COURT OF COMMON PLEAS DIVISION OF DOMESTIC RELATIONS CLERMONT COUNTY, OHIO ___________________ Plaintiff/Petitioner CASE NO. ___________________ SS#________________ DOB_______________ VS. NOTICE OF INTENT TO RELOCATE ____________________ Defendant/Respondent SS#________________ DOB________________ Pursuant to O.R.C. 3109.051(g)(1), this form may be used to file a Notice of the party’s intent to relocate to a residence other than the last residence of Court record. LAST RESIDENCE OF COURT RECORD INTENDED NEW RESIDENCE Name_____________________________ Name__________________________ Street_____________________________ Street__________________________ City______________ST____ZIP________ City_______________ST___ZIP_____ NAME OF CHILDREN AGE PARTY TO BE NOTIFIED __________________ ______ Name__________________________ __________________ ______ Street__________________________ __________________ ______ City_______________ST___ZIP_____ Date______________ _______________________________ Signature of Party INSTRUCTIONS TO THE CLERK The Clerk of Courts shall serve this notice on ________________ by regular U. S. Mail at the above address. A copy of this Notice was sent on this ___ day of ________________, _________. _______________________________ Clerk of Courts 2002 © American LegalNet, Inc.