THE PARENTING PROCEEDING AFFIDAVIT AND IV-D APPLICATION A Parenting Proceeding Affidavit must be filed pursuant to Ohio Revised Code �3127.23 at the initial filing of a complaint for divorce, legal separation, annulment or a petition for dissolution when there are minor children. It must also be filed with the initial filing of a Motion to Modify Parenting Order. The Parenting Proceeding Affidavit is a sworn statement stating the names and dates of birth of the minor children of the parties, their residence addresses for the previous five years and whether any or all of the children have been the subject of any court cases where a designation of parental rights has been made no matter where the location of the case. The Parenting Proceeding Affidavit is necessary for the Court to determine if it has the authority to issue parenting orders in the case being filed. The "IV-D Application" is an application to receive child support services from the Child Support Enforcement Agency for parents who are not receiving TANF or Medicaid. After you submit the application the Child Support Enforcement Agency can assist you in providing the following services: Location of Absent Parents. The agency can assist in finding where an absent parent is currently living, in what city, town or state. The applicant can request "Location Services Only", if the sole need is to find the whereabouts of the absent parent. Establishment or Modification of Child Support and Medical Support. The CSEA can assist you in obtaining an order for support if you are separated, have been deserted or need to establish paternity (fatherhood). The CSEA can also assist you in changing the amount of support orders (modification), and to establish a medical support order. Enforcement of Existing Orders. The CSEA can help you collect current and back child support. Federal and State Income Tax Refund Offset Submittals for the Collection of Child Support Arrearage. The agency can assist in collecting back support (arrearage) by intercepting a nonpayor's federal and state income tax refunds on some cases. Withholding of Wages and Unearned Income for the Payment of Court Ordered Support. The agency can help you get payroll deductions for current and back child support and can intercept unemployment compensation to collect child support. Establishment of Paternity. The agency can obtain an order for the establishment of paternity (fatherhood), if you were not married to the father of the child. Collection and Disbursement of Payments. The CSEA can collect the child support for you, and send you a check for the amount of the payments received. Back support collected will be paid to you until all of the back support you are owed is paid. Interstate Collection of Child Support. The agency can assist you in collecting support if the payor is living in another state or in some foreign countries. Recipients of child support services are required to cooperate to the best of their ability with the CSEA. The only fee you can be charged for services is a one-dollar application fee. In providing IV-D services, the CSEA and any of its contract agents (e.g., prosecutors, attorneys, hearing officers, etc.) represent the best interest of the children of the state of Ohio and do not represent any IV-D recipient or the IV-D recipients' personal interest. American LegalNet, Inc. www.FormsWorkFlow.com STATE OF OHIO ) CUYAHOGA COUNTY ) ss. ____________________________ Plaintiff/Petitioner/Defendant-01 ________________________________ ___ Address _______________________________________ Defendant/Respondent/Defendant-02 IN THE COURT OF COMMON PLEAS DIVISION OF DOMESTIC RELATIONS Case Number_________________________ Judge ______________________________________ PARENTING PROCEEDING AFFIDAVIT (ORC 3127.23) ____________________________ _____ Address ______________________________________________, being duly sworn, states the following regarding issues relevant to (Your name) parenting of the following minor child(ren): (Names and birth dates of children)__________________________________________ ___________________________________________________________________________________________________________ DIRECTIONS: You must answer questions and provide all information requested. If you do not, it is possible the Court will be unable to make orders in your case. If you need more space to answer any question, please use a separate piece of paper and attach it to the back of this form. If the answers/information are not the same for all children, a separate affidavit must be filed for each child. 1. Beginning with the child(ren)'s present address, state the residence where the child(ren) lived within the last five years, and the names and relationship of the persons with whom the child(ren) lived during that period. Period of Residence Address and Person(s) at residence Person(s) Relationship to Child a. __________to the present a. _________________________________________ a. ______________________ b. __________to ___________ b. _________________________________________ b. ______________________ c. __________to ___________ c. _________________________________________ c. ______________________ 2. Have you participated as a party, witness, or in any other capacity in any other proceedings concerning the allocation, between the parents of the same child, of parental rights and responsibilities for the care of the child including parenting time rights and the designation of the residential parent and legal custodian of the child or that otherwise concerned the custody of or visitation with the same child? No Yes If "Yes" you must provide the Court name, address, case number and date of determination, if any on the line below: ___________________________________________________________________________________________________________ 3. Do you know of any proceedings that could affect the current proceeding, including proceedings for enforcement of child custody determinations; proceedings relating to domestic violence or protection orders; proceedings to adjudicate the child as an abused, neglected, or dependent child; proceedings seeking termination of parental rights; and adoptions ? No Yes If "Yes" you must provide the Court name, address, case number and date of determination, if any on the line below: ___________________________________________________________________________________________________________ 4. State the name and address of any person or a