Rule 86 Effective Date
Title X: General Provisions
Rule Text
(A) Original rules The Ohio Rules of Civil Procedure originally took effect July 1, 1970, pursuant to Article IV, Section 5 of the Ohio Constitution. Some rules have been amended in succeeding years, again pursuant to the Constitution.
(B) Effective date of amendments Amendments to these rules filed hereafter by the Supreme Court with the General Assembly pursuant to Article IV, Section 5 of the Ohio Constitution, and not thereafter the subject of a concurrent resolution of disapproval, shall take effect on the following first day of July. They shall govern all proceedings in actions brought after they take effect and also all further proceedings in actions then pending, except to the extent that their application in a particular action pending when the amendments take effect would not be feasible or would work injustice, in which event the former procedure applies.
FORMS 1 THROUGH 20: GENERAL CIVIL FORMS (See Rule 84)
INTRODUCTORY STATEMENT The forms which follow are intended for illustration only. They are limited in number inasmuch as no attempt is made to furnish a manual of forms.
The forms are expressly declared by Rule 84 to be sufficient under the rules.
Departures from the forms shall not void papers which are otherwise sufficient, and the forms may be varied when necessary to meet the facts of a particular case.
Where appropriate, the forms assume that the action has been brought in the Court of Common Pleas, Franklin County, Ohio. FORM 1. CAPTION AND SUMMONS COURT OF COMMON PLEAS _____________ COUNTY, OHIO __________________ ) Case No. _________________ [Street Address] ) Judge ____________________ [City, State Zip] ) Plaintiff ) v. ) SUMMONS __________________ ) [Street Address] ) [City, State Zip] ) Defendant )
To the following named defendant(s):
Name: Address: ________________________________ ________________________________ ________________________________ You have been named as a defendant in this Court. The Plaintiff(s) has filed a lawsuit against you. A copy of the Complaint is attached. The Plaintiff’s attorney and that attorney’s address are: ____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ You must deliver to the Plaintiff’s attorney (or the Plaintiff if not represented by an attorney) a written Answer to the Complaint within 28 days; Civil Rule 5 explains the ways that you may deliver the Answer (http://www.supremecourt.ohio.gov/LegalResources/Rules/civil/Civil Procedure.pdf ). You must then file a copy of the Answer with this Court within three days after you serve it on the Plaintiff(s). If you fail to serve and file an Answer, the Court may enter judgment against you for the relief requested in the Complaint.
You may wish to hire an attorney to represent you. Because this is a civil suit, the Court cannot appoint an attorney for you. If you need help to find a lawyer, contact a local bar association and request assistance.
Date: _______________________________ Clerk: _________________________ Note The caption above designates the particular paper as a "SUMMONS." The particular pleading or paper should contain an appropriate designation, thus: "COMPLAINT," "ANSWER," etc. A more specific designation in a caption is also appropriate, thus: "MOTION TO INTERVENE AS A DEFENDANT."
******************************** ***Multilingual notice:
You have been named as a defendant in this Court. You must file an answer within 28 days; if you fail to answer, the Court may enter judgment against you for the relief stated in the Complaint. Seek assistance from both an interpreter and an attorney. Your inability to understand, write, or speak English will not be a defense to possible judgment against you.
1. Spanish (US)
***Aviso multilingüe:
Este Tribunal lo ha declarado como acusado. Debe presentar una respuesta en un plazo de 28 días. Si no contesta en dicho plazo, el Tribunal podrá dictar sentencia en su contra por el amparo que se detalla en la demanda. Solicite la ayuda de un intérprete y de un abogado. Su incapacidad para comprender, escribir o hablar inglés no se considerará como defensa ante una posible sentencia en su contra.
2. Somali ***Ogeysiis luqadda badan ah:
Waxaa laguu magacaabay sida eedeysane gudaha Maxkamadan. Waa in aad ku soo gudbisaa jawaab 28 maalmood gudahood; haddii aad ku guuldareysto jawaabta, Maxkamada laga yaabo in ay gasho xukun adiga kaa soo horjeedo ee ka nasashada lagu sheegay Cabashada. Raadi caawinta ka timid labadaba turjubaanka iyo qareenka. Karti la’aantaada aad ku fahmo, ku qoro, ama ku hadasho Af Ingiriisiga ma noqon doonto difaacida xukunkaaga suuralka ah ee adiga kugu lidka ah. 3. Russian ***Уведомление на разных языках:
Вы были названы в качестве ответчика в данном суде. Вы должны предoставить ответ в течение 28 дней; если Ваш ответ не будет получен, суд может вынести решение против Вас и удовлетворить содержащиеся в жалобе требования. Воспользуйтесь услугами переводчика и адвоката. Тот факт, что Вы не понимаете английскую речь и не можете читать и писать по-английски, не является препятствием для возможного вынесения судебного решения против Вас.
4. Arabic :***ﻣﻼﺣﻈﺔ ﻣﺘﻌﺪدة اﻟﻠﻐﺎت ﻓﻘﺪ ﺗﺼﺪر اﻟﻤﺤﻜﻤﺔ ﺣﻜ ًﻤﺎ ﺿﺪك ﺑﺎﻟﺘﻌﻮﯾﺾ، ﯾﻮ ًﻣﺎ؛ وإذا ﻟﻢ ﺗﻘﻢ ﺑﺎﻟﺮد28 ﯾﺠﺐ أن ﺗﻘﺪم ردًا ﺧﻼل.ﻟﻘﺪ ﺗﻢ اﻋﺘﺒﺎرك ﻣﺪﻋﻰ ﻋﻠﯿﮫ ﻓﻲ ھﺬه اﻟﻤﺤﻜﻤﺔ ﻓﻠﻦ ﺗُﻌﺪ ﻋﺪم ﻗﺪرﺗﻚ ﻋﻠﻰ ﻓﮭﻢ اﻟﻠﻐﺔ اﻹﻧﺠﻠﯿﺰﯾﺔ أو ﻛﺘﺎﺑﺘﮭﺎ أو ﺗﺤﺪﺛﮭﺎ.وﻣﺤﺎم ٍ اطﻠﺐ اﻟﻤﺴﺎﻋﺪة ﻣﻦ ﻣﺘﺮﺟﻢ ﻓﻮري.اﻟﻤﻨﺼﻮص ﻋﻠﯿﮫ ﻓﻲ ھﺬه اﻟﺸﻜﻮى اﻟﻘﻀﺎﺋﯿﺔ .دﻓﺎﻋًﺎ ﻟﻚ أﻣﺎم اﻟﺤﻜﻢ اﻟﻤﺤﺘﻤﻞ ﺿﺪك 5. Chinese (Simplified)
***多語版本通知： 您在本法庭已被列为被告。您必须于 28 日内递交答辩状；如果没有递交答辩状，法庭会针对诉状中声明的补救措施对您作出不利判决。请向口译人员和律 师寻求帮助。您无法理解、书写或说英语的情况不能作为对您可能作出不利判决的辩护理由。 INSTRUCTIONS FOR PERSONAL OR RESIDENCE SERVICE To:___________________________________________________________________________ You are instructed to make personal--residence [cross out one] service upon defendant(s) ______________________________________________________________________________ (name) at ____________________________________________________________________________ (address for service if different from body of summons). ______________________________________________________________________________ Special instructions for server:_____________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ******************************** RETURN OF SERVICE OF SUMMONS (PERSONAL)
Fees I received this summons on ___________, 20____, at Service$__________ _________ o'clock, __.m., and made personal service of it upon Mileage $__________ ___________________________________by locating him -- Copy $__________ them (cross out one) and tendering a copy of the summons and Docket $__________ accompanying documents, on _____________, 20 ___. Return $__________ Total $__________ __________________________________________________ Sheriff -- Bailiff -- Process Server By _______________________________________________ Deputy ******************************** RETURN OF SERVICE OF SUMMONS (RESIDENCE)
Fees I received this summons on ___________, 20____, at Service$__________ _________ o'clock, __.m., and made residence service of it upon Mileage $__________ ___________________________________by leaving it at his - Copy $__________ - their (cross out one) usual place of residence with Docket $__________ _______________, a person of suitable age and discretion then Return $__________ residing therein, a copy of the summons, a copy of the complaint Total $__________ and accompanying documents, on _____________, 20 ___.
__________________________________________________ Sheriff -- Bailiff -- Process Server By _______________________________________________ Deputy ******************************** FORM 2. COMPLAINT ON A PROMISSORY NOTE COURT OF COMMON PLEAS FRANKLIN COUNTY, OHIO A.B., Plaintiff ) (address) )
v. ) No.______________ C.D., Defendant ) (address) ) COMPLAINT 1. Defendant on or about _________________, 20____, executed and delivered to plaintiff a promissory note, a copy of which is hereto attached as Exhibit A.
2. Defendant owes to plaintiff the amount of said note and interest.
Wherefore plaintiff demands judgment against defendant for the sum of ________dollars, interest, and costs.
___________________________________ (Attorney for Plaintiff) ___________________________________ (Address) ___________________________________ Note 1. The pleader should follow the form above if he has possession of a copy of the note. The pleader should attach a copy of the note to the pleading. See Rule 10(D).
2. Under the rules free joinder of claims is permitted. See Rule 8(E) and Rule 18. Consequently the claims set forth in each and all of the following forms may be joined with this complaint or with each other. Ordinarily each claim should be stated in a separate division of the complaint, and the divisions should be designated as counts successively numbered (i.e., COUNT ONE, COUNT TWO, etc.). See Rule 10(B). In particular the rules permit alternative and inconsistent pleading. See Rule 8(E)(2).
3. The attorney must sign the pleading. See Rule 11. The pleading need not be verified. See Rule 11.
[Effective: July 1, 1970.] FORM 2A. COMPLAINT ON A PROMISSORY NOTE (REASON FOR OMISSION OF COPY STATED)
1. Defendant on or about_______________, 20____, executed and delivered to plaintiff a promissory note [in the following words and figures: (here set out the note verbatim)]
or [whereby defendant promised to pay plaintiff or order on________________, 20 _____, the sum of __________ dollars with interest thereon at the rate of _____ percent per annum].
2. Plaintiff is unable to attach a copy of the said note because (here set out the reason for failure to attach the note).
3. Defendant owes to plaintiff the amount of said note and interest.
Wherefore (etc. as in Form 2).
Note 1. The pleader states why, under Rule 10(D), he is unable to attach a copy of the note.
2. If pleader can set forth the note verbatim from information at hand, he may do so.
3. Or pleader may plead the legal effect of the note, he being unable to attach a copy of the note.
4. This type form may be used in other situations whenever pleader is required to attach a copy of an instrument, but a copy of the instrument is not available to him.
[Effective: July 1, 1970.] FORM 3. COMPLAINT ON AN ACCOUNT Defendant owes plaintiff _____________ dollars according to the account hereto annexed as Exhibit A.
Wherefore (etc. as in Form 2).
[Effective: July 1, 1970.] FORM 4. COMPLAINT FOR GOODS SOLD AND DELIVERED Defendant owes plaintiff __________ dollars for goods sold and delivered by plaintiff to defendant between______________, 20_______, and______________, 20_____.
Wherefore (etc. as in Form 2).
Note This form may be used where the action is for an agreed price or for the reasonable value of the goods.
[Effective: July 1, 1970.] FORM 5. COMPLAINT FOR MONEY LENT Defendant owes plaintiff _____________ dollars for money lent by plaintiff to defendant on______________, 20____.
Wherefore (etc. as in Form 2).
[Effective: July 1, 1970.] FORM 6. COMPLAINT FOR MONEY PAID BY MISTAKE Defendant owes plaintiff ____________ dollars for money paid by plaintiff to defendant by mistake on_____________, 20____, under the following circumstances: [here state the circumstances with particularity--see Rule 9(B) ].
Wherefore (etc. as in Form 2).
[Effective: July 1, 1970.] FORM 7. COMPLAINT FOR MONEY HAD AND RECEIVED Defendant owes plaintiff ____________ dollars for money had and received from one G.H. on____________, 20_____, to be paid by defendant to plaintiff.
Wherefore (etc. as in Form 2).
[Effective: July 1, 1970.] FORM 8. COMPLAINT FOR NEGLIGENCE 1. On_____________, 20_____, in a public highway called ___________Street in___________, Ohio, defendant negligently drove a motor vehicle against plaintiff who was then crossing said highway.
2. As a result plaintiff was thrown down and had his leg broken and was otherwise injured, was prevented from transacting his business, suffered great pain of body and mind, and incurred expenses for medical attention and hospitalization in the sum of one thousand dollars.
Wherefore plaintiff demands judgment against defendant in the sum of __________ dollars and costs.
Note Since contributory negligence is an affirmative defense, the complaint need contain no allegation of due care of plaintiff.
[Effective: July 1, 1970.] FORM 9. COMPLAINT FOR NEGLIGENCE WHERE PLAINTIFF IS UNABLE TO DETERMINE DEFINITELY WHETHER THE PERSON RESPONSIBLE IS C.D. OR E.F. OR WHETHER BOTH ARE RESPONSIBLE AND WHERE HIS EVIDENCE MAY JUSTIFY A FINDING OF WILFULNESS OR OF RECKLESSNESS OR OF NEGLIGENCE A.B., Plaintiff ) (address) ) No. __________ v. )
C.D. and E.F., Defendants ) COMPLAINT (addresses) )
1. On , 19 , in a public highway called Street in , Ohio, defendant C.D. or defendant E.F., or both defendants C.D. and E.F. wilfully or recklessly or negligently drove or caused to be driven a motor vehicle against plaintiff who was then crossing said highway.
2. As a result plaintiff was thrown down and had his leg broken and was otherwise injured, was prevented from transacting his business, suffered great pain of body and mind, and incurred expenses for medical attention and hospitalization in the sum of one thousand dollars.
Wherefore plaintiff demands judgment against C.D. or against E.F. or against both in the sum of ______ dollars and costs.
[Effective: July 1, 1970.] FORM 10. COMPLAINT FOR CONVERSION On or about , 19 , defendant converted to his own use ten bonds of the Company (here insert brief identification as by number and issue) of the value of dollars, the property of plaintiff.
Wherefore plaintiff demands judgment against defendant in the sum of dollars, interest, and costs.
[Effective: July 1, 1970.] FORM 11. COMPLAINT FOR SPECIFIC PERFORMANCE OF CONTRACT TO CONVEY LAND 1. On our about , 19 , plaintiff and defendant entered into an agreement in writing a copy of which is hereto annexed as Exhibit A.
2. In accord with the provisions of said agreement plaintiff tendered to defendant the purchase price and requested a conveyance of the land, but defendant refused to accept the tender and refused to make the conveyance.
3. Plaintiff now offers to pay the purchase price.
Wherefore plaintiff demands (1) that defendant be required specifically to perform said agreement, (2) damages in the sum of one thousand dollars, and (3) that if specific performance is not granted plaintiff have judgment against defendant in the sum of dollars.
Note The demand for relief seeks specific performance as well as ancillary damages resulting from the delay. In addition the demand for relief seeks damages in a certain sum if the court finds it impossible to grant specific performance as where, in the interim, defendant has conveyed the property to a purchaser for value without notice.
[Effective: July 1, 1970.] FORM 12. COMPLAINT ON CLAIM FOR DEBT AND TO SET ASIDE FRAUDULENT CONVEYANCE UNDER RULE 18(B)
A.B., Plaintiff ) (address) ) No. _________ v. )
C.D. and E.F., Defendants ) COMPLAINT (addresses) )
1. Defendant C.D. on or about executed and delivered to plaintiff a promissory note, a copy of which is hereto annexed as Exhibit A.
2. Defendant C.D. owes to plaintiff the amount of said note and interest.
3. Defendant C.D. on or about conveyed all his property, real and personal [or specify and describe] to defendant E.F. for the purpose of defrauding plaintiff and hindering and delaying the collection of the indebtedness evidenced by the note above referred to.
Wherefore plaintiff demands:
(1) That plaintiff have judgment against defendant C.D. for dollars and interest; (2) that the aforesaid conveyance to defendant E.F. be declared void and the judgment herein be declared a lien on said property; (3) that plaintiff have judgment against the defendants for costs.
[Effective: July 1, 1970.] FORM 13. COMPLAINT FOR INTERPLEADER AND DECLARATORY RELIEF 1. On or about , 19 , plaintiff issued to G.H. a policy of life insurance, a copy of which is attached as Exhibit A, whereby plaintiff promised to pay to K.L. as beneficiary the sum of dollars upon the death of G.H. The policy required the payment by G.H. of a stipulated premium on , 19 , and annually thereafter as a condition precedent to its continuance in force.
2. No part of the premium due , 19 , was ever paid and the policy ceased to have any force or effect on , 19 .
3. Thereafter, on , 19 , G.H. and K.L. died as the result of a collision between a locomotive and the automobile in which G.H. and K.L. were riding.
4. Defendant C.D. is the duly appointed and acting executor of the will of G.H.; defendant E.F. is the duly appointed and acting executor of the will of K.L.; defendant X.Y. claims to have been duly designated as beneficiary of said policy in place of K.L.
5. Each of defendants, C.D., E.F., and X.Y. is claiming that the abovementioned policy was in full force and effect at the time of the death of G.H.; each of them is claiming to be the only person entitled to receive payment of the amount of the policy and has made demand for payment thereof.
6. By reason of these conflicting claims of the defendants, plaintiff is in great doubt as to which defendant is entitled to be paid the amount of the policy, if it was in force at the death of G.H.
Wherefore plaintiff demands that the court adjudge:
(1) That none of the defendants is entitled to recover from plaintiff the amount of said policy or any part thereof.
(2) That each of the defendants be restrained from instituting any action against plaintiff for the recovery of the amount of said policy or any part thereof.
(3) That, if the court shall determine that said policy was in force at the death of G.H., the defendants be required to interplead and settle between themselves their rights to the money due under said policy, and that plaintiff be discharged from all liability in the premises except to the person whom the court shall adjudge entitled to the amount of said policy.
(4) That plaintiff recover its costs.
[Effective: July 1, 1970.] FORM 14. MOTION TO DISMISS, PRESENTING DEFENSES OF FAILURE TO STATE A CLAIM, OF LACK OF SERVICE OF PROCESS, AND OF LACK OF JURISDICTION UNDER RULE 12(B)
COURT OF COMMON PLEAS FRANKLIN COUNTY, OHIO A.B., Plaintiff ) (address) ) No. _________ v. )
C.D. Corporation, Defendant ) MOTION TO DISMISS (address) )
The defendant moves the court as follows:
1. To dismiss the action because the complaint fails to state a claim against defendant upon which relief can be granted.
2. To dismiss the action or in lieu thereof to quash the return of service of summons on the grounds (a) that the defendant is a corporation organized under the laws of Delaware and was not and is not subject to service of process within this state, and (b) that the defendant has not been properly served with process in this action, all of which more clearly appears in the affidavits of M.N. and X.Y. hereto attached as Exhibit A and Exhibit B, respectively.
3. To dismiss the action on the ground that the court lacks jurisdiction because [here state the reasons why the court lacks jurisdiction].
___________________________________ (Attorney for Defendant) ___________________________________ (Address) ___________________________________ SERVICE OF COPY A copy hereof was served upon X.Y., attorney for plaintiff, by mailing it to him on June 1, 19 [or set forth other method of service upon X.Y.].
___________________________________ (Attorney for Defendant)
Note 1. The form gives various examples of defenses which may be raised by motion under Rule 12(B).
2. Whether the motion should be accompanied by a notice of hearing on the motion or whether the motion should be accompanied by a memorandum brief depends upon the rules of a particular local court. See Rule 7(B) and the rules of the local court regarding motion practice.
3. All papers after the original pleading required to be served upon an opposite party shall have endorsed thereon, when filed with the court, a statement setting forth the date and method of service. See Rule 5.
[Effective: July 1, 1970; amended effective July 1, 1971.] FORM 15. ANSWER PRESENTING DEFENSES UNDER RULE 12(B)
A.B., Plaintiff ) (address) ) No. __________ v. )
C.D. and E.F., Defendants ) ANSWER, COUNTERCLAIM, (addresses) ) AND CROSS-CLAIM FIRST DEFENSE The complaint fails to state a claim against defendant C.D. upon which relief can be granted.
SECOND DEFENSE If defendant C.D. is indebted to plaintiff for the goods mentioned in the complaint, he is indebted to him jointly with G.H. G.H. is alive, is a resident of this state, is subject to the jurisdiction of this court and can be made a party but has not been made one.
THIRD DEFENSE Defendant C.D. admits the allegation contained in paragraphs 1 and 4 of the complaint; alleges that he is without knowledge or information sufficient to form a belief as to the truth of the allegations contained in paragraph 2 of the complaint; and denies each and every other allegation contained in the complaint.
FOURTH DEFENSE The right of action set forth in the complaint did not accrue within years next before the commencement of this action.
COUNTERCLAIM [Here set forth any claim as a counterclaim in the manner in which a claim is pleaded in a complaint.] CROSS-CLAIM AGAINST DEFENDANT M.N.
[Here set forth the claim constituting a cross-claim against defendant M.N. in the manner in which a claim is pleaded in a complaint.]
___________________________________ (Attorney for Defendant, C.D.)
___________________________________ (Address) ___________________________________ (Service of Copy as in Form 14)
Note 1. The above form contains examples of certain defenses provided for in Rule 12(B). The first defense challenges the legal sufficiency of the complaint. It is a substitute for a motion to dismiss; that is, under former practice the issue raised by the first defense would have been raised by demurrer, and under present practice the same issue might have been raised by motion at the option of the defendant. See Rule 12(B).
2. The second defense embodies the old plea in abatement. The decision thereon, however, may, for example, well provide under Rule 19(A) or Rule 21 for the citing in of the party rather than an abatement of the action.
3. The third defense is an answer on the merits.
4. The fourth defense is one of the affirmative defenses provided for in Rule 8(C).
5. The answer also includes a counterclaim and a cross-claim. See Rule 12(B).
[Effective: July 1, 1970.] FORM 16. SUMMONS AGAINST THIRD-PARTY DEFENDANT COURT OF COMMON PLEAS FRANKLIN COUNTY, OHIO A.B., Plaintiff ) (address) ) v. ) C.D., Defendant and Third-Party ) No. ___________ Plaintiff ) (address) ) SUMMONS v. ) E.F., Third-Party Defendant ) (address) )
To the above-named Third-Party Defendant:
You are hereby summoned and required to serve upon , plaintiff's attorney whose address is and upon , who is attorney for C.D., defendant and third-party plaintiff, and whose address is , an answer to the third-party complaint which is herewith served upon you within twenty-eight days after the service of this summons upon you exclusive of the day of service. If you fail to do so, judgment by default will be taken against you for the relief demanded in the third-party complaint. There is also served upon you herewith a copy of the complaint of the plaintiff which you may but are not required to answer. Your answer to the third-party complaint and your answer to the plaintiff's complaint must also be filed with the court.
___________________________________ (Clerk of Court) By ______________________ Deputy Clerk Dated _______________________________ Note It may be necessary, depending upon when the third-party complaint is served, to seek leave of court by motion to bring in a third-party defendant. See Rule 14(A).
[Effective: July 1, 1970.] FORM 16A. COMPLAINT AGAINST THIRD-PARTY DEFENDANT COURT OF COMMON PLEAS FRANKLIN COUNTY, OHIO A.B., Plaintiff ) (address) ) v. ) C.D., Defendant and Third-Party ) No. ___________ Plaintiff ) (address) ) THIRD-PARTY COMPLAINT v. ) E.F., Third-Party Defendant ) (address) )
1. Plaintiff A.B. has filed against defendant C.D. a complaint, a copy of which is hereto attached as Exhibit A.
2. [Here state the grounds upon which C.D. is entitled to recover from E.F., all or part of what A.B. may recover from C.D. The statement should be framed as in an original complaint.]
Wherefore C.D. demands judgment against third-party defendant E.F. for all sums [make appropriate change where C.D. is entitled to only partial recovery over against E.F.] that may be adjudged against defendant C.D. in favor of plaintiff A.B.
___________________________________ (Attorney for C.D., Third-Party Plaintiff) ___________________________________ (Address) ___________________________________ Note It is necessary to comply with Rule 5 regarding service of third-party papers on plaintiff.
[Effective: July 1, 1970.] FORM 17. MOTION TO INTERVENE AS A DEFENDANT UNDER RULE 24 COURT OF COMMON PLEAS FRANKLIN COUNTY, OHIO A.B., Plaintiff ) (address) ) No. v. ) C.D., Defendant ) MOTION TO INTERVENE (address) ) AS A DEFENDANT E.F., Applicant for Intervention ) (address) )
E.F. moves for leave to intervene as a defendant in this action in order to assert the defenses set forth in his proposed answer, of which a copy is hereto attached, on the ground that [here insert the appropriate grounds of intervention].
(Attorney for E.F., Applicant for Intervention)
(Address)
(Adopted eff. 7-1-70)
Note (Amended Effective July 1, 1999)
It is necessary that a motion to intervene be accompanied by a pleading as required in Civ.R. 24(C). It is also necessary to comply with Civ.R. 5 regarding service of the motion on the parties to the action. FORM 18. JUDGMENT ON JURY VERDICT COURT OF COMMON PLEAS FRANKLIN COUNTY OHIO A.B., Plaintiff ) (address) ) No. ____________ v. ) C.D., Defendant ) JUDGMENT (address) )
This action came on for trial before the Court and a jury, and the issues having been duly tried and the jury having duly rendered its verdict, It is ordered and adjudged [that the plaintiff A.B. recover of the defendant C.D. the sum of , with interest thereon at the rate of percent as provided by law, and his costs of action.]
[that the plaintiff take nothing, that the action be dismissed on the merits, and that the defendant C.D. recover of the plaintiff A.B. his costs of action.]
Dated at , Ohio, this day of , 19 ___________________________________ Judge, Court of Common Pleas Journalized this day of , 19 ______________________________ Clerk of Court By Deputy Clerk Note This form is illustrative of the judgment to be entered upon the general verdict of a jury. It deals with the cases where there is a general jury verdict awarding the plaintiff money damages or finding for the defendant, but is adaptable to other situations of jury verdict.
[Effective: July 1, 1970.] FORM 19. JUDGMENT ON DECISION BY THE COURT COURT OF COMMON PLEAS FRANKLIN COUNTY, OHIO A.B., Plaintiff ) (address) ) No. ___________ v. ) C.D., Defendant ) JUDGMENT (address) )
This action came on for [trial] [hearing] before the Court, and the issues having been duly [tried] [heard] and a decision having been duly rendered, It is ordered and adjudged [that the plaintiff A.B. recover of the defendant C.D. the sum of , with interest thereon at the rate of percent as provided by law, and his costs of action.]
[that the plaintiff take nothing, that the action be dismissed on the merits, and that the defendant C.D. recover of the plaintiff A.B. his costs of action.]
Dated at , Ohio, this day of , 19 ___________________________________ Judge, Court of Common Pleas Journalized this day of , 19 _______________________________ Clerk of Court By ____________________________ Deputy Clerk Note This form is illustrative of the judgment to be entered upon a decision of the court. It deals with the cases of decisions by the court awarding a party only money damages or costs, but is adaptable to other decisions by the court.
[Effective: July 1, 1970.] FORM 20. CIVIL FEE WAIVER AFFIDAVIT AND ORDER IN ____________________________________________ _______________________________________________ ) CASE NO. ) Plaintiff, ) JUDGE ) vs. ) ) FINANCIAL DISCLOSURE / FEE- ) WAIVER AFFIDAVIT Defendant. ) AND ORDER Pursuant to R.C. 2323.311, the below-named Applicant requests that the Court determine that the Applicant is an indigent litigant and be granted a waiver of the prepayment of costs or fees in the above captioned matter. The Applicant submits the following information in support of said request. Personal Information Applicant’s First Name Applicant’s Last Name Applicant’s Date of Birth Last 4 Digits of Applicant’s SSN Applicant’s Address Other Persons Living in Your Household First Name Last Name Is this person a child Relationship (Spouse or Child) under 18? ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No Public Benefits I receive the following public benefits and my gross income, including the cash benefits marked below, does not exceed 187.5% of the federal poverty guidelines. Place an “X” next to any benefits you receive. Ohio Works First 1: ___ SSI 2: ___ Medicaid 3: ___ Veterans Pension Benefit 4: ___ SNAP / Food Stamps 5: ___ Monthly Income I am NOT able to access my spouse’s income ☐ Spouse (If Living Applicant Total Monthly Income in Household) Gross Monthly Employment Income, including Self-Employment Income (Before Taxes) $ $ $ Unemployment, Worker’s Compensation, Spousal Support (If Receiving) $ $ $ TOTAL MONTHLY INCOME $ $ Liquid Assets Type of Asset Estimated Value Cash on Hand $ Available Cash in Checking, Savings, Money Market Accounts $ Stocks, Bonds, CDs $ Other Liquid Assets $ Total Liquid Assets $ Monthly Expenses Column A Column B Type of Expense Amount Type of Expense Amount Rent / Mortgage / Property Tax / Insurance (Medical, Dental, Insurance $ Auto, etc.) $ Food / Paper Products/Cleaning Child or Spousal Support that Products/Toiletries $ You Pay $ Medical / Dental Expenses or Utilities (Heat, Gas, Electric, Associated Costs of Caring for a Water / Sewer, Trash) $ Sick or Disabled Family Member $ Transportation / Gas $ Credit Card, Other Loans $ Phone $ Taxes Withheld or Owed $ Child Care $ Other (e.g. garnishments) $ Total Column A Expenses $ Total Column B Expenses $ TOTAL MONTHLY EXPENSES (Column A + Column B)
I, ______________________________________, hereby certify that the information I have provided on (Print Name) this financial disclosure form is true to the best of my knowledge and that I am unable to prepay the costs or fees in this case. ____________________________________ Signature NOTARY PUBLIC: Sworn to before me and signed in my presence this ______ day of _______________________, 20_____, in ___________________ County, Ohio.
____________________________________ Notary Public (Signature)
____________________________________ Notary Public (Printed) My Commission expires:________________ If available, an individual duly authorized to administer this oath at the Clerk of Court’s Office will do so at no cost to the Applicant. ____________________________________________________________________________________________ ORDER ☐ Upon the request of the Applicant and the Court’s review, the Court finds that the Applicant IS an indigent litigant and GRANTS a waiver of the prepayment of costs or fees in this matter. Pursuant to R.C. 2323.311(B)(3), upon the filing of a civil action or proceeding and the affidavit of indigency under division (B)(1) of this section, the clerk of the court shall accept the action, motion, or proceeding for filing. ☐ Upon the request of the Applicant and the Court’s review, the Court finds that the Applicant is NOT an indigent litigant and DENIES a waiver of the prepayment of costs or fees in this matter. Applicant is granted thirty (30) days from the issuance of this Order to make the required advance deposit or security. Failure to do so within the time allotted may result in dismissal of the applicant’s filing.
IT IS SO ORDERED ________________________________________________ ________________________ Judge / Magistrate Date [Effective: April 15, 2020; amended effective April 15, 2022; July 1, 2023.] APPENDIX R.C. 2323.311(B)
(4) A judge or magistrate of the court shall review the affidavit of indigency as filed pursuant to division (B)(2) of this section and shall approve or deny the applicant's application to qualify as an indigent litigant. The judge or magistrate shall approve the application if the applicant's gross income does not exceed one hundred eighty-seven and five-tenths per cent of the federal poverty guidelines as determined by the United States department of health and human services for the state of Ohio and the applicant's monthly expenses are equal to or in excess of the applicant's liquid assets as specified in division (C)(2) of section 120-1-03 of the Administrative Code, as amended, or a substantially similar provision. If the application is approved, the clerk shall waive the advance deposit or security and the court shall proceed with the civil action or proceeding. If the application is denied, the clerk shall retain the filing of the action or proceeding, and the court shall issue an order granting the applicant whose application is denied thirty days to make the required advance deposit or security, prior to any dismissal or other action on the filing of the civil action or proceeding.
(6) Nothing in this section shall prevent a court from approving or affirming an application to qualify as an indigent litigant for an applicant whose gross income exceeds one hundred eighty-seven and five-tenths per cent of the federal poverty guidelines as determined by the United States department of health and human services for the state of Ohio, or whose liquid assets equal or exceed the applicant's monthly expenses as specified in division (C)(2) of section 120-1-03 of the Administrative Code, as amended, or a substantially similar provision.
1Ohio Works First Income Limit: 50% FPL (R.C. 5107.10(D)(1)(a)) 2SSI Income Limit: cannot have countable income that exceeds the Federal Benefit Rate (FBR). 2019 FBR: $771 monthly for single disabled individual; $1157 monthly for disabled couple (20 CFR 416.1100) 3Medicaid Income Limit:
Modified Adjusted Gross Income (MAGI):138% FPL (OAC 5160:1-4-01; 42 USC 1396a(a)(10)(A)(i)(VIII)) Aged, Blind or Disabled: $791 for single person; $1177 for disabled couple 4Veterans Pension Benefit Income Limit: $13,535 annually / $1,127 monthly for a single person; $17,724 annually / $1,477 monthly for a veteran with one dependent 5Supplemental Nutrition Assistance Program (SNAP) Income Limit: 130% FPL for assistance groups with nondisabled/nonelderly member; 165% FPL for elderly and disabled assistance groups (OAC 5101:4-4-11; Food Assistance Change Transmittal No. 61) FORMS 1 THROUGH 32: DOMESTIC RELATIONS FORMS IN THE COURT OF COMMON PLEAS ______________________________ DIVISION ______________________________ COUNTY, OHIO Case No. Plaintiff/Petitioner 1 Judge vs./and Magistrate Defendant/Petitioner 2 Instructions: Check local court rules to determine when this form must be filed. This affidavit is used to make complete disclosure of income, expenses, and money owed. It is used to determine child and spousal support. Do not leave any category blank. For each item, if none, put “NONE.” If you do not know exact figures for any item, give your best estimate, and put “EST.” If you need more space, add additional pages.
AFFIDAVIT OF BASIC INFORMATION, INCOME, AND EXPENSES Affidavit of _____________________________________ (Print Name)
Date of marriage Date of separation SECTION I – BASIC INFORMATION Plaintiff/Petitioner 1 Defendant/Petitioner 2 Date of Birth _____________________________ Date of Birth ______________________________ Last 4 Digits of Social Security # XXX-XX-_____ Last 4 Digits of Social Security # XXX-XX-______ Phone Number___________________________ Phone Number___________________________ Email Address___________________________ Email Address____________________________ Is an interpreter needed? Yes or No Is an interpreter needed? Yes or No If yes, explain: ___________________________ If yes, explain: ___________________________ Health: Health: Good Fair Poor Good Fair Poor If health is not good, please explain: If health is not good, please explain:
Supreme Court of Ohio Page 1 of 8 Uniform Domestic Relations Form – Affidavit 1 AFFIDAVIT OF BASIC INFORMATION, INCOME, AND EXPENSES Approved under Ohio Civil Rule 84
Amended: June 1, 2021 Amended: June 1, 2021 Amended: June 1, 2021 Amended: June 1, 2021 Amended: June 1, 2021 Amended: June 1, 2021 Amended: June 1, 2021 Amended: June 1, 2021 1.__________________________ $ _______________ $ $ 2.__________________________ $ _______________ $ $ 1. ____________________________ _____________________________ ________________ $ 2. ____________________________ _____________________________ ________________ $ Amended: June 1, 2021 3. ____________________________ _____________________________ ________________ $ _______________ 4. ____________________________ _____________________________ ________________ $ _______________ 5. ____________________________ _____________________________ ________________ $ _______________ 6. ____________________________ _____________________________ ________________ $ _______________ 1. ____________________________ _____________________________ ________________ $ _______________ 2. ____________________________ _____________________________ ________________ $ _______________ 3. ____________________________ _____________________________ ________________ $ _______________ 4. ____________________________ _____________________________ ________________ $ _______________ 1. ____________________________ _____________________________ ________________ $ _______________ 2. ____________________________ _____________________________ ________________ $ _______________ 3. ____________________________ _____________________________ ________________ $ _______________ 4. ____________________________ _____________________________ ________________ $ _______________ 1. ____________________________ _____________________________ ________________ $ _______________ 2. ____________________________ _____________________________ ________________ $ _______________ 3. ____________________________ _____________________________ ________________ $ _______________ 4. ____________________________ _____________________________ ________________ $ _______________ Amended: XXXX, 2021 Page 2 of 5 1. ____________________________ _____________________________ ________________ $ _______________ 2. ____________________________ _____________________________ ________________ $ _______________ 1. ____________________________ _____________________________ ________________ $ _______________ 2. ____________________________ _____________________________ ________________ $ _______________ 3. ____________________________ _____________________________ ________________ $ _______________ 4. ____________________________ _____________________________ ________________ $ _______________ 1. ____________________________ _____________________________ ________________ $ _______________ 2. ____________________________ _____________________________ ________________ $ _______________ 3. ____________________________ _____________________________ ________________ $ _______________ 4. ____________________________ _____________________________ ________________ $ _______________ 1. ____________________________ _____________________________ ________________ $ _______________ 2. ____________________________ _____________________________ ________________ $ _______________ 3. ____________________________ _____________________________ ________________ $ _______________ 4. ____________________________ _____________________________ ________________ $ _______________ 1. ___________________________ _____________________________ ________________ $ _______________ 2. ___________________________ _____________________________ ________________ $ _______________ Amended: XXXX, 2021 Page 3 of 5 1. ____________________________ _____________________________ ________________ $ _______________ 2. ____________________________ _____________________________ ________________ $ _______________ 3. ____________________________ _____________________________ ________________ $ _______________ 4. ____________________________ _____________________________ ________________ $ _______________ 1. __________________________ _________________________ ____________ $___________ $___________ 2. __________________________ _________________________ ____________ $___________ $___________ 3. __________________________ _________________________ ____________ $___________ $___________ 4. __________________________ _________________________ ____________ $___________ $___________ 5. __________________________ _________________________ ____________ $___________ $___________ 1. __________________________ _________________________ ____________ $___________ $___________ 2. __________________________ _________________________ ____________ $___________ $___________ 3. __________________________ _________________________ ____________ $___________ $___________ Amended: XXXX, 2021 Page 4 of 5 4. __________________________ _________________________ ____________ $___________ $___________ 5. __________________________ _________________________ ____________ $___________ $___________ 1. __________________________ _________________________ ____________ $___________ $___________ 2. __________________________ _________________________ ____________ $___________ $___________ Amended: XXXX, 2021 Page 5 of 5 1. (Number): _______ Minor child(ren) is/are subject to this case as follows: Amended: June 1, 2021 Page 1 of 4 Amended: June 1, 2021 Page 2 of 4 2. Participation in custody case(s): (Check only one box) 3. Information about custody case(s): (Check only one box) 2. 4. Information about criminal convictions: 5. Persons not a party to this case: (Check only one box) Amended: June 1, 2021 Page 3 of 4 6. I understand that I have a continuing duty to advise this Court of any custody, visitation, parenting time, Amended: June 1, 2021 Page 4 of 4 Amended: June 1, 2021 Page 1 of 2 Amended: June 1, 2021 Page 2 of 2 Amended: June 1, 2021 Page 1 of 5 1. The parties are living separately. 2. Movant’s child(ren) attend(s) school in: 3. Movant requests to be named the temporary residential parent and/or legal custodian of the 4. Movant has reached an agreement regarding parenting time (companionship or visitation) with the Amended: June 1, 2021 Page 2 of 5 5. A Court or agency has made a child support order concerning the child(ren). 6. Movant requests the Court to order the other parent or party to pay: 7. Movant requests the Court order the following other relief: 8. Movant is willing to attend mediation. Amended: June 1, 2021 Page 3 of 5 9. Movant requests the following Court services. (See local rules of Court for available services.) Amended: June 1, 2021 Page 4 of 5 Amended: June 1, 2021 Page 5 of 5 1. Plaintiff has been a resident of the State of Ohio for at least six (6) months immediately before filing this 2. Plaintiff has been a resident of County for at least ninety (90) days 3. Plaintiff and Defendant were married on (date of marriage) 4. Neither party is pregnant OR a party is pregnant. 7. Plaintiff is entitled to a divorce from Defendant based upon the following grounds: (check all that apply) 8 Plaintiff and Defendant are owners of real estate and/or personal property. 1. Plaintiff has been a resident of the State of Ohio for at least six (6) months immediately before filing this 2. Plaintiff has been a resident of County for at least ninety (90) days Amended: June 1, 2021 Page 1 of 3 3. Plaintiff and Defendant were married on _____________________________________ (date of marriage) 4. Neither party is pregnant OR a party is pregnant. 5. Check all that apply: (If more space is needed, add additional pages) 6. Military Service: Amended: June 1, 2021 Page 2 of 3 7. Plaintiff is entitled to a divorce from Defendant based upon the following grounds: (check all that apply) 8. Plaintiff and Defendant are owners of real estate and/or personal property. Amended: June 1, 2021 Page 3 of 3 1. Plaintiff filed a Complaint for Divorce or a Complaint for Legal Separation. 2. Plaintiff alleged proper jurisdiction and venue. 3. Plaintiff and Defendant were married on (date of marriage) 4. Neither party is pregnant OR a party is pregnant. 7. Defendant is entitled to a divorce from Plaintiff based upon the following grounds: (check all that apply) 8. Plaintiff and Defendant are owners of real estate and/or personal property. 1. Plaintiff filed a Complaint for Divorce or a Complaint for Legal Separation. 2. Plaintiff alleged proper jurisdiction and venue. Effective Date: June 1, 2021 Page 1 of 4 3. Plaintiff and Defendant were married on (date of marriage) 4. Neither party is pregnant OR a party is pregnant. 5. Check all that apply: (If more space is needed, add additional pages) 6. Military Service: Effective Date: June 1, 2021 Page 2 of 4 7. Defendant is entitled to a divorce from Plaintiff based upon the following grounds: (check all that apply) 8. Plaintiff and Defendant are owners of real estate and/or personal property. Effective Date: June 1, 2021 Page 3 of 4 Effective Date: June 1, 2021 Page 4 of 4 1. Plaintiff has been a resident of the State of Ohio for at least six (6) months immediately 2. Plaintiff has been a resident of the County stated in the Complaint for at least ninety (90) 3. The date of Plaintiff and Defendant’s marriage stated in the Complaint. 4. Neither party is pregnant. 5. Any child(ren) born from or adopted during this marriage or relationship is/are now adults 6. Plaintiff is an active-duty servicemember of the United States military. 7. Defendant further admits or denies the following grounds for divorce: 8. Plaintiff and Defendant are owners of real estate and/or personal property. 9. Defendant denies any allegations not specifically admitted. 1. Plaintiff has been a resident of the State of Ohio for at least six (6) months immediately 2. Plaintiff has been a resident of the County stated in the Complaint for at least ninety (90) Amended: June 1, 2021 Page 1 of 3 3. The date of Plaintiff and Defendant’s marriage stated in the Complaint. 4. Neither party is pregnant. 5. The child(ren) stated in the Complaint was/were born of the relationship prior to the 6. Plaintiff is an active-duty servicemember of the United States military. 7. Defendant further admits or denies the following grounds for divorce: 8. Plaintiff and Defendant are owners of real estate and/or personal property. 9. Defendant denies any allegations not specifically admitted. Amended: June 1, 2021 Page 2 of 3 Amended: June 1, 2021 Page 3 of 3 1. Plaintiff filed a Complaint for Divorce or a Complaint for Legal Separation 2. Plaintiff alleged proper jurisdiction and venue. 3. The date of Plaintiff and Defendant’s marriage stated in the Counterclaim. Effective Date: June 1, 2021 Page 1 of 3 4. Neither party is pregnant. 5. Any child(ren) born from or adopted during this marriage or relationship is/are now adults 6. Plaintiff is an active-duty servicemember of the United States military. 7. Plaintiff further admits or denies the following grounds for divorce: 8. Plaintiff and Defendant are owners of real estate and/or personal property. 9. Plaintiff denies any allegations not specifically admitted. Effective Date: June 1, 2021 Page 2 of 3 10) filed with the Clerk of Courts Effective Date: June 1, 2021 Page 3 of 3 1. Plaintiff filed a Complaint for Divorce or a Complaint for Legal Separation. 2. Plaintiff alleged proper jurisdiction and venue. Effective Date: June 1, 2021 Page 1 of 3 3. The date of Plaintiff and Defendant’s marriage stated in the Counterclaim. 4. Neither party is pregnant. 5. The child(ren) stated in the Counterclaim was/were born of the relationship prior to the 6. Plaintiff is an active-duty servicemember of the United States military. 7. Plaintiff further admits or denies the following grounds for divorce: 8. Plaintiff and Defendant are owners of real estate and/or personal property. 9. Plaintiff denies any allegations not specifically admitted. Effective Date: June 1, 2021 Page 2 of 3 Effective Date: June 1, 2021 Page 3 of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¶SURSHUW\VKDOOEHGLYLGHGDVIROORZV 6HFWLRQV'(DQG)EHORZ 6XSUHPH&RXUWRI2KLR 8QLIRUP'RPHVWLF5HODWLRQV)RUP 7+,5' '(%7 7KHSDUWLHV¶GHEWVVKDOOEHGLYLGHGDVIROORZV 6XSUHPH&RXUWRI2KLR 8QLIRUP'RPHVWLF5HODWLRQV)RUP 1HLWKHU3ODLQWLIIQRU'HIHQGDQWVKDOOSD\VSRXVDOVXSSRUWWRWKHRWKHUVXEMHFWWRDQ\MXULVGLFWLRQUHVHUYHG 3ODLQWLII 'HIHQGDQW VKDOO SD\ VSRXVDO VXSSRUW WR 3ODLQWLII 'HIHQGDQW LQ WKH DPRXQW RI 6XSSRUW3D\PHQW&HQWUDO32%R[&ROXPEXV2KLRDVDGPLQLVWHUHGWKURXJKWKH 6SRXVDOVXSSRUWVKDOOWHUPLQDWHHDUOLHUWKDQWKHDERYHVWDWHGGDWHXSRQ3ODLQWLII¶VRU'HIHQGDQW¶VGHDWKRULQ 8QGHU DOO FLUFXPVWDQFHV WKH &RXUW VKDOO UHWDLQ MXULVGLFWLRQ RYHU WKH LVVXH RI VSRXVDO VXSSRUW WR KHDU DQG 7KH&RXUWVKDOOUHWDLQMXULVGLFWLRQWRHVWDEOLVKRUPRGLI\WKHDPRXQWDQGRUGXUDWLRQRIVSRXVDOVXSSRUW 6XSUHPH&RXUWRI2KLR 8QLIRUP'RPHVWLF5HODWLRQV)RUP 6,;7+ 27+(525'(56 6(9(17+ 7(0325$5<25'(56 1,17+ &2857&2676 6XSUHPH&RXUWRI2KLR 8QLIRUP'RPHVWLF5HODWLRQV)RUP 7(17+ &/(5.2)&28576 7KH&OHUNRI&RXUWVVKDOOSURYLGH 3ODLQWLII6LJQDWXUH 'HIHQGDQW6LJQDWXUH 3ULQWHG1DPH 3ULQWHG1DPH 3ODLQWLII¶V$WWRUQH\6LJQDWXUH 'HIHQGDQW¶V$WWRUQH\6LJQDWXUH 3ULQWHG1DPH 3ULQWHG1DPH 6XSUHPH&RXUW5HJ1R 6XSUHPH&RXUW5HJ1R 127,&( 7KLV LV D ILQDO DSSHDODEOH RUGHU 7KH &OHUN LV GLUHFWHG WR VHUYH XSRQ DOO SDUWLHV QRWLFH RI WKLV 6XSUHPH&RXUWRI2KLR 8QLIRUP'RPHVWLF5HODWLRQV)RUP Amended: June 1, 2021 Page 1 of 23 Amended: June 1, 2021 Page 2 of 23 Amended: June 1, 2021 Page 3 of 23 Amended: June 1, 2021 Page 4 of 23 3109.051 upon which it allocates the parties’ parental rights and responsibilities in the child(ren)’s best Amended: June 1, 2021 Page 5 of 23 Amended: June 1, 2021 Page 6 of 23 Amended: June 1, 2021 Page 7 of 23 Amended: June 1, 2021 Page 8 of 23 Amended: June 1, 2021 Page 9 of 23 Amended: June 1, 2021 Page 10 of 23 Amended: June 1, 2021 Page 11 of 23 Amended: June 1, 2021 Page 12 of 23 Amended: June 1, 2021 Page 13 of 23 Amended: June 1, 2021 Page 14 of 23 3119, 3121, 3123, and 3125 or a withdrawal directive issued pursuant to R.C. 3123.24 to 3123.38 and shall Amended: June 1, 2021 Page 15 of 23 Amended: June 1, 2021 Page 16 of 23 Amended: June 1, 2021 Page 17 of 23 1. Accessibility of Private Health Insurance Coverage. 2. Reasonableness of Cost of Private Health Insurance Coverage. Amended: June 1, 2021 Page 18 of 23 3. Person Required to Provide Private Health Insurance Coverage. Amended: June 1, 2021 Page 19 of 23 3109.19, or the Child Support Enforcement Agency, on written request, any necessary information on the Amended: June 1, 2021 Page 20 of 23 Amended: June 1, 2021 Page 21 of 23 152 of the Internal Revenue Code, as amended, on or before February 15th of the year following the tax year in Amended: June 1, 2021 Page 22 of 23 2 Amended: June 1, 2021 Page 23 of 23 1DPH 6WUHHW$GGUHVV 1DPH 6WUHHW$GGUHVV 7KH SDUWLHV¶ PDUULDJH ZDV WHUPLQDWHG LQ D -XGJPHQW (QWU\ ILOHG RQ BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 3XUVXDQW WR VDLG -XGJPHQW (QWU\ LW LV 25'(5(' WKDW BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB LV GLYHVWHG RI DOO 3DUFHO1XPEHUDWWDFKHGKHUHWRDV([KLELW$DQGPDGHDSDUWKHUHRI 6XSUHPH&RXUWRI2KLR 8QLIRUP'RPHVWLF5HODWLRQV)RUP 1. Petitioner 1 Petitioner 2 Both parties has/have been (a) resident(s) of the State of Ohio for at 2. Petitioners consent to venue. Amended: June 1,2021 Page 1 of 3 3. Petitioners were married on (date of marriage) 4. Neither party is pregnant OR a party is pregnant. 5. Check all that apply: (If more space is needed, add additional pages) 6. Military Service: Amended: June 1,2021 Page 2 of 3 7. Petitioners entered into a Separation Agreement which is attached and incorporated herein as if fully 8. If Petitioners have (a) minor child(ren): (select one) 9. Petitioners are both over eighteen (18) years of age, are not under any disability, and waive all rights to 10. _________________________________________________, requests to be restored to the former Amended: June 1,2021 Page 3 of 3 1. Petitioner 1 Petitioner 2 Both parties was/were (a) resident(s) of the State of Ohio for at least six 2. Both parties consented to venue. 3. Not less than thirty (30) days nor more than ninety (90) days have elapsed after the filing of the 4. The parties were married on (date of marriage) 5. Neither party is pregnant OR a party is pregnant. 6. There is/are no minor child(ren) born from or adopted during this marriage or relationship. 7. Military Service: 8. Upon examination under oath, the parties acknowledged that they voluntarily entered into a Separation 9. Upon examination under oath, the parties acknowledged that they voluntarily entered into a Shared 10. ____________________________________________________ requests to be restored to the former 11. Petitioners desire to have the marriage dissolved. 3109.04(D). 1. The parties were married on (date of marriage) 2. The parties request that the termination of marriage be the date of the final hearing or the date specified: Amended: June 1, 2021 Page 1 of 14 3. The parties intend to live separate and apart. 4. Each party completed (a) financial disclosure affidavit(s) which fully and accurately lists and values all marital 5. Each party acknowledges that he/she reviewed the other party’s completed financial disclosure affidavit(s). 6. Each party’s financial disclosure affidavit(s) shall be filed in the Court’s Family File pursuant to Sup.R. 44(C)(2)(h) 7. Neither party has knowledge of any other property or debts of any kind in which either party has an interest. 8. Each party had the opportunity to value and verify all marital property, separate property, and debts. 9. A party’s willful failure to disclose may result in the Court awarding the other party three (3) times the value of 10. This Agreement addresses spousal support, property, and debt division. 11. This Agreement is the complete agreement of the parties. 12. There are no other representations, agreements, statements, or prior writings that shall have any effect on this 13. Each party fully understands this Agreement and has knowingly and voluntarily signed this Agreement. 14. No change to the terms of this Agreement shall be valid unless in writing and knowingly and voluntarily signed Amended: June 1, 2021 Page 2 of 14 1. Neither party has any ownership interest in any real estate. 2. One or both of the parties has/have an interest in real estate and agree to distribute the interest(s) as follows: 3. A legal description of the property (found in the property’s deed) should be attached. 4. Each party shall pay and hold the other harmless from any debt, including mortgages, real estate taxes and 5. Other arrangements regarding real estate, including, but not limited to, refinancing or sale: 1. Neither party has any ownership interest in any titled vehicle(s). 2. Plaintiff/Petitioner 1 shall receive the following titled vehicle(s) free and clear of any claim of Amended: June 1, 2021 Page 3 of 14 3. Defendant/Petitioner 2 shall receive the following titled vehicle(s) free and clear of any claim of 4. Each party shall pay and hold the other harmless from any debt owing on the titled vehicle(s) received unless 5. Other arrangements regarding titled vehicles, including, but not limited to, refinancing or sale: 1. The parties divided all of their household goods and personal property. Each party shall retain all household 2. The parties divided all of their household goods and personal property. Each party shall retain all household Amended: June 1, 2021 Page 4 of 14 3. Delivery or pick-up of household goods and personal property shall be as follows: 4. Each party shall pay and hold the other harmless from any debt owing on the household goods and personal 5. Other arrangements regarding household goods and personal property: 1. Neither party has any ownership interest in any financial accounts. 2. Plaintiff/Petitioner 1 shall receive the following: Amended: June 1, 2021 Page 5 of 14 3. Defendant/Petitioner 2 shall receive the following: 4. Each party shall pay and hold the other harmless from any debt owing on the financial accounts he/she receives 5. Other arrangements regarding financial accounts: 1. Neither party has an interest in any stocks, bonds, securities, or mutual funds. 2. Plaintiff/Petitioner 1 shall receive the following: 3. Defendant/Petitioner 2 shall receive the following: Amended: June 1, 2021 Page 6 of 14 4. Each party shall pay and hold the other harmless from any debt owing on the stocks, bonds, securities, or 5. Other arrangements regarding the stocks, bonds, securities, or mutual funds: 1. Neither party has any interest in any business. 2. Plaintiff/Petitioner 1 shall receive the following: 3. Defendant/Petitioner 2 shall receive the following: 4. Each party shall pay and hold the other harmless from any debt owing on the business interests he/she receives 5. Other arrangements regarding business interests: 1. Neither party has any interest in any pension, profit sharing, IRA, 401(k), deferred compensation, or other Amended: June 1, 2021 Page 7 of 14 2. Plaintiff/Petitioner 1 shall receive the following: 3. Defendant/Petitioner 2 shall receive the following: 4. Each party shall pay and hold the other harmless from any debt owing on any pension, profit sharing, IRA, 401(k), deferred compensation, or other retirement plans he/she receives unless otherwise stated in this 5. Other arrangements regarding pension, profit sharing, IRA, 401(k), deferred compensation, or other Amended: June 1, 2021 Page 8 of 14 1. Neither party has any interest in any life insurance policy(ies) with a cash value. 2. Plaintiff/Petitioner 1 shall receive the following policy(ies): 3. Defendant/Petitioner 2 shall receive the following policy(ies): 4. Each party shall pay and hold the other harmless from any debt owing on the life insurance policy(ies) he/she 5. Other arrangements regarding life insurance policy(ies): 1. Neither party has any other property. 2. Other property owned by one or both of the parties shall be distributed as follows: 3. Each party shall pay and hold the other harmless from any debt owing on the property he/she receives Amended: June 1, 2021 Page 9 of 14 4. Other arrangements regarding the property above: 1. Neither party owes any debt(s) which are not paid in full each month, including, but not limited to, credit 2. Plaintiff/Petitioner 1 shall pay the following debt(s): 3. Defendant/Petitioner 2 shall pay the following debt(s): 4. Each party shall pay and hold the other harmless from the above listed debt unless otherwise stated in this Amended: June 1, 2021 Page 10 of 14 5. Other arrangements regarding debt(s), including refinancing: 6. The Court has continuing jurisdiction to determine whether a debt assigned to a party qualifies as an 7. Neither party shall incur liabilities in the name of the other party in the future. 3121.441.) Amended: June 1, 2021 Page 11 of 14 Amended: June 1, 2021 Page 12 of 14 1, who acknowledged that Plaintiff/Petitioner 1 has signed the Separation Agreement, that Plaintiff/Petitioner 1 Amended: June 1, 2021 Page 13 of 14 Amended: June 1, 2021 Page 14 of 14 Amended: June 1, 2021 Page 1 of 18 Amended: June 1, 2021 Page 2 of 18 Amended: June 1, 2021 Page 3 of 18 1. Participation in Activities 2. Transportation to Activities 3. Payment of Expenses Related to Activities Amended: June 1, 2021 Page 4 of 18 Amended: June 1, 2021 Page 5 of 18 Amended: June 1, 2021 Page 6 of 18 Amended: June 1, 2021 Page 7 of 18 Amended: June 1, 2021 Page 8 of 18 Amended: June 1, 2021 Page 9 of 18 Amended: June 1, 2021 Page 10 of 18 Amended: June 1, 2021 Page 11 of 18 Amended: June 1, 2021 Page 12 of 18 90 DAYS. 1. Accessibility of Private Health Insurance Coverage. Amended: June 1, 2021 Page 13 of 18 2. Reasonableness of Cost of Private Health Insurance Coverage. 1 and/or Defendant/Petitioner 2 does not exceed that parent’s Health Insurance 1 and/or Defendant/Petitioner 2 exceeds that parent’s Health Insurance Maximum 3. Person Required to Provide Private Health Insurance Coverage. Amended: June 1, 2021 Page 14 of 18 3109.19, or the Child Support Enforcement Agency, on written request, any necessary information on the Amended: June 1, 2021 Page 15 of 18 Amended: June 1, 2021 Page 16 of 18 Amended: June 1, 2021 Page 17 of 18 Amended: June 1, 2021 Page 18 of 18 Amended: June 1, 2021 Page 1 of 17 Amended: June 1, 2021 Page 2 of 17 1. Participation in Activities 2. Transportation to Activities Amended: June 1, 2021 Page 3 of 17 3. Payment of Expenses Related to Activities Amended: June 1, 2021 Page 4 of 17 Amended: June 1, 2021 Page 5 of 17 Amended: June 1, 2021 Page 6 of 17 Amended: June 1, 2021 Page 7 of 17 Amended: June 1, 2021 Page 8 of 17 3119, 3121, 3123, and 3125 or a withdrawal directive issued pursuant to R.C. 3123.24 to 3123.38 and shall Amended: June 1, 2021 Page 9 of 17 Amended: June 1, 2021 Page 10 of 17 Amended: June 1, 2021 Page 11 of 17 Amended: June 1, 2021 Page 12 of 17 1. Accessibility of Private Health Insurance Coverage. 2. Reasonableness of Cost of Private Health Insurance Coverage. Amended: June 1, 2021 Page 13 of 17 3. Person Required to Provide Private Health Insurance Coverage. Amended: June 1, 2021 Page 14 of 17 3109.19, or the Child Support Enforcement Agency, on written request, any necessary information on the 3119.34, which may result in the issuance of a notice requiring the new employer to take whatever action Amended: June 1, 2021 Page 15 of 17 29, Sole/Shared Parenting Child Support Computation Worksheet or Line 31 Split Parenting Amended: June 1, 2021 Page 16 of 17 1 is substantially current in any child support Plaintiff/Petitioner 1 is required to pay as of December 31 of 152 of the Internal Revenue Code, as amended, on or before February 15th of the year following the tax year in Amended: June 1, 2021 Page 17 of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mended: June 1, 2021 Page 1 of 3 1. Plaintiff is a parent of the following child(ren): 2. Defendant, _____________________________________ (name) is a parent of the following child(ren): 3. The child(ren) has/have resided in ________________________________________ County, Ohio since 4. A parent-child relationship has been established for the following child(ren): 5. A parent-child relationship has not been established for the following child(ren): 6. No Court has issued an order of parenting or support for the following child(ren): Amended: June 1, 2021 Page 2 of 3 7. Plaintiff requests that the Court: (check all that apply) Amended: June 1, 2021 Page 3 of 3 25/Uniform Juvenile Form 4) must be filed with this Motion. The Court may require additional forms to accompany Amended: September 21, 2020 Page 1 of 4 1. Interference with parenting time or other parenting orders filed on ____________________ (date), 2. Failure to pay child support as required by the order filed on ____________________ (date). The 3. Failure to pay spousal support as required by the order filed on____________________ (date). The 4. Failure to pay or reimburse health care expenses incurred for the minor child(ren) as required by the 29/Uniform Juvenile Form 8). 5. Failure to comply with the Court's order(s) filed on ____________________ (date) regarding: Amended: September 21, 2020 Page 2 of 4 Amended: September 21, 2020 Page 3 of 4 Amended: September 21, 2020 Page 4 of 4 1DPH 6WUHHW$GGUHVV 1DPH 6WUHHW$GGUHVV 6+2:&$86(25'(5$1'127,&( 72 6XSUHPH&RXUWRI2KLR 8QLIRUP'RPHVWLF5HODWLRQV)RUP 8QLIRUP-XYHQLOH)RUP 6+2:&$86(25'(5$1'127,&( 127,&(2)+($5,1* 7KH&RXUWZLOOFRPSOHWHWKLVSDUW 127,&( 6XSUHPH&RXUWRI2KLR 8QLIRUP'RPHVWLF5HODWLRQV)RUP 8QLIRUP-XYHQLOH)RUP 6+2:&$86(25'(5$1'127,&( Amended: September 21, 2020 Page 1 of 2 Amended: September 21, 2020 Page 2 of 2 Amended: September 21, 2020 Page 1 of 2 Amended: September 21, 2020 Page 2 of 2 Amended: September 21, 2020 Page 1 of 2 Amended: September 21, 2020 Page 2 of 2 1 Amended: September 21, 2020 Page 1 of 1 Amended: September 21, 2020 Page 1 of 2 Amended: September 21, 2020 Page 2 of 2 Amended: September 21, 2020 Page 1 of 3 Amended: September 21, 2020 Page 2 of 3 Amended: September 21, 2020 Page 3 of 3 31/Juvenile Form 10) is used to select how you want the parties to be served. You can find this 42 Effective Date: January 22, 2026 Page 1 of 5 20). This form asks that you be allowed to file without paying a fee in advance. You may 42 Effective Date: January 22, 2026 Page 2 of 5 1. My relationship with the child is (for example, grandparent, aunt, uncle, family friend, etc.) 42 Effective Date: January 22, 2026 Page 3 of 5 2. I, ____________________________________, request to be added as a party to the case because: 3. I am requesting to be made a party to this case because I am seeking one of the following 4. This motion is submitted by: Me as a self-represented litigant or Attorney. 42 Effective Date: January 22, 2026 Page 4 of 5 42 Effective Date: January 22, 2026 Page 5 of 5