DR 715 Eff. 1/05 Rev. 1/11 IN THE COURT COMMON PLEAS DIVISION OF DOMESTIC RELATIONS BUTLER COUNTY, OHIO : ______________________________________________ Plaintiff/1st Petitioner/Petitioner Address _______________________________________ Case No____________________ : ______________________________________________ SSN _______________________ DOB ______________ __________________________ vs./-and- : ______________________________________________ Defendant/2nd Petitioner/Respondent Address _______________________________________ : _____________________________________________ Magistrate : AGREED ENTRY FINAL APPEALABLE ORDER (Hearing Required) : SSN _______________________ DOB ______________ On___________________, 20________ , a hearing was held before Magistrate/Judge ____________________________ on: Plaintiff’s/1st Petitioner/Petitioner Defendant’s/2nd Petitioner/Respondent motion(s) for: or contempt motion(s) for: Allocation of parental rights or shared parenting: establish modify terminate Visitation: modification restriction or termination standard order notice of relocation Child support: increase decrease terminate establish Spousal support: increase decrease terminate Other (specify): ___________________________________________________________________ . Appearing before the Court were: Plaintiff/1st Petitioner/Petitioner with Defendant/2nd Petitioner/Respondent without with Attorney _____________________________ without Attorney__________________________ The following are the children of the parties: Name________________________ SSN:__________________ D.O.B:________ Name ________________________ SSN:__________________ D.O.B:________ Name ________________________ SSN:__________________ D.O.B:________ Name ________________________ SSN:__________________ D.O.B:________ This AGREED ENTRY applies to: All of the above children or Only these children: _____________________________________ _____________________________________ _____________________________________ _____________________________________ THE PARTIES AGREE AS FOLLOWS: American LegalNet, Inc. www.FormsWorkFlow.com Sole Residential Parent Status (Custody): Plaintiff/1st Petitioner/Petitioner Defendant/2nd Petitioner/Respondent is designated the residential parent and legal custodian of the parties’ minor child(ren). Plaintiff/1st Petitioner/Petitioner Defendant/2nd Petitioner/Respondent shall be designated the non-residential parent. The non-residential parent’s parenting time shall be as follows: The non-residential parent shall have DR610 parenting time with the child(ren) or the following: ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ __________________________________________________________________________ OR Shared Parenting: The parties shall share the allocation of parental rights and responsibilities for the care of their minor child(ren). Plaintiff/1st Petitioner/Petitioner Defendant/2nd Petitioner/Respondent shall be designated the residential parent for school purposes. Parenting time shall be divided as follows: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ __________________________________________________________________________________ All other terms of the existing Shared Parenting Plan remain in effect. Child Support: The support order does not change OR The support order is hereby amended as follows (worksheet is attached):  The child support order is pursuant to the guidelines: The child support order is pursuant to the guidelines: “Based upon Father’s adjusted gross income of $________ per year, and Mother’s adjusted gross income of $_________ per year, an award of child support, in accordance with child support guidelines, ORC 3119.021, is payable as follows: When private health insurance IS being provided by a party in accordance with this order for the child(ren) named above, the Child Support Obligor shall pay child support for the minor child(ren) in the sum of $_____________ per month ($_____________ per month per child) ($__________ per ___________ pay period) to the Child Support Obligee, and/or his/her assignee(s), which includes the 2% processing fees. American LegalNet, Inc. www.FormsWorkFlow.com When private health insurance IS NOT being provided by a party in accordance with this order for the child(ren) named above, the Child Support Obligor shall pay child support for the minor child(ren) in the sum of $_____________ per month ($_____________ per month per child) ($__________ per ___________ pay period) to the Child Support Obligee, and/or his/her assignee(s), for the minor children, which includes the 2% processing fees. When private health insurance IS NOT being provided by a party in accordance with this order for the child(ren) named above, the Child Support Obligor shall pay cash medical support in the sum of $_____________ per month ($_____________ per month per child) ($__________ per ___________ pay period), which includes the 2% processing fees. Said order is effective ___________and the order of support shall be paid through CSEA or OCSPC. (Choose one)  Insurance is available. The obligor shall pay child support in the amount of ___________ per month, per child, which includes the 2% processing fee. If private health insurance coverage is being provided and becomes unavailable or is terminated, the Child Support Obligor SHALL BEGIN paying cash medical support commencing the first day of the month immediately following the month in which private health insurance coverage became unavailable or is terminated, and SHALL CEASE paying cash medical support on the last day of the month immediately preceding the month in which private health insurance coverage begins or resumes. Cash medical support shall be paid in addition to child support.” or  Insurance is not available. The obligor shall pay child support in the amount of ____________ per month, per child, which includes the 2% processing fee and the cash medical support order in the amount of __________ per month, which includes the 2% processing fee and is payable to:  CSEA for disbursement to the obligee since the child(ren) do not receive State or Federal medical assistance or card or  CSEA since the child(ren) do receive State or Federal medical assistance or card. If private health insurance coverage is being provided and becomes unavailable or is terminated, the Child Support Obligor SHALL BEGIN paying cash medical support commencing the first day of the month immediately following the month in which private health insurance coverage became unavailable or is terminated, and SHALL CEASE paying cash medical support on the last day of the month immediately preceding the month in which private health insurance coverage begins or resumes. Cash medical support shall be paid in addition to child support.”  The child support order deviates from the guidelines: “Based upon Father’s adjusted gross income of $________ per year, and Mother’s adjusted gross income of $_________ per year, an award of child support, in accordance with child support guidelines, ORC 3119.021, is payable as follows: When private health insurance IS being provided by a party in accordance with this order for the child(ren) named above, the Child Support Obligor shall pay child support for the minor child(ren) in the sum of $_____________ per month ($_____________ per month per child) ($__________ per ___________ pay period) to the Child Support Obligee, and/or his/her assignee(s), which includes the 2% processing fees. When private health insurance IS NOT being provided by a party in accordance with this order for the child(ren) named above, the Child Support Obligor shall pay child support for the minor child(ren) in the sum of $_____________ per month ($_____________ per month per child) ($__________ per ___________ pay period) to the Child Support Obligee, and/or his/her American LegalNet, Inc. www.FormsWorkFlow.com assignee(s), for the minor children, which includes the 2% processing fees. The amount of guideline child support pursuant to ORC 3119.021 is unjust or inappropriate and not in the best interest of the minor child(ren.) A deviation pursuant to ORC 3119.22 is appropriate for the reason that (state reason(s): _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ _________________________________________________________________________ Based on the deviation factors contained in ORC 3119.23 and 3119.24, a deviation from guideline support is in the best interest of the minor child(ren) and payable as follows: When private health insurance IS being provided by a party in accordance with this order for the child(ren) named above, the Child Support Obligor shall pay child support for the minor child(ren) in the sum of $_____________ per month ($_____________ per month per child) ($__________ per ___________ pay period) to the Child Support Obligee, and/or his/her assignee(s), which includes the 2% processing fees. When private health insurance IS NOT being provided by a party in accordance with this order for the child(ren) named above, the Child Support Obligor shall pay child support for the minor child(ren) in the sum of $_____________ per month ($_____________ per month per child) ($__________ per ___________ pay period) to the Child Support Obligee, and/or his/her assignee(s), for the minor children, which includes the 2% processing fees. When private health insurance IS NOT being provided by a party in accordance with this order for the child(ren) named above, the Child Support Obligor shall pay cash medical support in the sum of $_____________ per month ($_____________ per month per child) ($__________ per ___________ pay period), which includes the 2% processing fees. Said order is effective ___________and the order of support shall be paid through CSEA or OCSPC. (Choose one)  Insurance is available. The obligor shall pay child support in the amount of ___________ per month, per child, which includes the 2% processing fee. If private health insurance coverage is being provided and becomes unavailable or is terminated, the Child Support Obligor SHALL BEGIN paying cash medical support commencing the first day of the month immediately following the month in which private health insurance coverage became unavailable or is terminated, and SHALL CEASE paying cash medical support on the last day of the month immediately preceding the month in which private health insurance coverage begins or resumes. Cash medical support shall be paid in addition to child support.” or  Insurance is not available. The obligor shall pay child support in the amount of ____________ per month, per child, which includes the 2% processing fee and the cash medical support order in the amount of __________ per month, which includes the 2% processing fee and is payable to:  CSEA for disbursement to the obligee since the child(ren) do not receive State or Federal medical assistance or card or  CSEA since the child(ren) do receive State or Federal medical assistance or card. If private health insurance coverage is being provided and becomes unavailable or is terminated, the Child Support Obligor SHALL BEGIN paying cash medical support commencing the first day of the month immediately following the month in which private health insurance coverage became unavailable or is terminated, and SHALL CEASE paying American LegalNet, Inc. www.FormsWorkFlow.com cash medical support on the last day of the month immediately preceding the month in which private health insurance coverage begins or resumes. Cash medical support shall be paid in addition to child support.” Arrears are preserved; waived; OR offset against new support order. NOTE: THE FOLLOWING LANGUAGE APPLIES TO ALL PARENTING ORDERS: IT IS FURTHER ORDERED the duty of support shall continue beyond the age of majority as long as the child continuously attends on a full-time basis any recognized and accredited high school. A child support order shall not remain in effect after a child reaches nineteen years of age unless the order provides that the duty of support continues under circumstances described ORC 3119.86 (A)(1)(a) or (b). IT IS FURTHER ORDERED that all support under this order shall be withheld or deducted from the income or assets of the obligor pursuant to a withholding or deduction notice or appropriate court order issued in accordance with sections 3121.02 to 3121.07 of the Revised Code or a withdrawal directive issued pursuant to section 3123.37 of the Revised Code and shall be forwarded to the obligee in accordance with section 3121.50 of the Revised Code. IT IS FURTHER ORDERED that until such time as a withholding or deduction order is in effect, the obligor shall discharge his or her obligation by making payments directly to the CSEA or the division of child support in the Ohio Department of Job and Family Services, as appropriate. IT IS FURTHER ORDERED that the obligor is restrained from making said payments directly to the obligee and the obligee is enjoined from accepting direct payments from the obligor. Any payments of support not made through the CSEA or the division of child support in the Ohio Department of Job and Family Services, as appropriate, shall be deemed a gift. EACH PARTY TO THIS SUPPORT ORDER MUST NOTIFY THE CHILD SUPPORT ENFORCEMENT AGENCY IN WRITING OF HIS OR HER CURRENT MAILING ADDRESS, CURRENT RESIDENCE ADDRESS, CURRENT RESIDENCE TELEPHONE NUMBER, CURRENT DRIVER’S LICENSE NUMBER, AND OF ANY CHANGES IN THAT INFORMATION. EACH PARTY MUST NOTIFY THE AGENCY OF ALL CHANGES UNTIL FURTHER NOTICE FROM THE COURT. IF YOU ARE THE OBLIGOR UNDER A CHILD SUPPORT ORDER AND YOU FAIL TO MAKE THE REQUIRED NOTIFICATIONS YOU MAY BE FINED UP TO $50.00 FOR A FIRST OFFENSE, $100.00 FOR A SECOND OFFENSE, AND $500.00 FOR EACH SUBSEQUENT OFFENSE. IF YOU ARE AN OBLIGOR OR OBLIGEE UNDER ANY SUPPORT ORDER AND YOU WILLFULLY FAIL TO MAKE THE REQUIRED NOTIFICATIONS YOU MAY BE FOUND IN CONTEMPT OF COURT AND BE SUBJECTED TO FINES UP TO $1,000.00 AND IMPRISONMENT FOR NOT MORE THAN NINETY (90) DAYS. IF YOU ARE AN OBLIGOR AND YOU FAIL TO MAKE THE REQUIRED NOTIFICATIONS YOU MAY NOT RECEIVE NOTICE OF THE FOLLOWING ENFORCEMENT LIENS AGAINST YOU: IMPOSITION OF LIENS AGAINST YOUR PROPERTY; LOSS OF YOUR PROFESSIONAL OR OCCUPATIONAL LICENSE, DRIVER’S LICENSE, OR RECREATIONAL LICENSE; WITHHOLDING FROM YOUR INCOME; ACCESS RESTRICTION AND DEDUCTION FROM YOUR ACCOUNTS IN FINANCIAL INSTITUTIONS; AND ANY OTHER ACTION PERMITTED BY LAW TO OBTAIN MONEY FROM YOU TO SATISFY YOUR SUPPORT OBLIGATION.” IT IS FURTHER ORDERED that obligor and obligee immediately notify the CSEA in writing of any change in the obligor’s income source and of the availability of any other sources of income that can be the subject of a withholding order. This duty to notify the CSEA shall continue until further notice from the court. A failure to provide such notification may make the obligor liable for retroactive support that would otherwise have been ordered. IT IS FURTHER ORDERED that if the obligee is to receive spousal support from the obligor, the obligee shall immediately notify the CSEA, in writing, of remarriage if the remarriage would terminate the American LegalNet, Inc. www.FormsWorkFlow.com obligation to pay spousal support. To make payments through the Butler County CSEA: Make cash or credit card payments only at the following location: Butler County Child Support Enforcement Agency, Government Services Center, 315 High Street, 8th Floor, Hamilton, Ohio 45011. Acceptable methods of payment are as follows: Visa, MasterCard, ATM, and Cash payments may be made locally in person only. Do not send cash by mail. Personal checks will not be accepted by the Butler County CSEA.” To make payments to the Ohio Child Support Payment Central (OCSPC): The obligor shall send payments to the following location: Ohio Child Support Payment Central, P.O. Box 182372, Columbus, Ohio 43218. The employer shall send payments to the following location: Ohio Child Support Payment Central, P.O. Box 182394, Columbus, Ohio 43218. Acceptable methods of payment to OCSPC are as follows: certified check, cashier’s check, personal check, or money order. The agreed entry shall specifically identify the deduction order to be issued. If the obligor is receiving income from a payor as defined in section 3121.01(E) of the Revised Code, an income withholding notice shall issue. If the obligor’s income is not subject to withholding, a bank account deduction notice shall issue. If the obligor has no income, but is able to post bond, an order to post bond shall issue. If the obligor is unemployed and has no funds from which support can be paid, an order to seek work shall issue and the obligor shall pay the current statutory minimum support order (currently $50.00 per month for all children subject to the order). The court may waive or modify the minimum order in appropriate circumstances. The agreed entry shall specify any child(ren) that either parent shall be entitled to claim as dependent(s) for federal income tax purposes. The agreed entry shall also specify the tax year(s) for which the child(ren) may be claimed as dependent(s), the name of the person who may claim them and the requirement that the person claiming them shall be substantially current in payment of child support for any tax year for which the child(ren) are claimed as dependents. A child support obligor shall be substantially current in payment of child support if less than $100 arrears are owed for the tax year for which the child(ren) are to be claimed as dependent(s), on or before January 31st of the following year. (ORC 3119.82) IT IS FURTHER ORDERED that both the obligor and obligee are liable for health care of the children who are not covered by private health insurance or cash medical support; IT IS FURTHER ORDERED that any person providing health insurance coverage shall, not later than 30 days after issuance of the order, provide all information regarding benefits, limitations, and exclusions of the coverage, copies of any insurance forms necessary to receive reimbursement, payment, or other benefits under to coverage, and a copy of any necessary insurance cards; IT IS FURTHER ORDERED that the health plan administrator may continue making payment for medical, optical, hospital, dental, or prescription services directly to any health care provider in accordance with the plan; IT IS FURTHER ORDERED that any person required to provide health insurance coverage for children shall designate the child(ren) as covered dependents under any private health insurance policy, contract, or plan. American LegalNet, Inc. www.FormsWorkFlow.com IT IS FURTHER ORDERED: (Choose one of the following)  If one of the parties has health insurance: “__________________________ shall provide the primary health insurance for the parties’ minor child(ren) so long as the health insurance is available through employment at a reasonable cost as defined in ORC 3119.30. _________________________ shall obtain secondary health insurance for the parties’ minor child(ren) when it becomes available through employment at a reasonable cost as defined in ORC 3119.30. Upon receipt of the health insurance_______________________ shall within 14 days of obtaining coverage inform the Child Support Enforcement Agency. In the future, the parties shall, upon receipt of new health insurance information regarding benefits, limitations, and exclusions of the coverage, copies of any insurance forms necessary to receive reimbursement, payment, or other benefits under to coverage, and a copy of any necessary insurance cards provide all updated information to the other party within fourteen (14) days. The parties shall divide all co-pays, deductible costs required under the health insurance policy and all other uncovered health care expenses as follows, father shall pay ______% and mother shall pay ______%. The parties shall provide each other with a copy of all health care bills for the minor child(ren) on a quarterly basis and a summary of all amounts paid by either party. The summary shall include an offset against all cash medical support received. The documentation of health care expenses shall be provided on the last day of the months of March, June, September, and December. Payment/reimbursement for all health care expenses shall be made within thirty (30) days. Absent extraordinary circumstances, motions for payment of health care bills must be made within one (1) year of the date the bills were incurred. The parties shall use all health and dental care providers within the health and dental care plan, unless the parties have entered into a written agreement. Any party who uses a health or dental care provider outside of the health and dental care plan shall solely pay said debt. The only exceptions to this provision are a medical emergency or a health and dental care provider under the plan does not exist in their area. Medical emergency is defined as a life threatening illness or serious injury.”  If both of the parties have health insurance: “________________________________ shall provide the primary health insurance for the parties’ minor child(ren) so long as the health insurance is available through employment at a reasonable cost as defined in ORC 3119.30. ________________________________ shall provide the secondary health insurance for the parties’ minor child(ren) so long as the health insurance is available through employment at a reasonable cost as defined in ORC 3119.30. In the future, the parties shall upon receipt of new health insurance information regarding benefits, limitations, and exclusions of the coverage, copies of any insurance forms necessary to receive reimbursement, payment, or other benefits under to coverage, and a copy of any necessary insurance cards provide all updated information within fourteen (14) days. The parties shall divide all co-pays, deductible costs required under the health insurance policy and all other uncovered health care expenses as follows, father shall pay ______% and mother shall pay ______%. The parties shall provide each other with a copy of all health care bills for the minor child(ren) on a quarterly basis and a summary of all amounts paid by either party. The summary shall include an offset against all cash medical support received. American LegalNet, Inc. www.FormsWorkFlow.com The documentation of health care expenses shall be provided on the last day of the months of March, June, September, and December. Payment/reimbursement for all health care expenses shall be made within thirty (30) days. Absent extraordinary circumstances, motions for payment of health care bills must be made within one (1) year of the date the bills were incurred. The parties shall use all health and dental care providers within the health and dental care plan, unless the parties have entered into a written agreement. Any party who uses a health or dental care provider outside of the health and dental care plan shall solely pay said debt. The only exceptions to this provision are a medical emergency or a health and dental care provider under the plan does not exist in their area. Medical emergency is defined as a life threatening illness or serious injury.”  If neither of the parties has health insurance: “Both parties shall provide health insurance for the child(ren) whenever it is available through their employment at a reasonable cost as defined in ORC 3119.30. Upon receipt of the health insurance the party shall within fourteen (14) days of obtaining coverage inform the Child Support Enforcement Agency. In the event either party obtains health insurance, that party shall upon receipt of new health insurance information regarding benefits, limitations, and exclusions of the coverage, copies of any insurance forms necessary to receive reimbursement, payment, or other benefits under to coverage, and a copy of any necessary insurance cards provide all updated information within fourteen (14) days. The parties shall divide all co-pays, deductible costs required under the health insurance policy and all other uncovered health care expenses as follows, father shall pay ______% and mother shall pay ______%. The parties shall provide each other with a copy of all health care bills for the minor child(ren) on a quarterly basis and a summary of all amounts paid by either party. The summary shall include an offset against all cash medical support received. The documentation of health care expenses shall be provided on the last day of the months of March, June, September, and December. Payment/reimbursement for all health care expenses shall be made within thirty days. Absent extraordinary circumstances, motions for payment of health care medical bills must be made within one (1) year of the date the bills were incurred. The parties shall use all health and dental care providers within the health and dental care plan, unless the parties have entered into a written agreement. Any party who uses a health or dental care provider outside of the health and dental care plan shall solely pay said debt. The only exceptions to this provision are a medical emergency or a health and dental care provider under the plan does not exist in their area. Medical emergency is defined as a life threatening illness or serious injury.” IT IS FURTHER ORDERED if either or both parents have health insurance available to them through a group policy, an order for obligee and/or obligor to provide health insurance (Form DR 705) shall issue. If neither parent has health insurance available through a group policy and neither is able to afford private insurance, an order for the payment of medical expenses (Form DR 707) shall issue. If neither parent has health insurance available through a group policy, but one or both has the means of providing private insurance, an order to provide private insurance (Form DR 708) shall issue. IT IS FURTHER ORDERED that the parties must comply with any obligations concerning health insurance coverage imposed under section 3119.30 to 3119.31 of the Revised Code no later than thirty (30) days after the applicable order is issued. IT IS FURTHER ORDERED that any person who fails to provide health insurance as ordered may be punished for contempt of Court and shall be solely responsible for the payment of all health care expenses incurred on the child(ren)’s behalf as a result of the failure to provide insurance. If the obligor is found in contempt for failing to provide health insurance coverage and the obligor has previously been found in contempt under Chapter 2705 of the Revised Code, the Court shall consider the obligor’s failure to comply with the order as a change of circumstances for the purpose of modification of the amount of support due under the child American LegalNet, Inc. www.FormsWorkFlow.com support order that is the basis of the order issued under Revised Code 3119.30 to 3119.31. IT IS FURTHER ORDERED: (Choose one of the following)  Division of Dependent(s) and Alternating Remaining Dependent(s)  Mother shall claim the following dependent(s)________________________________ _____________________________________________________________________________ for all federal, state, and local income tax purposes and Father shall claim the following dependent(s)_____________________________________________________ ____________________________________for all federal, state, and local income tax purposes.  When only one dependent remains then  Mother shall claim the child(ren) as dependents in  even  odd years for all federal, state, and local income tax purposes and Father shall claim the child(ren) as dependents in  even  odd years for all federal, state, and local income tax purposes. Alternating Dependent(s) Yearly  Mother shall claim the child(ren) as dependents in  even  odd years for all federal, state, and local income tax purposes and Father shall claim the child(ren) as dependents in  even  odd years for all federal, state, and local income tax purposes. IT IS FURTHER ORDERED that any person who is the residential parent of a child, including any party to a shared parenting agreed entry an any other legal custodian, shall send a notice of intent to relocate to the Domestic Relations Court Case Management Office, as follows: (A) If a parent or other legal custodian desires to move, he/she must notify, in writing: 1. The other parent; 2. The Domestic Relations Court Compliance Office; and 3. The Butler County Child Support Enforcement Agency (CSEA.) (B) Notice must be sent within the following time frames: 1. If relocating within Butler County - at least thirty (30) days in advance of the move. 2. If relocating outside Butler County - at least sixty (60) days in advance of the move. (C) Written notice must be submitted to the Case Management Office on form C13, if relocating within Butler County, and on form C13-A, if relocating outside Butler County. (D) If either parent believes the relocation requires a change in the allocation of parenting time, it is the responsibility of that parent to file a motion to review the allocation parenting time. (E) If a parent believes that the move requires a change in residential parent status, that parent may file a motion for change of residential parent or modification of the shared parenting plan, in accordance with rule DR 41 (B). IT IS FURTHER ORDERED that each parent, or other legal custodian, shall have equal access to the children’s school, day care center, medical or educational records and extracurricular or recreational activities. Any school, day care center official, medical, educational, and extracurricular or recreational activity coordinator or keeper of all records shall provide each parent or legal custodian with all records, documents, and materials related to the child(ren). Failure to comply with this order may be punishable as contempt of Court. MEDIATION AGREEMENT ATTACHED: The parties have entered into a mediation agreement and this agreement has been approved and signed by the parties and their attorneys and the Guardian Ad Litem. The mediation agreement is found to be fair and just to all parties and in the best interest of the child(ren). The agreement shall be approved and shall be the order of this Court with the attached mediation agreement incorporated into this Entry by reference. American LegalNet, Inc. www.FormsWorkFlow.com OTHER AGREEMENTS: _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _______________________________________________________________________________________________ The parties in the above-captioned matter hereby waive the necessity of the Magistrate’s making findings of fact and issuing a decision, and further waive the time period for filing objections to said decision as provided by Ohio Civil Rule 53, and consent to the immediate filing of a Judgment Entry in this matter, service of which is hereby acknowledged and waived. THE PARTIES AND THEIR LEGAL COUNSEL, IF REPRESENTED, APPROVE THE FORGOING AGREEMENT BY THEIR SIGNATURES BELOW: __________________________________ Plaintiff/1st Petitioner/Petitioner Telephone # _________________________ _________________________________________ Defendant/2nd Petitioner /Respondent Telephone#________________________________ __________________________________ Attorney for Plaintiff/1st Petitioner/Petitioner Supreme Court Reg. #________________ Address: __________________________ Telephone #_______________________ __________________________________ Attorney for Defendant/2nd Petitioner/Respondent Supreme Court Reg. #_________________ Address____________________________ Telephone# _________________________ ORDER I find that the parties have freely and voluntarily entered into the above agreement and that this agreement has been signed and approved by the parties and their attorneys. The agreement is found to be fair and just to all parties and is in the best interest of the children. I recommend that the agreement be approved and that the agreement become the order of this Court. _________________________ Date _______________________________ Magistrate _________________________ Date _____________________________ Judge American LegalNet, Inc. www.FormsWorkFlow.com NOTICE OF RIGHTS TO APPEAL The filing of timely written objections by any party to this action shall act as an automatic stay of the above judgment entry until the Court takes further action as delineated in Civil Rule 53. INTERIM ORDERS, HOWEVER, ARE NOT SUBJECT TO THIS AUTOMATIC STAY, AND SHALL REMAIN IN EFFECT REGARDLESS OF THE FILING OF OBJECTIONS. OBJECTIONS MUST BE FILED WITHIN FOURTEEN (14) DAYS OF THE FILING OF THIS MAGISTRATE’S DECISION OR AMENDED MAGISTRATE’S DECISION. Objections must be in writing, must be specific and state with particularity the grounds of the objection. For other requirements, see Civil Rule 53 and Local Rule. PARTIES WAIVE THEIR RIGHT TO OBJECT WITHIN 14 DAYS CERTIFICATE OF SERVICE I hereby certify that a copy of the within Entry was personally given to the parties or their attorneys, if present, this on ________________________ 20 _______ . __________ _________________ Court Officer OR I hereby certify that a copy of the within Entry was mailed on_________________ 20___ , by U. S. regular mail to Plaintiff/1st Petitioner/Petitioner or _____________________ , Attorney for Plaintiff/1st Petitioner/Petitioner; and Defendant/2nd Petitioner/Respondent or _______________________ , Attorney for Defendant/2nd Petitioner/Respondent, at their respective residences or offices. ____________________________ Court Officer American LegalNet, Inc. www.FormsWorkFlow.com