1 Form 7.01B Rev. 4/2018 IN THE COURT OF COMMON PLEAS DOMESTIC RELATIONS DIVISION MEDINA COUNTY, OHIO Judge Mary R. Kovack DISSOLUTION CHECKLIST (with children) PETITIONER - 1: C OUNSEL : PETITIONER - 2: C OUNSEL : C ASE N UMBER : M ARRIAGE D ATE : C HILD ( REN S NAME ( S ), A GE ( S ) & D ATE ( S ) OF B IRTH : Pursuant to Loc. R. 7.01 (check off if needed and included) CASE DESIGNATION FORM PETITION FOR DISSOLUTION Jurisdiction and venue requirements met Signed by attorneys/parties If applicable, the a WAIVER OF SERVICE executed by both parties IV-D APPLICATION signed by the Obligee (mandatory for all cases with minor children) UCCJEA/CHILD CUSTODY AFFIDAVIT CERITIFICATES OF ATTENDANCE FOR PARENTING SEMINAR H W SEPARATION AGREEMENT, original, executed by the parties (Italicized portion may appear in shared parenting plan) Disclosure statement Personal property division addressed (including vehicles) Real property division addressed Financial division of property addressed (accounts, investments, life insurance, etc.) Pension division addressed Liabilities and debt division addressed Taxes Spousal support addressed - including jurisdiction Spousal support must have an effective date and must address duration Mandatory CSEA language, if spousal support will go through CSEA Mandatory health insurance provisions re: child(ren) covered (including cash medical) Mandatory child support provisions included Child support must have an effective date and termination language If deviation from guidelines, you must include an explanation American LegalNet, Inc. www.FormsWorkFlow.com 2 Form 7.01B Rev. 4/2018 Must address arrearages, if applicable Must address tax dependency/exemptions Must incorporate a parenting plan designating a legal custodian/residential parent, unless shared parenting plan is incorporated and sets forth companionship schedule. Must address intent to relocate, access to school and medical records CHILD SUPPORT WORKSHEET SHARED PARENTING PLAN, original, executed by the parties, if applicable. mpanionship time and school district Italicized provisions listed above appear in the plan JUDGMENT ENTRY DECREE OF DISSOLUTION Includes names and dates of birth of the minor children Jurisdiction and venue requirements met Contains date of hearing Signed by attorneys/parties Contains mandatory child support language Support Order Tax dependency/exemption Contains mandatory health insurance language Cash medical support Statement that wife (1) wishes to be restored to former name or (2) does not wish to be restored to a former name Payment of court costs and attorney fees (please acknowledge that court costs must be paid from any deposits first; then, indicate any additional formula for sharing them between the parties, as appropriate) American LegalNet, Inc. www.FormsWorkFlow.com