IN THE COMMON PLEAS COURT OF MONTGOMERY COUNTY, OHIO DIVISION OF DOMESTIC RELATIONS _____________________________ Plaintiff/Petitioner (1) DOB ________ Address ______________________ ______________________ v. _____________________________ Defendant/Petitioner(2)/Respondent DOB ________ Address ______________________ ______________________ : : : ENTRY AND ORDER OF CUSTODY UPON DEATH OF A PARTY : : : Case No. SETS No. JUDGE ________________ ________________ CROSS/WOOD MAGISTRATE ______________ The court finds that the parties were divorced on date of decree and the plaintiff/defendant was awarded custody of the parties' minor children, names DOB's. The court further finds that plaintiff/defendant was ordered to pay $_________ per month per child as and for child support to plaintiff/defendant. Plaintiff/defendant has submitted a certified copy of a death certificate, attached hereto, which states that name; plaintiff/defendant herein died on date of death. The plaintiff/defendant is the legal surviving parent of the parties' minor children. Plaintiff/defendant represents to the court that there is no other custody proceeding pending in any court. IT IS THEREFORE ORDERED that: Plaintiff/defendant, the surviving legal parent of name children designated legal custodian and residential parent of said children. DOB's is Plaintiff/defendant's child support obligation for name children in the amount of $ per month per child is hereby terminated effective date of death. An order to terminate the withholding notice of _________________ shall issue name at address forthwith. to plaintiff/defendant's employer American LegalNet, Inc. www.FormsWorkFlow.com In the event it is determined that no child support arrearage is due and owing to the deceased or to the state, any funds being held by the OCSPC shall be returned to the plaintiff/defendant. Costs of the within Entry and Order shall be paid by plaintiff/defendant. Approved: ________________________ JUDGE Submitted by: _______________________ Plaintiff/Defendant or Attorney Name: Address: Telephone: American LegalNet, Inc. www.FormsWorkFlow.com