IN THE COURT OF COMMON PLEAS DOMESTIC RELATIONS DIVISION LAKE COUNTY, OHIO __________________________________ CASE NUMBER: _______________________ Plaintiff/Petitioner DOB _____________________________ CSEA SETS# __________________________ ADDRESS: ________________________ __________________________________ JUDGE COLLEEN A. FALKOWSKI vs/and __________________________________ JUDGMENT ENTRY Defendant/Petitioner DOB _____________________________ ORDER TO REPORT ADDRESS: ________________________ ORDER ON OBLIGOR __________________________________ ORDER ON OBLIGEE IT IS ORDERED, ADJUDGED AND DECREED THAT _____________________(OBLIGOR) shall seek employment, if able to engage in employment, and to immediately notify the LAKE COUNTY CHILD SUPPORT ENFORCEMENT DIVISION, in writing, upon commencement of employment (including self-employment), receipt of additional income/monies, obtaining ownership of any asset with a value of $500 or more, or opening an account at a financial institution. The OBLIGOR shall include a description of the nature of any employment and the name, business address and telephone number of any employer, or a description of the nature of any account opened at anyfinancial institution, along with the name and businessaddress of that financial institution. IT IS FURTHER ORDERED that, as long as the OBLIGOR is not gainfully employed, he/she shall report in writing to the DIVISION every _____ weeks(s) regarding his/her employment status or receipt of additional income/monies. The OBLIGOR is further Ordered to immediately notify the DIVISION, in writing, of his/her current mailing address and residence address, as well as anynges in ei cha ther address until further order of theCourt. The OBLIGORs failure to comply with the foregoing order to report and order of notification shall be considered contempt of Court, punishable by a fine and/or jail sentence. Attorney fees and court costs may the be assessed against the OBLIGOR held in contempt. ORDER ON OBLIGEE The OBLIGEE is Ordered to immediately notify the DIVISION, in writing, of his/her current mailing address and residence address, as well as any change in either address until further order of the Court. The OBLIGEE is further Ordered to immediately notify the DIVISION of any reason for which the support order should terminate, including but not limto death, marriage, emited ancipation, age 18 or highschool completion or termination, incarceration, enlistment in Armed Services, deportation, or change of legal or physical custody of the child. The OBLIGEEs failure to comply with the regoing order of notification, IMMEDIATELY UPONfo ANY CHANGE in his/her address OR the status of the child, shall be considered contempt of Court, punishable by a fine and/or jail sentence. THIS ORDER TO REPORT SUPERCEDES ANY PRIOR ORDER TO REPORT ISSUED UNDER THIS CASE NUMBER. IT IS SO ORDERED. Prepared by _____________________________ CC: Obligor _____________________________ ________________________________ Obligee _____________________________ COLLEEN A. FALKOWSKI, JUDGE C.S.E.A., Inter-Office Mail 03/2005 American LegalNet, Inc. www.USCourtForms.com