COURT OF COMMON PLEAS DIVISION OF DOMESTIC RELATIONS CLERMONT COUNTY, OHIO _________________________________ CASE NO._______________________ Plaintiff/Petitioner _________________________________ SETS NO._______________________ Address _________________________________ City ST ZIP VS. AGREED CHANGE OF RESIDENTIAL PARENT AND LEGAL CUSTODIAN _________________________________ Defendant/Respondent _________________________________ Address _________________________________ City ST ZIP BY AGREEMENT OF THE PARTIES and with the consent of the Court it is hereby ordered that: 1. PARENTING The residential parent and legal custodian of (name of minor child(ren)): _________________________________ DOB _________________________________ _________________________________ DOB _________________________________ _________________________________ DOB _________________________________ _________________________________ DOB _________________________________ is/are hereby changed from ___________ (Mother/Father) TO ___________ (Mother/Father). The non-residential parent shall have parenting time as follows: [ ] Standard Order; [ ] Other (You must be specific)_________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 2. CHILD SUPPORT AND MEDICAL INSURANCE/EXPENSES See attached order. 3. TAX EXEMPTIONS _____________________shall be entitled to claim the following child/ren as his/her dependent(s) for all income tax purposes, beginning with tax year ________; or as follows:_____________________________ _________________________________________________________. See attached additional orders. 4. Additional documents/orders as necessary are attached hereto and incorporated herein for all purposes including [ ] Support Worksheet; [ ] Parenting Time Order; [ ] Other _____________ ______________________________________________________________________________________ 5. It is further ordered that ___________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ Obligor acknowledges that he/she is under no disability; he/she has received a copy of the Support Order, the O.R.C. §3121.03 and §3119.30 orders; and that he/she waives service of same. By signature on this agreed entry, both parties expressly, knowingly and voluntarily waive their right, if any, to a Magistrate’s Decision or Order as well as any requirements that the Court issue separate findings of fact/conclusions of law pursuant to O.R.C. §3109.04, 3109.051, 3109.052, and 3119. _______________________________ Plaintiff/Petitioner ___________________________________ Defendant/Respondent _______________________________ Attorney for Plaintiff/Petitioner ___________________________________ Attorney for Defendant/Respondent ___________________________________ Magistrate ___________________________________ Judge Kathleen M. Rodenberg Rev. 1/11 Form DR-603 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com