COMMON PLEAS COURT DIVISION OF DOMESTIC RELATIONS CLERMONT COUNTY, OHIO _____________________________ Case No. ________________ Plaintiff/Petitioner (1) SETS No. ________________ Address ______________________ _____________________________ V. ENTRY AND ORDER OF CUSTODY UPON DEATH OF A PARTY _____________________________ Defendant/Petitioner(2)/Respondent Address ______________________ _____________________________ The court finds that the parties were divorced on ________________ and the plaintiff/defendant was awarded custody of the parties’ minor children, ________________________ Name of child ________________________ Name of child ________________________ Name of child _________________________ DOB _________________________ DOB _________________________ DOB The court further finds that plaintiff/defendant was ordered to pay $_________ per month per child as and for child support to plaintiff/defendant. Plaintiff/defendant has submitted a certified copy of a death certificate, attached hereto, which states that _________________; plaintiff/defendant herein died on ______________. The plaintiff/defendant is the legal surviving parent of the parties’ minor children. Plaintiff/defendant represents to the court that there is no other custody proceeding pending in any court. IT IS THEREFORE ORDERED that: Plaintiff/defendant, the surviving legal parent of _____________________________ ___________________________ Name of child DOB _____________________________ ___________________________ Name of child DOB _____________________________ ___________________________ Name of child DOB is designated legal custodian and residential parent of said children. Plaintiff/defendant’s child support obligation for the above-named child(ren) in the amount of $________ per month per child is hereby terminated effective _______________. An order to terminate the withholding notice of _________________ shall issue American LegalNet, Inc. www.FormsWorkflow.com to plaintiff/defendant’s employer_______________ at ___________________________ forthwith. In the event it is determined that no child support arrearage is due and owing to the deceased or to the state, any funds being held by the OCSPC shall be returned to the plaintiff/defendant. Costs of the within Entry and Order shall be paid by plaintiff/defendant. Submitted by: _______________________ Plaintiff/Defendant or Attorney Name:__________________ Address:________________ _______________________ Telephone:______________ _______________________ Magistrate ________________________ Judge Michael J. Voris 3/06 Form DR-616 American LegalNet, Inc. www.FormsWorkflow.com