H954 (Revised /201) C ase N o . 1 COURT OF COMMON PLEAS DIVISION OF DOMESTIC RELATIONS CUYAHOGA COUNTY, OHIO : CASE NO. P E T I T I ON E R - 01 : A nd J UDG E : P E T I T I ON E R - 02 : J UDG ME N T ENTR Y O F D ISS O LUT I O N ( With Children ) (With Spousal Support) This cause came on for hearing on , 20 and was duly heard before the Honorable , Judge of the Domestic Relations Division of the Court of Common Pleas Magistrate to whom it was referred by the Honorable , Judge of the Domestic Relations Division of the Court of Common Pleas, upon the Petition of the parties and the evidence. The Court finds that Petitioner-01 was Petitioner-02 was both parties were resident(s) of the State of Ohio for more than six months immediately preceding the filing of the Petition and venue is proper in this county. The parties were married as alleged and there is/are minor child(ren) of the marriage, to wit: Full name and Date of Birth of each child: The Court further finds that the Petition for Dissolution of Marriage was filed on , service was waived thereon pursuant to law and attached thereto was a Separation Agreement signed by the parties. A copy of the Separation Agreement is attached hereto as Exhibit A and incorporated herein as if fully rewritten. The Court further finds, in open Court this date, the parties acknowledged that they were still in agreement as to the terms thereof and that there has been a full disclosure by each of the parties of all of his or her income, assets and liabilities. The Court further finds that the Separation Agreement is fair, just, and equitable. IT IS THEREFORE ORDERED, ADJUDGED AND DECREED that the marriage contract heretofore existing between the parties is hereby dissolved and that the terms of the attached Separation Agreement are hereby ordered into execution. SPOUSAL SUPPORT (Check one of the following two boxes) The Court finds, upon considering the factors set forth in Ohio Revised Code 2473105.18(C)(1), that spousal support is neither appropriate nor reasonable. American LegalNet, Inc. www.FormsWorkFlow.com H954 (Revised /201) C ase N o . 2 IT IS THEREFORE ORDERED, ADJUDGED AND DECREED that neither party shall pay spousal support to the other party. The Court shall not retain jurisdiction to modify this order. -OR- The Court finds, upon considering all of the factors set forth in Ohio Revised Code 2473105.18(C)(1) and in particular those specified below, that it is appropriate and reasonable for Petitioner-01 Petitioner-02 to pay spousal support to Petitioner-01 Petitioner-02. The Court finds that the following factors support this award: . IT IS THEREFORE ORDERED, ADJUDGED AND DECREED that Petitioner-01 Petitioner-02 shall pay spousal support to Petitioner-01 Petitioner-02 in the sum of $ per month, plus 2% processing charge, for a term of , commencing . The Court shall shall not retain jurisdiction to modify this order. Pursuant to Ohio Revised Code 2473105.18(B), all payments shall terminate upon the death of either party or . ALLOCATION OF PARENTAL RIGHTS AND RESPONSIBILITIES (Check only one of the following boxes) The Court shall not modify and/or enforce parenting orders on behalf of any parent who has not completed a court-approved parenting education program. Shared Parenting (Do not check this box unless you have a Shared Parenting Plan signed by both parties attached) The Court finds that the parents have agreed to a Shared Parenting Plan and either filed the Plan timely or waive the requirement for filing said Plan 30 days in advance of the hearing, or alternatively, that at least one parent has filed a Shared Parenting Plan 30 days prior to the hearing. The Court determines said Plan to be in the best interest of the minor child(ren). IT IS THEREFORE ORDERED, ADJUDGED AND DECREED that this Judgment Entry shall constitute an ORDER FOR SHARED PARENTING, and the parties shall share the rights and responsibilities for the care of the child(ren) in accordance with the approved Shared Parenting Plan, attached as Exhibit , which is adopted and incorporated herein. -OR- Sole Residential Parent and Legal Custodian The Court finds that it is in the best interest of the minor child(ren) that Petitioner-01 Petitioner-02 be designated residential parent and legal custodian. In determining the best interest of the child(ren) in allocating parental rights and responsibilities, the Court has considered all relevant factors, including but not limited to, the factors set forth in Ohio Revised Code 2473109.04(F). IT IS THEREFORE ORDERED, ADJUDGED AND DECREED that parental rights and responsibilities are allocated primarily to Petitioner-01 Petitioner-02 who is hereby designated the residential parent and legal custodian of the minor child(ren). The parent who is not the residential parent shall have parenting time in accordance with the schedule this Court222s Parenting Time Guidelines attached as Exhibit and incorporated by reference. American LegalNet, Inc. www.FormsWorkFlow.com H954(Revised /201) C ase N o . 3 Residential Addresses of Parents The residence address of each parent is: Petitioner-01: Petitioner-02: Notice of Intent to Relocate IT IS FURTHER ORDERED, ADJUDGED AND DECREED that each parent shall file a notice of intent to relocate if he/she intends to move to a residence other than the one specified in this order. The Notice of Intent to Relocate shall be filed on or before 60 days from the date of the intended move, or within 10 days after the relocating parent knew or should have known of the move if the relocating parent cannot satisfy the 60 day requirement. A copy of any such notice filed with the Court shall be sent to the non-relocating party unless the box below is checked. Pursuant to a determination made under Ohio Revised Code 2473109.051(G)() and subject to further order of the Court Petitioner-01 Petitioner-02 shall not be sent a copy of any relocation filed with the Court. FEDERAL INCOME TAX EXEMPTION The Court finds that upon considering Ohio Revised Code 2473119.82, the dependency exemption for the child(ren) who is/are the subject of this order for federal income tax purposes shall be awarded as set forth below. IT IS THEREFORE ORDERED, ADJUDGED AND DECREED that the following person(s) shall claim the dependency exemption for the child(ren) who is/are the subject of this order for federal income tax purposes: Petitioner-01 Petitioner-02 Both Petitioner-01 and Petitioner-02 according to the following terms:IT IS FURTHER ORDERED, ADJUDGED AND DECREED that the parties shall take whatever action is necessary, pursuant to section 152 of the 223Internal Revenue Code of 1986,224 100 Stat. 2085, 26 U.S.C. 1, as amended, to enable the parent who has been awarded the right to claim the dependency exemption(s) for the children for federal income tax purposes in accordance with this order. Failure of a party to comply with the order may be considered contempt of court. CHILD(REN)222S HEALTH CARE Uncovered Healthcare Expenses The Court finds that pursuant to Ohio Revised Code 2473119.30(A), both parents are liable for the health care of the child(ren) who is/are not covered by private health insurance or cash medical support as calculated in accordance with Ohio Revised Code 2473119.022 or 2473119.023. IT IS THEREFORE ORDERED, ADJUDGED AND DECREED that the Petitioner-01 pay % and the Petitioner-02 pay % of the annual costs of the health care needs of the child(ren) that exceed the amount of cash medical support ordered to be paid, if any, when private health insurance coverage American LegalNet, Inc. www.FormsWorkFlow.com H954 (Revised /201) C ase N o . 4 is not available or is not being provided in accordance with this order, or of the uninsured health care costs or co-payment or deductible cost required under the health insurance policy, contract or plan that covers the child(ren) when private health insurance coverage is being provided in accordance with this order. The parent who receives a medical bill, and/or an Explanation of Benefits (EOB), or who incurs a medical expense, shall provide the other parent the original or a copy of the bill, and/or EOB, if available, within 30 days o