COURT OF COMMON PLEAS DIVISION OF DOMESTIC RELATIONS CLERMONT COUNTY, OHIO __________________________ CASE NO. __________________ Plaintiff And PETITION FOR CONCILIATION __________________________ Defendant The undersigned petitioner respectfully represents that ________________ and _______________ are the parties to the above-entitled action; and alleges that a controversy between the said spouses which may, unless a reconciliation or amicable settlement is achieved, result in dissolution of the marriage or disruption of the household. The name and age of each minor child whose welfare may be affected by the controversy is as follows: NAME DOB YEARS OF AGE Wherefore, said petitioner requests the aid of the Court to effect reconciliation or an amicable settlement of the controversy between the parties to preserve the marriage. If the parties have not sought counseling regarding reconciliation of the marriage, the parties must schedule a conciliation appointment with the Court’s Parental Specialist. ____________________________ Plaintiff’s/Defendant’s Signature The State of Ohio, Clermont County: SS. The petitioner herein named, being first duly sworn, says that the statements in the foregoing petition are true, as he/she verily believes. Sworn to before me and signed in my presence this ___________ day of ______________________________. ____________________________ Notary Public My Commission Expires: ____________________________ A Report on Conciliation is scheduled on the _____ day of ______________, 20___, at _________ a.m./p.m. before Magistrate _________________. 5/07 Form DR-109 American LegalNet, Inc. www.FormsWorkflow.com