FORM 10.01-K: MOTION TO MODIFY OR TERMINATE DOMESTIC VIOLENCE CIVIL PROTECTION ORDER OR CONSENT AGREEMENT COURT OF COMMON PLEAS DIVISION OF DOMESTIC RELATIONS CLERMONT COUNTY, OHIO Petitioner Address City, State, Zip Code : : : Case Number: Judge Kathleen M. Rodenberg v. : : MOTION TO MODIFY OR TERMINATE DOMESTIC VIOLENCE PROTECTION ORDER OR CONSENT AGREEMENT Respondent : Address : City, State, Zip Code CHECK EVERY THAT APPLIES. IF YOU ARE REQUESTING YOUR ADDRESS REMAIN CONFIDENTIAL, DO NOT WRITE YOUR ADDRESS ON THIS FORM. PLEASE PROVIDE ANOTHER MAILING ADDRESS WHERE YOU CAN SAFELY RECEIVE NOTICES FROM THE COURT. THIS FORM IS A PUBLIC RECORD. Petitioner Respondent moves this Court to modify or terminate the Domestic Violence Civil Protection Order or Consent Agreement issued on / / . In the original proceeding, I was the 1. Petitioner Respondent. The terms of the civil protection order or consent agreement to be modified or terminated are: 2. The reasons for the modification or termination are: 3. Court fees cannot be assessed against the Petitioner for filing a Motion to Modify or Terminate Domestic Violence Civil Protection Order or Consent Agreement, which is in connection with a previously issued protection order or approved consent agreement. FORM 10.01-K: MOTION TO MODIFY OR TERMINATE DOMESTIC VIOLENCE CIVIL PROTECTION ORDER OR CONSENT AGREEMENT Amended: March 1, 2014 American LegalNet, Inc. www.FormsWorkFlow.com [Page 2 of 2 Form 10.01-K] Case No._____________________ Respectfully submitted, SIGNATURE OF PETITIONER/RESPONDENT Safe mailing address where the Court may contact the moving party (YOU). Signature of Attorney for Petitioner/Respondent (if applicable) Name Address Attorney Registration Telephone Fax Email REQUEST FOR SERVICE Please serve a copy of this Motion upon the Petitioner Respondent, pursuant to Civ.R. 65.1(C)(3) at the following address: Print FORM 10.01-K: MOTION TO MODIFY OR TERMINATE DOMESTIC VIOLENCE CIVIL PROTECTION ORDER OR CONSENT AGREEMENT Amended: March 1, 2014 American LegalNet, Inc. www.FormsWorkFlow.com