IN THE WARREN COUNTY, OHIO COMMON PLEAS COURT JUVENILE DIVISION ______________________________ Plaintiff/Petitioner (dob:___________) : CASE NO._________________ : vs. : ______________________________ Defendant/Respondent (dob:___________) : NOTICE OF INTENT TO RELOCATE : ______________________________________________________________________ If you are a residential parent, non-parent legal custodian or participate in a shared parenting plan and intend to move, you MUST serve a copy of this notice upon the Child Support Enforcement Agency and any other person having parental or visitation rights for the child and file this notice of your intent to relocate with the Clerk of the Warren County Juvenile Court, 570 Justice Drive, Lebanon, Ohio 45036 at least 30 days prior to a move within Warren County and 60 days prior to a move out of Warren County. ADDRESS CHANGE My name is:__________________________________________________________________________ New Address:________________________________________________________________________ Telephone Number:___________________________________________________________________ Other Parent/Party’s Name:_______________________ Other Parent/Party’s Name:________________________ Other Parent/Party’s Address:_____________________ Other Parent/Party’s Address:______________________ I intend to move on or about _____________ (Date) Fill out this section to request a hearing only if you do not want the other parent to know where you are moving. You may ask for a hearing only if domestic violence against you or abuse of a child is involved. I request a hearing and an Order that the non-residential parent not be given a copy of the notice of relocation because the other parent has been convicted of or pled guilty to: Check the applicable section: A violation of §2919.25 O.R.C. (domestic violence) involving a victim who at the time of the commission of the offense was a member of this family or household; Any other offense involving a household member which resulted in physical harm to the household member, or; A Juvenile Court has found a child(ren) to be abused child(ren) because of something the other parent did. PROVIDE: Name of Court:________________________________ Date of Conviction:_____________________________ Location of Court: _______________________________ Case Number:__________________________________ __________________________________________ Parent/Legal Custodian Telephone Number:__________________________ WCJC Form 7.0 Eff. 04/04/11 American LegalNet, Inc. www.FormsWorkFlow.com