DR 627-A Eff. 1/1/2015 IN THE COURT OF COMMON PLEAS DIVISION OF DOMESTIC RELATIONS BUTLER COUNTY, OHIO REQUEST FOR INTERPRETER ___________________________________ Plaintiff/1st Petitioner ________________________________ Case Number ___________________________________ ___________________________________ vs./and ___________________________________ Defendant/2nd Petitioner ________________________________ Date ________________________________ Judge or Magistrate assigned for hearing ___________________________________ ___________________________________ ___________________________________ Name of party requiring interpreter ________________________________ Phone number of party or other contact person ___________________________________ Name of attorney/party making request ________________________________ Phone number of attorney/party making request ___________________________________ Hearing day, date, and time ________________________________ Type of hearing ___________________________________ Type of interpretive service required ________________________________ Estimated amount of time interpreter needed I hereby request interpretive services as described above. I understand that the court will arrange for an interpreter to be present as requested, and will inform me of the name and address of the interpretive service selected. I further understand that it is my responsibility to notify the interpretive service, in writing, if there is any change in the date or time of hearing, and that if I fail to do so, I will be held responsible for payment of the interpreter's fee for time spent at court for a hearing that was rescheduled without notice to the interpreter. ________________________________ Signature of attorney/party making request ____________________________________ Court Officer American LegalNet, Inc. www.FormsWorkFlow.com CASE MANAGERS USE ONLY Date Interpreter Agency Contacted: _______________________________________________ Name of Interpreter Agency:_____________________________________________________ Contact person: _______________________________________________________________ Interpreter Agency Address:_____________________________________________________ Street Number Street Name Suite Number _____________________________________________________ City State Zip ____________________________________________________ Phone Number Fax Number Date the interpreter request form sent to administrative office: Court Officer who scheduled interpreter: CERTIFICATE OF SERVICE I hereby certify that a copy of the within Entry was mailed on _________________________,20 , by U. S. regular mail to Plaintiff or , Attorney for Plaintiff, and Defendant or , Attorney for Defendant, at their respective residences or offices. __________________________________________ Court Officer American LegalNet, Inc. www.FormsWorkFlow.com