COURT OF COMMON PLEAS DIVISION OF DOMESTIC RELATIONS CLERMONT COUNTY, OHIO ____________________________________ Plaintiff/Petitioner ____________________________________ Address ____________________________________ City ST ZIP Vs CASE NO. _______________________ JUDGE KATHLEEN M. RODENBERG MAGISTRATE ___________________ POST DECREE MOTION AND AFFIDAVIT _________________________________ Defendant/Respondent _________________________________ Address _________________________________ City ST ZIP _________________________________ requests this Court make the following Order(s): ____ ____ ____ ____ modification of spousal support modification of parental rights and responsibilities modification of parenting time modification of child support, health care provisions and tax dependency exemptions You are required to bring to the hearing: 1. Your three most recent pay stubs; 2. Copies of your three most recent year’s tax returns; 3. Forms W-2 or 1099's for the three most recent calendar years; 4. Documents verifying any child care costs you pay; 5. If you provide PRIVATE insurance for the children: A. Documentation verifying the amount you pay to obtain health insurance for you and everyone else you cover; B. Documentation verifying the amount you would pay to insure yourself only. ____ modification of child support arrearage or arrearage payment You are required to bring to the hearing an updated print-out from the CSEA showing the child support arrearage ____ Other: . ________________________ Signature of Party NOTICE OF HEARING A hearing shall be held before Magistrate _________________ on the ______ day of _______________, 20_____, at _____________a.m./p.m., at the Court of Common Pleas, Division of Domestic Relations, Suite 200, 2340 Clermont Center Drive, Batavia, OH 45103. INSTRUCTIONS TO THE CLERK Please serve the above motion on __________________________________ at the following address:_____________________________________________________________________________ By ( ) Certified Mail ( ) Sheriff American LegalNet, Inc. www.FormsWorkFlow.com AFFIDAVIT Affiant states the following in support of the Motion: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ I, ____________________________, hereby swear and affirm the information set forth in this Affidavit is true, complete and accurate. ________________________________ AFFIANT SWORN to and SUBSCRIBED before me this __________ day of ___________________, 20______. ________________________________ NOTARY PUBLIC 6/11 Form DR-301 American LegalNet, Inc. www.FormsWorkFlow.com