COURT OF COMMON PLEAS DIVISION OF DOMESTIC RELATIONS CLERMONT COUNTY, OHIO DISSOLUTION WITH MINOR CHILDREN AND/OR SPOUSAL SUPPORT Employees of the Domestic Relations Court cannot, by law, give legal advice. This form is used only to provide information as to what documents this Court requires in a dissolution proceeding. If legal advice is necessary, please consult with an attorney. Case Caption: _______________ and ____________________ The following is a list of documents, which must be completed and submitted to the Domestic relations Court for review before filing with the Clerk of Courts. You cannot file the documents until each item has a " " beside it. In other words, the items without a " " mark must be completed and resubmitted before you can file the dissolution and set it for a hearing. ___ ___ Petition for Dissolution original and 2 copies Waiver of Service (signed by each party) (DR701) ___ Separation Agreement (original plus 5 copies) ___ Affidavit of Income, Expenses and Financial Disclosure (509-2) ___ Health Insurance Disclosure Affidavit (DR405) ___ Affidavit in compliance with ORC 3127.23 (DR604) (only cases with minor children) ___ Child Support Worksheet (only cases with minor children)(original plus 5 copies) ___ Shared Parenting Plan (original plus 5 copies-only cases with minor children) (605) ___ Certificate of Readiness (101) ___ Classification form (115) ___ Copies of petitioners' last pay stub ___ Title IV-D Application (7076) ___ Legible copies of each parties' driver's licenses or state identification ***The following documents need to be submitted to the Court for review when you file the dissolution, but you need to bring the documents back with you to the final hearing***. Decree of Dissolution (original plus 4 copies with Separation Agreement and ___ child support worksheet attached to original and each copy) ___ Wage/Income Withholding Notice and Addendum (monthly and pay period amounts to be filled in only after review of forms by Court) (4047/4048) ___ Appropriate Health Care Order (401, 402, 403, or 404) ___ CSE Information Sheet (509-4) ___ Shared Parenting Decree - only when parties have filed a Shared Parenting Plan (original plus 4 copies with shared parenting plan attached to original and each copy. Make sure child support calculations in Shared Parenting Decree, Decree of Dissolution, Shared Parenting Plan, and Separation Agreement match and are accurate.) (601) ____ Rev. 7/06 This Dissolution is ready to be filed and set for hearing. _______Initialed by Court personnel Checklist 2 American LegalNet, Inc. www.FormsWorkflow.com COURT OF COMMON PLEAS DIVISION OF DOMESTIC RELATIONS CLERMONT COUNTY, OHIO Date_______________________ CASE NO. _____________________ ___________________________ Plaintiff/Petitioner ______________________________ Defendant/Respondent The undersigned hereby certifies that: Date motion filed:________________ Time required for hearing: _____ minutes _____ hours _____ days Counsel and/or party requesting hearing:___________________________________________ ATTORNEY FOR PLAINTIFF ________________________ ATTORNEY FOR DEFENDANT ______________________________ ________________________ ______________________________ ________________________ ______________________________ NAME AND ADDRESS OF UNREPRESENTED PARTIES PLAINTIFF DEFENDANT ________________________ _______________________________ ________________________ _______________________________ ________________________ _______________________________ The following is a final hearing: ____ yes _____no TYPE OF ACTION: Dissolution with children Dissolution without children Divorce uncontested Divorce contested Pre Trial Pre Trial with litigants Report ____ attorney ____ ____ ____ ____ ____ ____ Post Decree Motion for: reallocation of parental rights _____ modification of parenting schedule _____ modify/enforce child support ____ modify/enforce health care provisions___ modification of tax dependency ____ fees and costs ____ THIS HEARING IS SCHEDULED BEFORE: Judge Michael Voris ____ Visiting Judge____________________ Magistrates: Finney ____ Gates ____ Johnson____ Dean ____ ASSIGNED DATE: _________________________, 20____, AT __________________a.m./p.m. Form DR-101 American LegalNet, Inc. www.FormsWorkflow.com