case has/have physical custody or claim(s) to have custody or visitation rights with respect to any child subject to this case.

a. Name/Address of Person Has physical custody Claims custody rights Claims visitation rights Name of each child: b. Name/Address of Person Has physical custody Claims custody rights Claims visitation rights Name of each child: c. Name/Address of Person Has physical custody Claims custody rights Claims visitation rights Name of each child:

OATH

(Do Not Sign Until Notary is Present)

I, (print name) , swear or affirm that I have read this document and, to the best of my knowledge and belief, the facts and information stated in this document are true, accurate and complete. I understand that if I do not tell the truth, I may be subject to penalties for perjury.

Your Signature

Sworn before me and signed in my presence this day of , .

Notary Public

My Commission Expires:


SCIOTO COUNTY DR FORM 4 Scioto Co. CSEA 710 Court Street PO Box 1347 Portsmouth, Ohio 45662 740-355-8904 800-354-6377 Name: Address:

APPLICATION FOR CHILD SUPPORT SERVICES NON-PUBLIC ASSISTANCE APPLICANT/RECIPIENT

IMPORTANT: If you are receiving ADC or Medicaid, do not complete this application because you became eligible for child support services when you signed the ADC/Medicaid application. I, request child support services from the Scioto County CSEA (Child Support Enforcement Agency). I understand and agree to the following: A. I am a resident of the county in which services are requested and no other Ohio county has jurisdiction over support –OR –I

am requesting services from the Ohio county of jurisdiction.

B. The only fee that can be charged for services is a one dollar application fee. Some counties pay this fee for the applicants.

C. Recipients of child support services shall cooperate to the best of their ability with the CSEA. (See attached rights and responsibility information).

D. In providing IV-D services, the CSEA and any of its contracted agents (e.g., prosecutors, attorneys, hearing officers, etc.) represent the best interest of the children of the state of Ohio and do not represent any IV-D recipient or the IV-D recipient's personal interest.

The Child Support Enforcement Agency can assist you in providing the following services: 1. Location of Absent Parents.

The agency can assist in finding where an absent parent is currently living, in what city, town, or state. The applicant can request 'Location Only Services', if the sole need is to find the whereabouts of the absent parent.

2. Establishment or Adjustment of Child Support and Medical Support.

The CSEA can assist you to obtain an order for support if you are separated, have been deserted, or need to establish paternity (fatherhood). The CSEA can also assist you in changing the amount of support orders (adjustment), and to establish a medical support order.

3. Enforcement of Existing Orders. The CSEA can help you collect current and past-due child support. 4. Federal and State Income Tax Refund Offset Submittals for the Collection of Child Support Arrearages.

The agency can collect past-due support (arrearages) by intercepting a payor's federal and state income tax refunds in some cases.

5. Withholding of Wages and Unearned Income for the Payment of Court Ordered Support.

The agency can help you get payroll deductions for current and past-due child support and can intercept unemployment compensation to collect child support.

6. Establishment of Paternity.

The agency can obtain an order for the establishment of paternity (fatherhood), if you were not married to the father of the child. An absent parent may request paternity services.

7. Collection and Disbursement of Payments.

The CSEA can collect the child support for you, and send you a check for the amount of the payments received. Past due support collected will be paid to you until all of the past-due support you are owed is paid.

8. Interstate Collection of Child Support.

The agency can assist you in collecting support if the payor is living in another state or in some foreign countries.

JFS 07076 1 of 4

APPLICANT INFORMATION Name: Date of Birth:

Home Address: Mailing Address:

Home Phone #:

Social Security #: Sex:

Race:

Single Married

Relationship to Children: Divorced Separated

Military Service Ever Been on Public

(Branch, Dates) Assistance?

(When, Where)

EMPLOYER INFORMATION

Employer Name: Employer Phone #:

Employer: Is Medical Insurance

Address: Available?

CHILD 1 CHILD 2 CHILD 3

Name:

Sex:

Race:

Social Security #:

Date of Birth:

Home Address:

Location of Birth: (country, State, city)

Has Paternity (fatherhood) Been Established?

JFS 07076 2 of 4

Name(s) of absent parent(s):

Is there an Order for Support?

Is the child covered by medical insurance?

ABSENT PARENT INFORMATION

Absent Parent #1

Absent Parent #2

Absent Parent #3

Name (and alias):

Home Address:

Mailing Address:

SSN:

Date of Birth (DOB)

Location of Birth: (Country, State, city)

Race:

Sex:

Height/Weight:

Hair/Eye Color:

Identifying Marks: (tattoos, scars, etc.)

Names of Children:

Name of Employer:

Address of Employer: (City, State, Zip Code)

Employer Phone #:

Medical Insurance Provided?

Support Order #:

JFS 07076 3 of 4

Date of Support Order:

Amount of Support: $

$

$

Order Frequency:

Per

Per Per

Location Where Order Issued:

Military Service (Branch, Dates):

Ever Incarcerated? (Location, Dates):

Arrest Record: (Location, Dates):

Current Spouse: (Name, Address)

Father’s Name:

Mother’s Name: (maiden)

Ever been on Public Assistance? (Location, Dates)

Type(s) of Service(s) Requested:

All Services Listed

Location of absent parent only

Other (please explain):

I understand that the Child Support Agency within 20 days of receiving this application will contact me by written notice to inform me if my case has been accepted for child support services (IV-D Services). Signature of Applicant: _____________________________________ Date:_______________________________

JFS 07076 4 of 4

Scioto County DR Form 12

IN THE SCIOTO COUNTY COURT OF COMMON PLEAS DOMESTIC RELATIONS DIVISION, SCIOTO COUNTY

PORTSMOUTH, OHIO

PLAINTIFF

v.

DEFENDANT

CASE NUMBER: JUDGE JERRY L. BUCKLER MAGISTRATE MICHAEL L. JONES

PETITION FOR WAIVER OF PREPAYMENT OF FILING FEE AND COUT COSTS DEPOSIT WITH POVERTY AFFIDAVIT

Please mark one of the following boxes and fill in the appropriate information:

□ I, _______________________, am the Plaintiff/Defendant in the above-captioned case.

Or

□ We, ___________________________ and ___________________________, are the Petitioners in the above-captioned case.

I/We request the Court grant a Waiver of the Prepayment of the Filing Fee and Court Costs Deposit so that this case can proceed without the initial payment or deposit of any fees.

Telephone No.

Telephone No.

In support of my/our petition under Ohio R.C. §2323.31, the attached affidavit(s) is/are submitted. I/We understand that this petition could be denied and a deposit or fee may have to be paid. If not paid, this case may be dismissed. I/We understand that even if granted, the Court may assess costs against me/us after the case is over. ___________________________ Plaintiff/Petitioner ___________________________ Defendant/Petitioner STATE OF OHIO ) ) SS. POVERTY AFFIDAVIT SCIOTO COUNTY ) I/We, __________________________________, being duly sworn sayeth:

1. I am a party in the foregoing action; 2. I am without the funds or assets to give security or a cash deposit to secure

costs at this time. 3. I understand that I must inform the court if my financial situation should

change before the disposition of my case; 4. I understand that I am subject to criminal charges for providing false

information; 5. I understand that if it is determined by the court, that I was not entitled to the

suspended deposit/costs that were provided to me, I may be required to reimburse the county for the costs;

6. I understand that the court will ultimately determine which party will be responsible for the payment of costs in this case, unless costs are waived.

_____________________________ Affiant Sworn before me and subscribed in my presence this __________________ day of _________________, 20 _________ . _____________________________ Notary public or Deputy Clerk

FINANCIAL DISCLOSURE/AFFIDAVIT OF INDIGENCY

($25.00 application fee may be assessed – see notice on reverse side) I.PERSONAL INFORMATION

Name/Applicant

Party Represented (if applicant enter “same)

DOB:

Mailing Address

City State Zip

Case No.

Phone ( )

Message Phone (within 48 hours) ( )

II. OTHER PERSONS LIVING IN HOUSEHOLD Name 1)

DOB Relationship Name 3)

DOB Relationship

2)

4)

III. MONTHLY INCOME/EMPLOYMENT INFORMATION Type of Income Applicant Spouse (or Parents if

application is a juvenile) Other Household Members

Total

Employment (Gross) Unemployment Worker’s Comp Pension/Social Security Child Support Works First/TANF Disability Other

Employer’s Name (for all household members)

A.TOTAL INCOME $

Phone ( )

IV. ALLOWABLE EXPENSES V. TOTAL INCOME Type of Expense Amount Child Support Paid Out Child Care (if working only) Total Income – Allowable Expenses = Adjusted Total Income Transportation for work Insurance A.TOTAL INCOME $ Medical Dental - B.EXPENSES $ Medical & Associated Costs of Caring for Infirm Family members

= C.ADJUSTED TOTAL INCOME $

B. EXPENSES $

VI. ASSET INFORMATION Type of Asset Describe/Length of Ownership/Make, Model, Year (where applicable) Estimated Value Real Estate/Home Price:$ Date Purchased: Amt. Owed $: Stocks/Bonds/CD’s Automobiles Trucks/Boats/Motorcycles Other Valuable Property Cash on Hand Money Owed to Applicant Other Checking Acct. (Bank/Acct #) Savings/MM Acct. (Bank/Acct #)

D. TOTAL ASSETS $

1 of 2

VII. MONTHLY LIABILITIES/OTHER EXPENSES VIII. GRAND TOTALS

Type of Liability Amount

Rent / Mortgage

Food C. ADJ. TOTAL INCOME Electric Gas D. TOTAL ASSETS Fuel

Telephone E. LIABILITIES & OTHER

Cable

Water / Sewer / Trash $25.00 APPLICATION FEE NOTICE Credit Cards By submitting this Financial Disclosure Form/Affidavit of

Indigency Form, you will be assessed a non-refundable $25.00 application fee unless waived or reduced by the court. If assessed, the fee is to be paid to the clerk of courts within seven (7) days of submitting this form to the court, the public defender, your appointed counsel or any other party who will make a determination regarding your indigency.

Loans Taxes Owed Other

E. LIABILITIES & OTHER EXPENSE IX. AFFIDAVIT OF INDIGENCY

I, _______________________________________________________(affiant) being duly sworn, say:

1. I am financially unable to retain private counsel without substantial hardship to me or my family.

2. I understand that I must inform the public defender or appointed attorney if my financial situation should change before the disposition of the case(s) for which representation is being provided.

3. I understand that if it is determined by the county, or by the Court, that legal representation should not have been provided, I may be required to reimburse the county for the costs of representation provided. Any action filed by the county to collect legal fees hereunder must be brought within two years form the last date legal representation was provided.

4. I understand that I am subject to criminal charges for providing false financial information in connection with the above application for legal representation pursuant to Ohio Revised Code Sections 120.05 and 2921.13.

5. I hereby certify that the information I have provided on this financial disclosure form is true to the best of my knowledge.

Affiant’s Signature Date Notary Public/Individual duly authorized to administer oath: Subscribed and duly sworn before me according to law, by the above named applicant this ______ day of

_______________________, _______, at _______________________, County of _______________________ and State of _________________.

Signature of person administering oath Title

X. JUDGE CERTIFICATION I hereby certify that above-noted applicant is unable to fill out and/or sign this financial disclosure/ affidavit for

the following reason: __________________________________________________________________________.

I have determined that the applicant meets the criteria for receiving court appointed counsel. Judge’s Signature Date

2 of 2

IN THE COURT OF COMMON PLEAS Division COUNTY, OHIO IN THE MATTER OF:

A Minor

: Name : Case No.

:

Street Address : Judge : City, State and Zip Code :

Plaintiff/Petitioner : Magistrate : vs./and : : : Name : : Street Address : : City, State and Zip Code :

Defendant/Petitioner : Instructions: This form is used when you want to request documents to be served on the other party. You must indicate the requested method of service by marking the appropriate box.

REQUEST FOR SERVICE TO THE CLERK OF COURT: Please serve the following documents on the following parties as I have indicated below:

Defendant/Petitioner at the address shown above. Certified Mail, Return Receipt Requested Issuance to Sheriff of County, Ohio for Personal or Residence service Other (specify)

Supreme Court of Ohio Uniform Domestic Relations Form – 28 Page 1 of 2 Uniform Juvenile Form – 10 REQUEST FOR SERVICE Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46 Effective Date: 7/1/2013

Plaintiff/Petitioner at the address shown above. Certified Mail, Return Receipt Requested Issuance to Sheriff of County, Ohio for Personal or Residence service Other (specify)

County Child Support Enforcement Agency (provide address below): Certified Mail, Return Receipt Requested Issuance to Sheriff of County, Ohio for Personal or Residence service Other (specify)

Other (address): Certified Mail, Return Receipt Requested Issuance to Sheriff of County, Ohio for Personal or Residence service Other (specify) SPECIAL INSTRUCTIONS TO SHERIFF: Your Signature

Supreme Court of Ohio Uniform Domestic Relations Form – 28 Page 2 of 2 Uniform Juvenile Form – 10 REQUEST FOR SERVICE Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46 Effective Date: 7/1/2013

IN THE COURT OF COMMON PLEAS Division COUNTY, OHIO IN THE MATTER OF: A Minor : Plaintiff/Petitioner : Case No. : Street Address : : Judge City, State and Zip : : vs. : Magistrate : : Defendant/Respondent/Petitioner : : Street Address : : City, State and Zip Code : :

WAIVER OF SERVICE OF SUMMONS I, (name), acknowledge that I am the Petitioner Plaintiff

Defendant Respondent (select one) and that I have received a copy of the following documents filed or to be filed by the other party: Complaint for Parentage Complaint Motion (select one) for Allocation of Parental Rights and Responsibilities (Custody) Complaint Motion (select one) for Parenting Time (Companionship and Visitation) Complaint Motion (select one) for Establishment or Change of Child Support Journal Entry and Findings of Fact Supporting Child Support Deviation Health Insurance Affidavit Complaint for Divorce with Children Complaint for Divorce without Children Separation Agreement Shared Parenting Plan Parenting Plan Petition for Dissolution Agreed Judgment Entry, Magistrate’s Decision, Order, and/or Magistrate’s Order Affidavit of Income and Expenses Supreme Court of Ohio Uniform Domestic Relations Form – 27 Uniform Juvenile Form – 9 Page 1 of 2 WAIVER OF SERVICE OF SUMMONS Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46 Effective Date: 7/1/2013

Affidavit of Property Parenting Proceeding Affidavit Motion for Contempt and Affidavit Motion and Affidavit or Counter Affidavit for Temporary Orders with Oral Hearing Other (specify): I waive service of summons of said document by the Clerk of Court.

Date Your Signature Telephone number at which the Court may reach you

or at which messages may be left for you

Supreme Court of Ohio Uniform Domestic Relations Form – 27 Uniform Juvenile Form – 9 Page 2 of 2 WAIVER OF SERVICE OF SUMMONS Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46 Effective Date: 7/1/2013

IN THE COURT OF COMMON PLEAS, SCIOTO COUNTY, OHIO DOMESTIC RELATIONS DIVISION

Case No.

Plaintiff, JUDGE BUCKLER

vs. Magistrate Jones

AFFIDAVIT FOR SERVICE PURSUANT TO O.R.C. 4.4(A)(2)

Defendant. I, being first duly sworn and cautioned, depose and state as follows:

1. I have filed for a Complaint for Parentage and am not able to prepay the filing fees;

2. I do not know the current address of the defendant;

3. I have made efforts to determine the defendant’s current address but have been unable

to do so;

4. The defendant’s residence cannot be learned with reasonable effort

5. The defendant’s last known mailing address is:

Affiant

STATE OF OHIO, COUNTY OF , SS:

Sworn to before me and signed in my presence this day of __________________,20 .

______________________________________ Notary Public

If you do decide to represent yourself, you need tomanage all aspects of your case.

Familiarize yourself with the local court rules.Rules and procedures vary slightly from court tocourt, and you need to know the rules that applyin the court that will hear your case. Obtain acopy of the local rules from your court.

Make sure your filings and documents con-form to local standards. Generic forms andsample filings are available in books and on theinternet. However, these generic documents maynot conform to the standards of the court thatwill hear your case. To make sure that yourdocuments will be accepted, ask your court forforms and sample filings.

Respond to all inquiries on time. During trialpreparations, you may receive inquiries from thecourt or the opposing party. For example, theopposing party may be entitled to “discovery”—to learn about evidence or testimony you plan tointroduce (you may be entitled to the same). Ifyou fail to respond to such inquiries, you maylimit your ability to present your case.

Rules about admissible evidence are compli-cated. There are many possible reasons thatevidence or testimony you think is relevant andimportant may not be admissible in court. Sincequestions about what evidence is admissible arelegal questions that are often contested, neithercourt staff nor the judge may answer them aheadof time. This can be frustrating for non-attor-neys: if your case will involve contested evidence,consider again whether you need an attorney.

Make sure evidence you plan to use will beacceptable and available in court. If your casewill involve evidence—documents, pictures, costestimates, receipts, or other items—you mustprepare it for court use. In particular, you must

bring at least three copies of all documents(for the court, for the opposing party, and foryourself ); and

be able to verify that documents are what yousay they are or contain accurate information.

Make sure any witnesses are prepared andavailable in court. If your case will involvetestimony from witnesses, you need to workwith them before you and they appear in court.Make sure your witnesses know what you willask, and instruct them to answer truthfully. Andremember that your witnesses must be

present at your trial (they may not, forexample, prepare written statements orappear by telephone); and

prepared to answer questions from theopposing party or his or her attorney.

When you decide to represent yourself, you take onfull responsibility for your case. You need to handlelegal questions as well as deadlines, documents,evidence, witnesses, and any other issues that maycome up. Even a seemingly simple case can demanda lot of your time and attention.

At the trial or hearing itself, you need to present yourcase in its strongest way. Here are some simple tips:

Make a good impression. Dress appropriately.Arrive on time with all your materials.

Respect the court. Stand when the judge entersor leaves the courtroom and when you speak tothe judge. Address the judge as “Your Honor.”

Respect the opposing party. Never argue withthe opposing party in front of the judge. Userespectful terms of address.

Speak clearly and succinctly. Be prepared tostate your case in a few sentences. Listencarefully and answer questions directly.

Be prepared. Courts are very busy. You wantto present your case in the strongest way, but youalso want to help the proceedings move effi-ciently. The better prepared you are, the betterthe case will go.

In the Courtroom

Preparing Your Case

Your case will be heard and decided by a judge (or amagistrate). Keep in mind that the role of the judgeis to be an impartial referee in the dispute betweenyou and the opposing party. Among other things,this means that

The judge may not help you present yourcase. Helping you—by pointing out possiblemistakes or by letting you know what you needto do next—would be unfair to the opposingparty. When you represent yourself, you take onthe full responsibility of presenting your case.

The judge may not speak with you about yourcase when the opposing party is not present.This is true even if the issue you want to speakwith the judge about seems like a simple proce-dural question. Again, such communicationswould be unfair to the opposing party.

The judge will decide the case on the basis ofthe facts presented in court and the applicablelaw. The judge may only consider the facts asthey are presented in court, through evidenceand testimony. You need to make sure that allfacts supporting your case are properly pre-sented. The judge also needs to follow the lawsthat apply. Sometimes the law dictates whichfacts the judge may and may not consider. Youneed to make sure that you present the facts thatthe law requires or permits.

The Role of the Judge

REPRESENTINGYOURSELF IN COURT

A CITIZENS GUIDE

Prepared byOhio Judicial Conference 65 South Front Streetwww.ohiojudges.org Columbus, OH 43215-3431

It is always a good idea to consult with an attor-ney and be represented by an attorney in court.

The law is complex. Attorneys are trainedprofessionals who understand the law and how itrelates to your case.

Even matters that initially look simple may raisecomplicated issues.

Your interests will be best protected by a legalprofessional.

Attorneys can be expensive, but consider this:

What might you lose if your case goes badly?Paying for an attorney may be a good invest-ment.

Meet with several attorneys to discuss your caseand their fees—don’t let one consultation makeup your mind.

You may qualify for legal aid or help from legalclinics or other programs—be sure to investigatethe resources in your community.

Ohio courts and judges will provide a fair hearing foryour case whether or not you are represented by anattorney, and it is your right to represent yourself ifyou so choose.

When you bring a case to court without the help ofan attorney, you are taking on a complex task that isnormally done by highly trained professionals. Youmay do yourself a disservice.

Legal Advice

For help with finding an attorney, you mightturn to your local bar association. Your local barassociation is:

Court staff may not give legal advice. You may havequestions that court staff are not permitted to answer.

Court staff may notprovide you with legal research;tell you what sorts of claims to file or what toput on forms;tell you what to say in court;give an opinion about how a judge is likely todecide your case;give you information that they would not giveto the opposing party;tell you about a judge’s decision before it isissued by the judge.

Court staff mayanswer questions about how the court works;explain terms used in the court process;give you information from your case file;provide you with court forms and samplefilings and documents.

Court staff are there to help those who use the court.They can usually tell you how to do things, but maynot advise you about what you ought to do. Pleasebe courteous to staff and respect the limits on whatthey may do for you.

Asking Court Staff

Representing

Yourself in Court?

How to Use Photographs,

Letters, Business Records,

and Other Evidence to Help

Prove Your Case

What is Evidence?

Evidence is anything you use to prove your claim. Evidence can be a photograph, a letter,

documents or records from a business, and a variety of other things. All evidence that is

properly admitted will be considered by the judge.

Your case probably will be decided by a judge. If there is a jury, it will look at admitted

exhibits during its deliberations.

For example:

• In a request for change of custody, the child’s school records could be introduced as

evidence that the child’s grades have dropped or he/she has missed a significant amount of

school while living with the other parent.

• In a domestic violence or stalking civil protection order case, a photograph of any

injury you suffered or a threatening letter written by your abuser may help your case.

• In a divorce case, a copy of tax return documents or documents showing who has title to

a car may be introduced as evidence.

Exhibit 1

Why Use Evidence?

Ø Evidence is more believable and trustworthy than what a person says. For example, in a

domestic violence case, if you say that your ex-boyfriend has left you threatening messages

but he testifies that this is an absolute lie, the judge may not know whom to believe.

However, if you submit a tape recording of one of these messages the judge will be more

likely to believe you.

Ù Evidence may make something easier to understand. “A picture is worth a thousand

words.” Some things are hard to explain in words, while a drawing or photograph is

descriptive and clear.

How Do I Present Evidence to the Court?

Each court is different, but in most courts, you can’t just walk into court with a photograph or

document and show it to the judge or jury. There are many things you must do before the court

will even look at the evidence you have. Further, there are many different types of evidence, and

the rules for using each type of evidence are different. Once you follow these rules, your

evidence will be “admitted”.

Steps to Follow to Admit Evidence

º Before you ever go to court, think about the evidence you want to use to

prove your case. Mark each piece of evidence with an exhibit number

(attach a sticker labeled “Exhibit 1,” “Exhibit 2,” etc.)

º Bring these marked Exhibits with you to court. When you want to show

the court one of the exhibits, do the following things:

ì Show the exhibit to the other party or the other party’s attorney.

í Then “lay the foundation” for the evidence. To do this, you must show that the

evidence is relevant to your case and authentic (not a forgery). Depending upon

what you want the court to consider, follow the rules listed in this pamphlet for

“laying the foundation” - explaining why and how the exhibit is connected to your

case.

Ú Either you or your witness must testify about the exhibit.

Û Ask the court to admit the exhibit into evidence. The other party or attorney may

object to the exhibit for some reason. Try to answer these objections as best you

can. If you can’t, let the judge decide.

Ü If there are no objections from the other party, or the judge has ruled in your favor,

ask the court to “admit the Exhibit into evidence.”

Laying the Foundation for Photographs

1. Explain why a photo is connected to your case. For example:

“This photo shows the injury I suffered after my ex-boyfriend punched andkicked me.”

2. Explain how you know about what is in the photo. For example:

“I had my sister take this photograph within 2 hours after theincident occurred and went to get the film developed myselfthe following day.”

3. Explain that the photo is timely. For example:

“At the bottom right-hand corner of the photo is the date on which it was taken. As you can see, the photo was taken on the sameday that the incident occurred, which is also thesame day the police arrested my ex-boyfriend.”

4. Explain that the photo “fairly and accurately” shows what

is depicted in the photo as it appeared on the date relevant

to your case. For example:

“This photo is a fair and accurate depiction ofhow my face and side looked two hours afterthe incident and for the next two weeks.”

Foundation for Letters

1. Explain why the letter is connected to your case. For example:

“This is the letter that I received from my ex-boyfriend shortlybefore he beat me up."

2. Explain when and how you got the letter. For example:

“This letter was shoved under the door to my apartmentsome time before 6 p.m. on Wednesday, January 2, 2001. I found it on the floor when I came home from work thatday.”

3. Prove that the signature is that of a party to the case. Ways to prove this:

• Explain to the court: that you are familiar with the other party’s signature, how

you came to know that person’s signature, and that it is your opinion that the

signature on the letter is the other party’s signature.

TIPWhen using photographs, it is

best to use color photos and

enlarge them, if possible.

• Call a witness who is familiar with the party’s signature, and ask the witness:

“Do you know the other party in this case? Are you familiar with the party’ssignature? How?”

Then show them the letter and ask “Is thisthe other party’s signature?”

• Call the person who signed the letter.Show the witness the document, and ask

the witness if that is his or her signature.

(Only do this if you think they will admit to

it).

4. Explain that the letter is in the same condition

now as when you received it. (“The letter waskept in a safe place and nothing has been changed since I received it.”)

Laying the Foundation for Documents and Records

From Businesses

1. Explain how the document or record is related to your case.

2. Call a witness from the business/agency that produced the record, ask

the witness what his or her responsibilities are at the business/agency

and how he or she is involved in record keeping.

3. Show the witness the record and ask him/her if it is a record from the business/agency.

4. Ask the witness:

• Was the record made by a person with

knowledge of the acts or events appearing on

it.

• Was the record made at or near the time of the

acts or events appearing on it.

• Is it the regular practice of the business/agency

to make such a record, and

• Was the record kept in the course of a

regularly conducted business activity.

Created by: NAPIL Equal Justice Fellow, Ohio State Legal Services Association®

© 1/2001 OSLSA

TIPSDo not read anything from the letter

until the court has admitted it into

evidence.

If the other party objects to the letter

saying that it is hearsay, respond by

saying: “The letter shows the letter

writer’s state of mind.”

TIPIf the record is certified (a statement is

attached to the record stating that it is

in fact a record from a public agency

or it has an agency seal on it) you do

not need to do anything before you

show it to the judge. Just let the judge

know it is certified.

In addition to the forms in this packet, you may find additional forms and informational pamphlets to help you on the internet at the

following website:

www.ohiolegalhelp.org

Click on “Statewide Forms and Information”

Locate and click on the legal area that you would like to review – use the “search this site” box if you are not sure which area to

review

You can also search this website to learn how to access the local legal services

program for your area

Petition for Custody-Parentage - SciotoCOUNTY, OHIOSECTION I - INCOMEA. YEARLY INCOME, OVERTIME, COMMISSIONS AND BONUSES FOR PAST THREE YEARSB. COMPUTATION OF CURRENT INCOMETOTAL MONTHLY TOTAL MONTHLY TOTAL MONTHLYType of LiabilityAmountRent / MortgageCable

PETITION FOR WAIVER OFWAIVER OF SERVICE OF SUMMONS

Judicial College Citizen Guide to Representing Yourself in CourtHow to Handle WitnessesRepresenting Yourself in Court - documentsWebsite Information

NOTE If you did not complete the poverty affidavit the filing fee is: Style: CLASSIFICATION FORM: DR Divorce: 1: 2: DM Dissolution: 1_2: 2_2: DV Domestic Violence: DO Other Domestic Relations Matters: 1_3: 2_3: 3: 4: 5: 6: K 1: K 2: K 3: K 4: IN THE COURT OF COMMON PLEAS: COUNTY OHIO: IN THE MATTER OF: undefined: Plaintiff: Case No: Street Address: Judge: Magistrate: undefined_2: Defendant: Street Address_2: PARENTING TIME COMPANIONSHIP AND VISITATION: Father: OffMother select one of the following children: OffName of Child 1: Name of Child 2: Name of Child 3: Date of Birth 1: Date of Birth 2: Date of Birth 3: of the children: Father_2: OffMother select one: Offdate residence established as set out in the Parenting Proceeding Affidavit Uniform Domestic: County Ohio since: has: Offhas not select one been established If it has been: OffNo court has issued an order about the following children: Off1_4: 2_4: 3_2: The following Court has issued an order about the following children: Off1_5: 2_5: I request that the Court check all that apply: Name: OffFathers name as the: Father of the children: Correct the childrens birth certificate to indicate the childrens father: OffOrder genetic testing and determine the father of the children: OffName the: OffPlaintiff_2: OffDefendant select one as the residential parent and legal custodian: OffGrant reasonable parenting time visitation to the: OffChange the childrens name to: OffAdopt the proposed Shared Parenting Plan for the children which is attached: OffOrder the appropriate amount of child support for the children allocate the income tax: OffMother: OffFather select one: Offundefined_3: coverage for the children: Other specify: Off1_6: 2_6: 3_3: Telephone number at which the Court may reach you: COUNTY OHIO_2: PlaintiffPetitioner: Case No_2: Judge_2: Magistrate_2: DefendantPetitioner: Affidavit of: Date of marriage: Date of separation: undefined_4: Yes1_7: 2_7: 3_4: 1_8: 2_8: 3_5: 12: Off24: Off26: Off52: Off12_2: Off24_2: Off26_2: Off52_2: Offundefined_5: undefined_6: undefined_7: undefined_8: undefined_9: undefined_10: 20: undefined_11: 20_2: undefined_12: 20_3: undefined_13: 20_4: undefined_14: 20_5: undefined_15: 20_6: undefined_16: Check Box2: OffWorkers Compensation: OffSocial Security: OffOther: Offundefined_17: Social Security_2: OffOther_2: Offundefined_18: source 1: source 2: Other income type and source 1: Other income type and source 2: undefined_19: undefined_20: undefined_21: undefined_22: undefined_23: undefined_24: undefined_25: undefined_26: undefined_27: undefined_28: undefined_29: undefined_30: undefined_31: undefined_32: undefined_33: undefined_34: undefined_35: undefined_36: undefined_37: undefined_38: undefined_39: undefined_40: Name 1: Name 2: Name 3: Name 4: Date of birth 1: Date of birth 2: Date of birth 3: Date of birth 4: Living with 1: Living with 2: Living with 3: Living with 4: adults: other minor andor dependent children: undefined_41: undefined_42: undefined_43: undefined_44: undefined_45: undefined_46: undefined_47: undefined_48: undefined_49: undefined_50: undefined_51: undefined_52: Other 1: Other 2: undefined_53: undefined_54: undefined_55: undefined_56: undefined_57: undefined_58: undefined_59: undefined_60: undefined_61: undefined_62: undefined_63: undefined_64: Other_3: undefined_65: undefined_66: undefined_67: Other_4: undefined_68: undefined_69: undefined_70: undefined_71: undefined_72: undefined_73: undefined_74: undefined_75: undefined_76: undefined_77: undefined_78: Other_5: undefined_79: undefined_80: undefined_81: undefined_82: undefined_83: undefined_84: undefined_85: Other_6: undefined_86: undefined_87: undefined_88: undefined_89: undefined_90: undefined_91: undefined_92: Other 1_2: Other 2_2: undefined_93: undefined_94: undefined_95: undefined_96: undefined_97: undefined_98: Other 1_3: Other 2_3: undefined_99: undefined_100: undefined_101: undefined_102: undefined_103: undefined_104: undefined_105: undefined_106: undefined_107: undefined_108: undefined_109: undefined_110: undefined_111: undefined_112: undefined_113: undefined_114: type: undefined_115: Additional taxes paid not deducted from wages type: undefined_116: Other 1_4: Other 2_4: undefined_117: undefined_118: undefined_119: To whom paid 1: To whom paid 2: To whom paid 3: To whom paid 4: To whom paid 5: To whom paid 6: To whom paid 7: To whom paid 8: To whom paid 9: To whom paid 10: To whom paid 11: To whom paid 12: To whom paid 13: To whom paid 14: To whom paid 15: Purpose 1: Purpose 2: Purpose 3: Purpose 4: Purpose 5: Purpose 6: Purpose 7: Purpose 8: Purpose 9: Purpose 10: Purpose 11: Purpose 12: Purpose 13: Purpose 14: Purpose 15: undefined_120: undefined_121: undefined_122: undefined_123: undefined_124: undefined_125: undefined_126: undefined_127: undefined_128: undefined_129: undefined_130: undefined_131: undefined_132: undefined_133: undefined_134: undefined_135: undefined_136: undefined_137: undefined_138: undefined_139: undefined_140: undefined_141: undefined_142: undefined_143: undefined_144: undefined_145: undefined_146: undefined_147: undefined_148: undefined_149: undefined_150: undefined_151: this document and to the best of my knowledge and belief the facts and information stated in this document: day of: undefined_152: undefined_153: Notary Public: My Commission Expires: COUNTY OHIO_3: PlaintiffPetitioner_2: 1_9: 2_9: Magistrate_3: DefendantPetitionerRespondent: Affidavit of_2: Childs Name: Place of Birth: Date of Birth: Persons With Whom Child Lived: OffMale: Offundefined_154: Confidential: OffAddress 1: Address 2: undefined_155: undefined_156: undefined_157: Confidential_2: OffAddress 1_2: Address 2_2: undefined_158: undefined_159: undefined_160: Confidential_3: OffAddress 1_3: Address 2_3: undefined_161: undefined_162: undefined_163: Confidential_4: OffAddress 1_4: Address 2_4: undefined_164: Check Box3: OffCheck Box4: OffChilds Name_2: Place of Birth_2: Date of Birth_2: Sex: OffCheck this box if the information requested below would be the same as in subsection 2a and skip to the next question: Offundefined_165: Address: Offundefined_166: undefined_167: Address_2: OffConfidential_5: undefined_168: undefined_169: Address_3: OffConfidential_6: undefined_170: undefined_171: Address_4: OffConfidential_7: name address 1: name address 2: name address 3: name address 4: name address 5: name address 6: name address 7: name address 8: undefined_172: Childs Name_3: Place of Birth_3: Date of Birth_3: Sex_2: OffCheck this box if the information requested below would be the same as in subsection 2a and skip to the next question_2: Offundefined_173: Address_5: Offundefined_174: undefined_175: Confidential_8: Address_6: Offundefined_176: undefined_177: Address_7: OffConfidential_9: undefined_178: undefined_179: Address_8: OffConfidential_10: 1_10: 2_10: 3_6: 4_2: 5_2: 6_2: 7: 8: undefined_180: undefined_181: OffCheck Box5: OffCheck Box6: OffName of each child: 1_11: 2_11: 1_12: 2_12: Type of case: Court and State: undefined_182: Date and court order or judgment if any: undefined_183: Offneglect or abuse allegations or adoptions concerning a child subject to this case Do not repeat: cases already listed in Paragraph 3 Explain: Name of each child_2: undefined_184: undefined_185: Type of case_2: Court and State_2: undefined_186: Date and court order or judgment if any_2: undefined_187: OffName 1_2: Name 2_2: Name 3_2: Name 4_2: Case Number 1: Case Number 2: Case Number 3: Case Number 4: CourtStateCounty 1: CourtStateCounty 2: CourtStateCounty 3: CourtStateCounty 4: What Crime 1: What Crime 2: What Crime 3: What Crime 4: undefined_188: OffCheck Box7: OffCheck Box8: OffI DO NOT KNOW OF ANY PERSONS not a party to this case who hashave physical custody or: OffI KNOW THAT THE FOLLOWING NAMED PERSONS not a party to this case hashave physical: Offcustody or claims to have custody or visitation rights with respect to any child subject to this case: undefined_189: Has physical custody: OffClaims custody rights: OffClaims visitation rights: OffName of each child_3: 1_13: 2_13: 1_14: 2_14: NameAddress of Person: undefined_190: Has physical custody_2: OffClaims custody rights_2: OffClaims visitation rights_2: OffName of each child_4: 1_15: 2_15: NameAddress of Person_2: 1_16: 2_16: Has physical custody_3: OffClaims custody rights_3: OffClaims visitation rights_3: OffName of each child_5: 1_17: 2_17: 1_18: 2_18: this document and to the best of my knowledge and belief the facts and information stated in this document_2: day of_2: undefined_191: undefined_192: Notary Public_2: My Commission Expires_2: County CSEA Child Support Enforcement Agency I understand and agree to the following: Date of Birth_4: 1_19: 2_19: 3_7: 4_3: 5_3: 1_20: 2_20: 3_8: 4_4: 5_4: 6_3: Married: OffSeparated: OffSingle: OffDivorced: Off1_21: 2_21: 3_9: 4_5: 5_5: 6_4: 1_22: 2_22: 3_10: 4_6: Employer Phone: undefined_193: 1_23: 2_23: 3_11: undefined_194: Text9: Text10: Text11: Text12: Text13: Text14: Text15: Text16: Text49: Text50: Text51: Text52: Text53: Text54: Text55: Text56: Text88: Text89: Text90: Text91: Text92: Text93: Text94: Text95: Text17: Text18: Text19: Text20: Text21: Text22: Text23: Text24: Text25: Text26: Text27: Text28: Text29: Text30: Text31: Text32: Text33: Text34: Text35: Text36: Text57: Text58: Text59: Text60: Text61: Text62: Text63: Text64: Text65: Text66: Text68: Text69: Text70: Text71: Text72: Text73: Text74: Text75: Text76: Text78: Text96: Text97: Text98: Text99: Text100: Text101: Text102: Text103: Text104: Text105: Text106: Text107: Text108: Text109: Text110: Text111: Text112: Text113: Text114: Text115: fill_6: fill_7: fill_8: Per: Per_2: Per_3: Date: Text37: Text38: Text39: Text40: Text41: Text42: Text43: Text44: Text45: Check Box46: OffCheck Box47: OffCheck Box48: OffText79: Text80: Text81: Text82: Text83: Text84: Text85: Text86: Text87: Text116: Text117: Text118: Text119: Text120: Text121: Text122: Text123: Text124: 1_24: 2_24: 3_12: undefined_197: 1_25: 2_25: 3_13: undefined_198: CASE NUMBER: case: the Petitioners in the abovecaptioned case: are: Check Box125: OffCheck Box127: OffPlaintiffPetitioner_3: DefendantPetitioner_2: being duly sworn sayeth: Affiant: Sworn before me and subscribed in my presence this: 20_7: undefined_199: Notary public or Deputy Clerk: NameApplicant: Party Represented if applicant enter same DOB: Mailing Address: City: State: Zip: Case No_3: Phone: Name 1_3: Name 3_3: DOB2: Relationship2: DOB4: Relationship4: ApplicantEmployment Gross: Spouse or Parents if application is a juvenileEmployment Gross: Other Household MembersEmployment Gross: TotalEmployment Gross: ApplicantUnemployment: Spouse or Parents if application is a juvenileUnemployment: Other Household MembersUnemployment: TotalUnemployment: ApplicantWorkers Comp: Spouse or Parents if application is a juvenileWorkers Comp: Other Household MembersWorkers Comp: TotalWorkers Comp: ApplicantPensionSocial Security: Spouse or Parents if application is a juvenilePensionSocial Security: Other Household MembersPensionSocial Security: TotalPensionSocial Security: ApplicantChild Support: Spouse or Parents if application is a juvenileChild Support: Other Household MembersChild Support: TotalChild Support: ApplicantWorks FirstTANF: Spouse or Parents if application is a juvenileWorks FirstTANF: Other Household MembersWorks FirstTANF: TotalWorks FirstTANF: ApplicantDisability: Spouse or Parents if application is a juvenileDisability: Other Household MembersDisability: TotalDisability: ApplicantOther: Spouse or Parents if application is a juvenileOther: Other Household MembersOther: TotalOther: Employers Name for all household members: fill_62: Phone_2: AmountChild Support Paid Out: AmountChild Care if working only: AmountTransportation for work: AmountInsurance: fill_77: AmountMedical Dental: BEXPENSES: fill_79: AmountMedical Associated Costs of Caring for Infirm Family members: fill_80: fill_82: Estimated ValuePrice Date Purchased Amt Owed: Price Date Purchased Amt Owed StocksBondsCDs: Estimated ValueStocksBondsCDs: Price Date Purchased Amt Owed Automobiles: Estimated ValueAutomobiles: Price Date Purchased Amt Owed TrucksBoatsMotorcycles: Estimated ValueTrucksBoatsMotorcycles: Price Date Purchased Amt Owed Other Valuable Property: Estimated ValueOther Valuable Property: Price Date Purchased Amt Owed Cash on Hand: Estimated ValueCash on Hand: Price Date Purchased Amt Owed Money Owed to Applicant: Estimated ValueMoney Owed to Applicant: Price Date Purchased Amt Owed Other: Estimated ValueOther: Price Date Purchased Amt Owed Checking Acct BankAcct: Estimated ValueChecking Acct BankAcct: Price Date Purchased Amt Owed SavingsMM Acct BankAcct: Estimated ValueSavingsMM Acct BankAcct: fill_85: Text128: Text131: Text132: Text133: Text134: Text135: Text136: Text137: Text138: AmountRent Mortgage: AmountFood: undefined_200: AmountElectric: AmountGas: undefined_201: AmountFuel: AmountTelephone: E LIABILITIES OTHER: AmountCable: AmountWater Sewer Trash: AmountCredit Cards: AmountLoans: AmountTaxes Owed: AmountOther: AmountE LIABILITIES OTHER EXPENSE: affiant being duly sworn say: Date_2: day of_3: Subscribed and duly sworn before me according to law by the above named applicant this: and State of: undefined_202: undefined_203: County of: Title: undefined_204: Date_3: Division: COUNTY OHIO_4: A Minor: Name_2: Case No_4: Street Address_3: Judge_3: City State and Zip Code: Magistrate_4: Name_3: Street Address_4: City State and Zip Code_2: Please serve the following documents on the following parties as I have indicated below 1: Please serve the following documents on the following parties as I have indicated below 2: DefendantPetitioner at the address shown above: OffCertified Mail Return Receipt Requested: OffIssuance to Sheriff of: OffOther specify_2: OffCounty Ohio for: Personal or: OffResidence service: Offundefined_205: PlaintiffPetitioner at the address shown above: OffCertified Mail Return Receipt Requested_2: OffIssuance to Sheriff of_2: OffOther specify_3: Offundefined_206: Personal or_2: OffResidence service_2: OffCounty Ohio for_2: undefined_208: County Child Support Enforcement Agency provide address below: Certified Mail Return Receipt Requested_3: OffIssuance to Sheriff of_3: OffOther specify_4: Offundefined_209: Personal or_3: OffResidence service_3: OffCounty Ohio for_3: Other address: Offundefined_210: Certified Mail Return Receipt Requested_4: OffIssuance to Sheriff of_4: OffOther specify_5: Offundefined_211: Personal or_4: OffResidence service_4: OffCounty Ohio for_4: SPECIAL INSTRUCTIONS TO SHERIFF 1: SPECIAL INSTRUCTIONS TO SHERIFF 2: SPECIAL INSTRUCTIONS TO SHERIFF 3: Check Box139: OffDivision_2: COUNTY OHIO_5: A Minor_2: undefined_212: Case No_5: undefined_213: undefined_214: Judge_4: Magistrate_5: undefined_215: undefined_216: undefined_217: name acknowledge that I am the: Petitioner: OffPlaintiff_3: OffDefendant_2: OffRespondent select one and that I have received a copy of the following documents filed or: OffComplaint for Parentage: OffComplaint: OffComplaint_2: OffComplaint_3: OffJournal Entry and Findings of Fact Supporting Child Support Deviation: OffHealth Insurance Affidavit: OffComplaint for Divorce with Children: OffComplaint for Divorce without Children: OffSeparation Agreement: OffShared Parenting Plan: OffParenting Plan: OffPetition for Dissolution: OffAgreed Judgment Entry Magistrates Decision Order andor Magistrates Order: OffAffidavit of Income and Expenses_2: OffMotion select one for Allocation of Parental Rights and Responsibilities Custody: OffMotion select one for Parenting Time Companionship and Visitation: OffMotion select one for Establishment or Change of Child Support: OffAffidavit of Property: OffParenting Proceeding Affidavit_2: OffMotion for Contempt and Affidavit: OffMotion and Affidavit or Counter Affidavit for Temporary Orders with Oral Hearing: OffOther specify_6: Offundefined_218: I waive service of summons of said document by the Clerk of Court: undefined_219: undefined_220: undefined_221: undefined_222: undefined_223: 1_26: 2_26: 3_14: Affiant_2: SS: day of_4: 20_8: Notary Public_3:

COMPLAINT FOR PARENTAGE, ALLOCATION OF PARENTAL …...you are filing a poverty affidavit, you must...

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Transcript of COMPLAINT FOR PARENTAGE, ALLOCATION OF PARENTAL …...you are filing a poverty affidavit, you must...