COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.IN THE COURT OF COMMON PLEAS DOMESTIC RELATIONS DIVISION COLUMBIANA COUNTY, OHIOJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)JUDGE CASE NO. CSEA SETS NO.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .JUDGMENT ENTRY COMBINED ORDER FOR SUPPORT AND HEALTH INSURANCETHE PEOPLE OF THE STATE OF NEW YORK TOThis matter came for hearing before Magistrate on . Upon review of the Magistrate's decision, and upon independent review of the findings of fact and conclusions of law, IT IS THE ORDER OF THE COURT: CHILD SUPPORT ORDER:GREETINGS:The Obligor is ordered to pay $,per month PER CHILD, (forchild(ren)), FOR A TOTAL CURRENT CHILD SUPPORT ORDER PER MONTH OF $, PLUS 2% CSEA ADMINISTRATIVE FEE, AND $ PER MONTH ON CHILD SUPPORT ARREARAGE, PLUS 2% CSEA ADMINISTRATIVE FEE, effectiveWE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,, as and for the child support.located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomSPOUSAL SUPPORT ORDER:CURRENT SPOUSAL SUPPORT has been ordered in the amount of $ per month, PLUS 2% CSEA ADMINISTRATIVE FEE. $per month has been ordered on SPOUSAL SUPPORT ARREARAGE, PLUS 2% CSEA ADMINISTRATIVE FEE.Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply., one of the Justices of theCourt in Witness, Honorableday of, 20 County,ORDER FOR HEALTH INSURANCE COVERAGE: INDICATE BELOW, AS APPROPRIATE, THE ORDERED HEALTH INSURANCE COVERAGE: THE OBLIGOR SHALL OBTAIN AND MAINTAIN HEALTH INSURANCE COVERAGE FOR THE ABOVE NAMED MINOR CHILD(REN), as coverage is available at a reasonable cost through a group policy, contract, or plan offered by the Obligor's employer or through any other group policy, contract, or plan available to the Obligor and is not available for a more reasonable cost through a group policy, contract, or plan available to the Obligee. O.R.C. 3119.30(A)(Attorney must sign above and type name below)THE OBLIGEE SHALL OBTAIN AND MAINTAIN HEALTH INSURANCE COVERAGE FOR THE ABOVE NAMED MINOR CHILD(REN), as coverage is available through a group policy, contract, or plan offered by the Obligee's employer or through any other group policy, contract, or plan available to the Obligee and is available at a more reasonable cost than coverage is available to the Obligor. O.R.C. 3119.30(B) NEITHER OBLIGOR NOR OBLIGEE HAS HEALTH INSURANCE AVAILABLE FOR THE ABOVE NAMED MINOR CHILDREN at a reasonable cost through a group policy, contract, or plan offered by the Obligor's or Obligee's employer or through any other group policy, contract, or plan available to the Obligor or Obligee. The FIRST $100.00 PER CHILD PER CALENDAR YEAR OF UNINSURED MEDICAL/DENTAL EXPENSES SHALL BE PAID BY THE OBLIGEE (CUSTODIAL PARENT). THE PARTIES SHALL THEREAFTER DIVIDE THE COST OF MEDICAL/DENTAL EXPENSES OF THE CHILD(REN) IN ACCORDANCE WITH THEIR PRO RATA SHARE OF SUPPORT ACCORDING TO THE CHILD SUPPORT WORKSHEET, TO WIT,Attorney(s) forOffice and P.O. Address% TO OBLIGOR AND % TO OBLIGEE. O.R.C.3119.01(C)(4), 3119.05(F),3119.30(C). Both parties are ordered to immediately notify the Court and CSEA (110 N. Nelson Ave., Lisbon, OH 44432 (330) 424-7781, 1-800-353-0125) ifTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:1American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.health insurance coverage for the children becomes available at a reasonable cost through a group policy, contract, or plan offered by the Obligor's or Obligee's employer, or through any other group policy, contract, or plan available to the Obligor or Obligee, so that the child(ren) can be added to said coverage. O.R.C. 3119.30(C) BOTH THE OBLIGOR AND THE OBLIGEE SHALL OBTAIN AND MAINTAIN HEALTH INSURANCE COVERAGE FOR THE ABOVE NAMED MINOR CHILD(REN),as coverage is available for the children at a reasonable cost to both the Obligor and Obligee, and dual coverage would provide for coordination of medical benefits without unnecessary duplication of coverage. The 's insurance shall serve as the primary insurance coverage. O.R.C. 3119.30(D)JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)HEALTH INSURANCE IS TO BE CARRIED BY A THIRD PARTY, (NAME:), OTHER THAN THE OBLIGOR OR OBLIGEE, OR IN ADDITION TO THE OBLIGOR OR OBLIGEE, AS SPECIFIED BELOW. The. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .is ordered to provide coverage, if the third party's coverage is no longer available, only if available through employment and at reasonable cost. The THIRD PARTY coverage is IN ADDITION to the coverage above. The THIRD PARTY coverage is the ONLY COVERAGE presently ordered.THE PEOPLE OF THE STATE OF NEW YORK TOCosts to .ALL UNTIL FURTHER ORDERED BY THIS COURT.GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,JUDGElocated at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomApproved:Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.Attorney for, one of the Justices of theCourt in Witness, Honorableday of, 20 County,INSTRUCTIONS FOR SERVICE: THE CLERK OF COURTS SHALL SERVE A COPY OF THIS ENTRY UPON THE OBLIGOR AND OBLIGEE, THE CHILD SUPPORT ENFORCEMENT AGENCY, AND THE INDIVIDUALS/ENTITIES LISTED BELOW, IF ANY. 1.(Attorney must sign above and type name below)2.Attorney(s) for3.Office and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:2American LegalNet, Inc. www.USCourtForms.com