COURT OF COMMON PLEAS DOMESTIC RELATIONS DIVISION CLERMONT COUNTY, OHIO CASE NUMBER: Plaintiff/Petitioner Address City ST Zip Vs Defendant/Petitioner NOTICE OF INTENT TO RELOCATE WITHIN 75 MILE RADIUS OF RESIDENCE Address City ST Zip I, , am the parent of the following minor child/ren: Name Date of Birth: Name Date of Birth: Name Date of Birth: Effective (date), I intend to relocate from: Present address: TO New address: If either parent believes this relocation requires a change in the parenting time or the residential parent status, it is the responsibility of that parent to file a motion to modify parenting time or to modify the residential parent status. The current order for parenting time is in effect until changed by court order. American LegalNet, Inc. www.FormsWorkFlow.com Choose one: I have no objection to the Clerk of Courts mailing a copy of this notice to the other parent at his/her above-captioned address. The other parent has been convicted of criminal domestic violence, or pleaded guilty to criminal domestic violence, or another criminal offense involving a member of our immediate family, or has been determined to be the perpetrator of an abusive act resulting in a judicial determination that a child is an abused child. Therefore, I object to the Clerk of Courts mailing a copy of this Notice to the other parent. Signature of Parent filing this Notice INSTRUCTIONS TO THE CLERK OF COURTS Choose one: Please serve a copy of this Notice on (name) at his/her address in the caption above by ordinary mail, with a certificate of mailing. Please do not serve a copy of this Notice, but provide a time-stamped copy of the Notice to the Domestic Relations Court. The Court will then provide supplemental instructions for Service. American LegalNet, Inc. www.FormsWorkFlow.com