Ohio > County (Court Of Common Pleas) > Tuscarawas > Dissolution Of Marriage

Medical Expenses And Tax Exemptions - Ohio

Medical Expenses And Tax Exemptions Form. This is a Ohio form and can be used in Dissolution Of Marriage Tuscarawas County (Court Of Common Pleas) .
 Fillable pdf Last Modified 4/7/2005
Get this form for FREE as a print-only pdf

He alth and Me dic al Expense s A. Ea ch pa rty sha ll ha ve a cce s s to a ll he a lth records as provide d by sta tute. B. Che ck e ithe r 1, 2 or 3 be low and comple te : 1. The sha ll provide he a lth ins ura nce for the minor child(ren) of the parties . The insurance carrie r is whos e addre ss is P roof of ins ura nce , insura nce forms a nd a n insura nce ca rd s ha ll be s ubmitted to the other pa rty. Acopy of me dica l bills mus t be submitted to the pa rty holding the insurance within thirty (30) da ys of rece ipt of sa me . 2. Both pa rtie s sh all provide and ma inta in he a lth ins uran ce for the be n e fit of the minor child(ren). The s ins ura nce ca rrie r, whose a ddre ss is , sha ll be prima ry and the s ins ura nce carrie r, whos e addre ss is , s ha ll be s e conda ry. P roof of insura nce , ins urance forms and a n ins urance ca rd s ha ll be s ubmitte d to the othe r pa rty. A copy of me dical bills must be submitte d to the prty ha olding the ins urance within thirty (30) da ys of receipt of sa me . 3. Neithe r pa rty has he a lth insu rance covera ge availab le to the m at a re as ona ble cost through a group he a lth ins ura nce pla n offe re d by a n e mploye r or through a ny othe r he a lth insura nce ca re policy, contra ct, or plan for the be ne fit of the minor child(re n). If hea lth ins ura nce cove ra ge be come s availa ble to eithe r pa rty, the y sh all obta in the insu rance and no tify the othe r pa rty and su bmit proof of in sura nce , ins uran ce forms and a n ins ura nce ca rd. A copy of me dicaillsl b mus t be su bmitte d to the pa rty holding the insurance within thirty (30) da ys of rece ip t of sa me. C. Any ordina ry uninsure d me dica l, de nta l, optica l, pre scription a nd re la te d he a lth ca re expe ns e s for the child(re n) in the a mount of $100. 00 pe r ye a r pe r child s hall be pa id by the custodial pa re nt. The cos t of a ny unins ure d me dica l, de nta l, optica l, psychologica l a nd re la te d he a lth ca re expe nse s , including co- pa yme nts and de ductible s unde r any he alth insurance pla n for the child, in e xce ss of $100. 00 pe r ye a r pe r child s ha ll be cons ide re d e xtraordina ry me dica l a nd rela ted he a lth ca re expe nse s and sha ll be divide d be twee n the partie s a s follow: % by fa the r % by mothe r American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 Tax Exemptions A. Che ck e ithe r 1, 2 or 3 be low a nd comple te : 1. (res ide ntial parent), agree s that if (nonre s identiaPl arent), is in full comp liance with this Agree me nt or any ame nd me nt to this Agree me nt or su bse qu e nt modifica tion to this Agree me nt, (nonre sidential pa rent) s ha ll be e ntitled to claim the child(re n) on the ir fe deral, state, or othe r tax returns as de pende nt(s). (reside ntial pa rent) shall sig n any forms required by the Interna l Re ve nue Se rvice to imple me nt the terms of this pa ragra ph a nd s ha ll provide s uch forms to (nonre s ide ntia l pa rent). 2. (reside ntial pa rent), sha ll be entitle d to claim the minor child(ren) a s de pe nde nt(s) on of a ll a pplica ble fe deral, sta te and loca l tax re turns notwiths ta nding a ny fina ncia l contribution ma de by (nonre sidential pa re nt), for the support and ma intena nce of the minor child(ren). 3. Th e p arties ag ree t hat, for c alen dar year a nd e ach ye ar the re afte r, s o long a s , is complying with the s upport orde r he rein a nd the child(ren) continue to re side with , , sha ll be e ntitle d to claim a s a de pende nt for all tax purpos e s and (othe r spous e) shall be e ntitle d to claim as a de pende nt. Ea ch pa rty sha ll sign any fo rms required by the Internal Re ve nue Se rvice to imple me nt the te rms of this pa ra gra ph a nd s hall provide s uch forms to the othe r pa rty. American LegalNet, Inc. www.USCourtForms.com
Link/Embed this Document
URL
Embed


Popular Searches

  1. Petition for Administration
  2. at issue memorandum
  3. mechanics lien
  4. amendment to complaint
  5. grant deed
  6. information subpoena
  7. Form Interrogatories-General
  8. durable power of attorney
  9. deposition subpoena
  10. bill of costs

Bookmark and Share