C-20,EFF.7/96IN THE COURT OF COMMON PLEAS DIVISION OF DOMESTIC RELATIONSBUTLER COUNTY, OHIO:CaseNo.Plaintiff/1stPetitioner:Judge:Defendant/2ndPetitionerSUPPLEMENTAL AFFIDAVIT1. Iamaparentofthefollowingminorchild(ren):NameDateofBirthNameDateofBirthNameDateofBirth2. Thepresentaddressofmyformerspouse(thenon-residentialparent)is:3. Thenon-residentialparenta)9 has 9 hasnotbeenconvictedoforpleadedguiltytoaviolationofOhioRevisedCode Section2919.25(criminaldomesticviolence)involvingavictimwho,atthetimeofthe commissionoftheoffense,wasamemberofthefamilyorhouseholdthatisthesubjectof theproceedingsinthiscase;b) 9 has 9 hasnotbeenconvictedoforpleadedguiltytoanyotheroffensewhichcausedharmtoavictimwho,atthetimeoftheoffense,wasamemberofthefamilyorhousehold thatisthesubjectoftheproceedingsinthiscase;2001 © American LegalNet, Inc.c) 9 has 9 hasnotbeendeterminedtobethepersonwhocommittedanactwhichisthebasisofacourtfindingthatachildhasbeenabused.Affiant(residentialparent)Sworntoandsubscribedbeforemethisdayof,19.NotaryPublic MycommissionexpiresNOTE:Thisaffidavitisonlyrequiredifyouarerequestingthatyournewaddressbewithheld fromtheformerspouse.Iftheresponsetoeachofthestatementsinquestion#3ishasnot,thecourtwillissuean orderstatingthatthenon-residentialparentistobesentacopyofthisandanysubsequentNotice ofIntenttoRelocatethatisfiledwiththecourt.Iftheresponsetoany ofthestatementsinquestion#3ishas,thecourtwillissuean orderstatingthatthenon-residentialparentshallnot besentacopyofthisoranyfutureNoticeof IntenttoRelocate. Thecourtwill,however,sendanoticetothenon-residentialparentthat he/shemayfileamotionrequestingacourthearingtodeterminewhetheritwouldbeinthebest interestofthechild(ren)thathe/shebegiventhenewaddress,andwhetherthevisitationorder shouldberevised.2001 © American LegalNet, Inc.
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