IN THE COURT OF COMMON PLEAS ASHLAND COUNTY, OHIO DOMESTIC RELATIONS DIVISION Case No. Plaintiff/Petitioner, vs./and Defendant/Petitioner. WAIVER OF RECEIPT AND HEARING ON NOTICE OF INTENT TO RELOCATE O. R. C. Section 3109.051(G) In accordance with Ohio Revised Code Section 3109.051 (G), I hereby state as follows with regard to a Notice of Intent to Relocate dated 1. 2. 3. I am the nonresidential parent of the child(ren) named in that Notice. I have received a copy of that Notice of Intent to Relocate. I hereby waive any further service of the Notice of Intent to Relocate and any hearing to determine whether or not a copy of the Notice of Intent to Relocate should be served upon me. : Dated: Nonresidential Parent Sworn to and subscribed before me this _________ day of ___________________________20___. _____________________________________ Notary Public Page 1 of 1 FORM 11.10 (Eff. 3/1/2017) American LegalNet, Inc. www.FormsWorkFlow.com