IN THE COURT OF COMMON PLEAS AFFIDAVIT APPLICATION FOR REGISTRATION OF AN OUT-OF-STATE [ ] CUSTODY [ ] VISITATION CASE NO. _______________________ DIVISION OF DOMESTIC RELATIONS/ JUVENILE In re:________________________________________________________________________________ ____________________________________________________________________________________ Name of child(ren) subject of the attached order Date(s) of birth (1) I, (full legal name)____________________________, residing at ______________________________ ______________________________________________, being sworn according to law am petitioning (list current address) this Court to register the attached out-of-state [ ]custody [ ]visitation order that has been issued by ____________________________________________________________________________________ (Indicate the court, state or other jurisdiction and date) [ ] I am requesting the court to not disclose my address or that of the child(ren). My address is confidential pursuant to ORC 3127.23(D) and should be placed under seal in that the health, safety, or liberty of myself and/or the child(ren) would be jeopardized by the disclosure of identifying information. (2) The name(s) and address(es) of any person(s), other than myself, who have been awarded custody or visitation (parenting time) in the attached custody and/or visitation order are as follows (specify): ____________________________________________________________________________________ (Name) (Relationship to Child(ren) (Address) _________________________________________________________________________________________________________ (Name) (Relationship to Child(ren) (Address) _________________________________________________________________________________________________________ (Name) (Relationship to Child(ren) (Address) (3) This order has been registered in the following other jurisdiction(s) or State(s) (specify): _____________________________________________________________________________________ (Jurisdiction/State) [Registration accepted/denied/pending (list only one)] _______________________________________________________________________ (Jurisdiction/State) [Registration accepted/denied/pending (list only one)] I understand I am swearing or affirming under oath to the best of my knowledge and belief, the attached order which I am seeking to register is in effect and has not been stayed or modified. I understand if I knowingly make a false statement to this regard I can be fined or imprisoned. ___________________ (Date) _______________________________________ (Petitioner) State of Ohio, County of ____________________ss: Sworn to or affirmed and signed before me on this _____________ by _______________________ (Date) (Notary Public) My commission expires: _____________________ American LegalNet, Inc. www.USCourtForms.com NOTICE: Attach two (2) copies of the order sought to be registered with at least one of the orders being certified. INSTRUCTIONS TO THE CLERK Please serve a copy of this APPLICATION FOR REGISTRATION OF AN OUT-OF-STATE ORDER to the individual(s) listed in item number two (2) by certified U.S. mail. NOTICE TO RECIPIENT An application for registration of an out-of-state custody or visitation order has been filed with this court. The registered order is enforceable in the same manner as a custody or visitation order issued by an Ohio court as of the date of registration. If you wish to contest the validity of the registered custody or visitation order, you must request a hearing with this court within thirty (30) days following service of this notice. If you fail to request a hearing to contest the registered custody or visitation order, then the order will be confirmed by this court and you will be precluded from contesting the registration with respect to any matter that could have been asserted. American LegalNet, Inc. www.USCourtForms.com