IN THE COURT OF COMMON PLEAS JUVENILE COURT DIVISION CUYAHOGA COUNTY, OHIO In the Matter of: D.O.B. D.O.B. D.O.B. D.O.B. Judge: MOTION TO MODIFY: CUSTODY SHARED PARENTING PLAN PARENTING TIME COMPANIONSHIP AND VISITATION , and moves this Honorable Court, to (your name) Case Number(s): Now comes modify its order of custody shared parenting plan companionship and visitation that was ordered on parenting time . The petitioner is requesting that the child be placed in his or her custody he or she be granted additional parenting time visitation with the child. In addition the undersigned prays this Honorable Court to grant an order of support or toc modify the existing support order, including an order regarding health insurance or cash medical support for the child. The reasons for this request are fully explained in the attached affidavit and Uniform Child Custody Jurisdiction Enforcement Act Affidavit made a part hereof. Signature Print Name Street Address City, State, Zip Code Telephone Number E-mail address (date of order) American LegalNet, Inc. www.FormsWorkFlow.com AFFIDAVIT Now comes 1. I am the (your name) and deposes and states: of the above named child. (relationship) 2. The child's last known or present address in Cuyahoga County is 3. The child was placed in the custody of the 4. A change of circumstances has occurred for circumstance is as follows: (be specific) on The change in 5. I am seeking custody because:(be specific) I am seeking an order of support if custody is granted to me, including an order of regarding health insurance or cash medical support for the child. 6. I am seeking shared parenting, parenting time or visitation because: (be specific) I, the parent of the child, am seeking a modification of the current child support order if my parenting time or shared parenting plan is modified as a result of this motion. Affiant sayeth naught. Affiant Witness by and sworn to before me on this day of , 20 . Notary Public 7/2015 American LegalNet, Inc. www.FormsWorkFlow.com