DR 715 Eff. 1/1/2015 Rev. 8/23/2016 IN THE COURT COMMON PLEAS DIVISION OF DOMESTIC RELATIONS BUTLER COUNTY, OHIO ______________________________________________ Plaintiff/1st Petitioner/Petitioner Address _______________________________________ ______________________________________________ SSN _______________________ DOB ______________ vs./-and- : : : Case No____________________ Magistrate________________ Judge ___________________ : ______________________________________________ Defendant/2nd Petitioner/Respondent Address _______________________________________ _____________________________________________ SSN _______________________ DOB ______________ On___________________, 20________ , a hearing was held before Magistrate/Judge ____________________________ on: Plaintiff's/1st Petitioner/Petitioner Motion Code Defendant's/2nd Petitioner/Respondent motion(s) : Date Motions were Filed Resolution of the Motion : AGREED ENTRY (Hearing Required) FINAL APPEALABLE ORDER NON FINAL APPEALABLE ORDER : Name of Motion Appearing before the Court were: Plaintiff/1st Petitioner/Petitioner with without Attorney _____________________________ Defendant/2nd Petitioner/Respondent with 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: _____________________________________ American LegalNet, Inc. www.FormsWorkFlow.com _____________________________________ _____________________________________ _____________________________________ THE PARTIES AGREE AS FOLLOWS: 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: "Based upon Father's adjusted gross income of $________ per year, and Mother's adjusted gross income of American LegalNet, Inc. www.FormsWorkFlow.com $_________ per year, an award of child support, in accordance with child support guidelines, ORC 3119.021, __________________is the obligor and child support 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) 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) 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) 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 IMMEDIATELY NOTIFY CSEA AT 513-887-3362 AND 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