COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.IN THE COURT OF COMMON PLEAS, MAHONING COUNTY, OHIOREV. 3/22/01 DIVISION OF DOMESTIC RELATIONS Calendar No.)Case No. Petitioner/Plaintiff) )JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)JUDGE BETH A. SMITH -vs-/and))PARENTING AFFIDAVIT )(R.C. 3109.27) Defendant/Respondent)State of Ohio, County of Mahoning: ss , being first duly sworn says that (s)he is one of the parties in this cause and action, and that the parties hereto are the parents of the following named minor child(ren): Age. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Age AgeTHE PEOPLE OF THE STATE OF NEW YORK TO Age Age AgeAffiant says this affidavit is submitted in compliance with R.C. 3109.27 and (s)he A.[ ] has not (check one)[ ] has participated as a party, a witness, or in any other capacity in any other litigation, in this or any other state, that concerned the allocation, between the parents of the same child, of parental rights and responsibilities for the care of the child and the designation of the residential parent and legal custodian of the child or that otherwise concerned the custody of the same child.GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the HonorableB. [ ] has not (check one),located at County of[ ] has information concerning a parenting or visitation proceeding concerning the child pending in a court of this or any other state, and the name and address of the court iso'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 roomYour 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,(Attorney must sign above and type name below)Attorney(s) forC. [ ] does not know (check one) [ ] does know of any person who is not a party to the proceeding, and has physical custody of the child or claims to be a parent of the child who is designated the residential parent and legal custodian of the child or to have visitation rights with respect to the child or to be a person other that a parent of the child who has custody or visitation rights with respect to the child; D. [ ] has not (check one) [ ] has been convicted of or pleaded guilty to any criminal offense involving any act that resulted in a child being an abused child or a neglected child or previously has been determined, in a case in which a child has been adjudicated an abused child or a neglected child, to be the perpetrator of the abusive or neglectful act that was the basis of the adjudication. Further affiant says that the minor child(ren) have lived at the following addresses with the following persons within the last five years and that if the present address of said parties is different from the place the child(ren) lived, the present address shall also be listed: (include address AFTER date of separation). From to with Address From to with Address From to with Address From to with Address From to with Address Said affiant further states all of the above facts are true under penalty of law. AFFIANT Sworn to before me and subscribed in my presence, thisday of , 20.Office and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Notary PublicMobile Tel. No.:American LegalNet, Inc. www.USCourtForms.com