COURT OF COMMON PLEAS DOMESTIC RELATIONS DIVISION CLERMONT COUNTY, OHIO Case Number: Plaintiff/Petitioner Vs Waiver of Counsel Defendant/Respondent I, , the Plaintiff/Defendant in the above-captioned case, being now in open Court and having been advised that I have a right to be represented by counsel at this hearing, do hereby affirmatively waive my right to be represented by counsel. I understand that attorney for does not represent my legal interests. Date Plaintiff/Defendant Print DR-702 Rev. 8/13 American LegalNet, Inc. www.FormsWorkFlow.com