COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.APPLICATION PACKETJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)To file an application to determine legal custody, you will need the following:1. Birth Certificate for each child. (You can get a birth certificate from the Bureau of VitalStatistics in the county where the child was born). 2. Social Security card: If you don't have a social security card for each child, you must get a print. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .out or letter of refusal from the social security office. (If you do not have the child's social security card contact any Federal Social Security office for necessary information). If you are refused the print out, please request a refusal letter. 3. Proof of paternity for each child. If you don't have legal verification of paternity you will beTHE PEOPLE OF THE STATE OF NEW YORK TOreferred to either the Child Support Enforcement Agency, 1640 Superior Ave., or Bureau of Vital Statistics at Cleveland City Hall. If a paternity affidavit was completed in the hospital please call 1-888-810-6446 to obtain the paternity registry number. You must supply a copy of the court order establishing parentage. 4. Application to determine custody, completed and notarized. 5. Affidavit: Uniform Child Custody Jurisdiction Act, completed and notarized. 6. Filing fee of $84.00. (Must be in check or money order, written out to Juvenile Court). Note: IfGREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofyou have a low monthly income, and cannot pay this filing fee and meet your basic needs for food and shelter, the filing fee may be waived if you file a poverty affidavit with the Court. To complete this poverty affidavit you must verity your monthly income and assets, as well as your necessary expenses and fixed debts. Note: If you know that you cannot pay this filing fee and maintain food and shelter, ask court intake staff for a poverty affidavit and complete the affidavit according to the attached instructions before filing your application/motion. 7. Custody Intake Information sheet.o'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomNote: IF A CURRENT LEGAL CUSTODIAN IS DECEASED, YOU MUST PROVIDE THE COURT WITH A COPY OF THE DEATH CERTIFICATE OR OBITUARY WITH YOUR FILING.Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.Return this completed application to:Custody Intake1910 Carnegie Ave. 1st floor, Rm. 117 Cleveland, OH 44115, one of the Justices of theIntake hours are from 9:00 a.m. to 4:00 p.m. Monday through Friday.Court in Witness, Honorableday of, 20 County,Note: Custody intake staff will be available to assist you in getting information about past court cases and the other specific juvenile court-related information necessary to complete this application. You must supply all current address information about the parties, and must have the information set forth in 1-3 above in order to file your case. Call (216) 443-3149 if you have questions.(Attorney must sign above and type name below)Special Notice Concerning Right to a Court Appointed AttorneyAttorney(s) forYou have a right to represent yourself in Court. If the court case becomes difficult, or if other parties to the case have attorneys to represent them in court, Ohio law does provide that you have a right to a court-appointed attorney if you cannot afford one and are the parent or primary caretaker of the child at issue in the case. To obtain a court-appointed attorney you will be required to compete an application and verify your low income status. Contact the assigned counsel clerk at 216-443-4772 or 4773 for an application, or pick up an application at the juvenile court clerk's office, 2163 E. 22nd Street, Cleveland, Ohio 44115 (1st. Floor, Courthouse Annex).Office and P.O. AddressTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.STATE OF OHIOIN THE COMMON PLEAS COURTCOUNTY OF CUYAHOGAJUVENILE COURT DIVISIONCalendar No.In the Matter of:JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)APPLICATION TO DETERMINED.O.B.//CUSTODYD.O.B.//D.O.B.//Name of Mother: Name of Father:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Address: Address: Soc. Sec. No: Soc. Sec. No: THE PEOPLE OF THE STATE OF NEW YORK TOPhone: Phone: Race:Mother: Father: Child #1Child #2Child #3, applicant in the above-titled action asks the Court to determinethe custody of the named child(ren) pursuant to Sections 2151.23(A)(2) and 2151.27(E) of the Ohio Revised Code and Juv.R. 10(A).GREETINGS:ApplicantAddress: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomPhone:AFFIDAVITYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.The applicant, being duly sworn, states:1) That the named child(ren) is/are in CUYAHOGA COUNTY or was /were last known to be in this county. Address of child(ren) or last know address of child(ren): 2) That it is in the best interest of the child(ren) for the Court to determine his/her/their custody. 3) That the child(ren) is /are not ward(s) of any other Court of this state. 4) That pursuant to O.R.C. Sections 3109.21 to 3109.36 and Local Rule 15(D), a Uniform Child Custody Jurisdiction Act affidavit was filed with this application and is incorporated herein as though fully rewritte
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