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Magistrates Order-Order And Notices To Obligor And Obligee Payor And Insurer 1 - Ohio
| Magistrates Order-Order And Notices To Obligor And Obligee Payor And Insurer Form. This is a Ohio form and can be used in Domestic Division Clerk Of Courts Franklin County (Court Of Common Pleas) . |
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IN THE COURT OF COMMON PLEAS OF FRANKLIN COUNTY, OHIO DIVISION OF DOMESTIC RELATIONS AND JUVENILE BRANCH MAGISTRATES ORDER/ORDER AND NOTICES TO OBLIGOR AND OBLIGEE, PAYOR, AND INSURER CASE NO. PLAINTIFF/PETITIONER DOB: SSN: JUDGE Drivers License Number: Full Names of Children Subject to Child Support Order: Residence Address: Name: D OB: Name: D OB: Residence Phone: Name: D OB: Mailing Address (if Different): Name: D OB: Name: D OB: Health Insurer: Address: CHECK WHICH PARTY IS TO BE REIMBURSED FOR OUT-OF-POCKET MEDICAL, OPTICAL, HOSPITAL, DENTAL, OR PRESCRIPTION EXPENSES PAID FOR THE CHILD AS PROVIDED IN PARAGRAPH 16 ON PAGE 3. Policy Number: Plaintiff Defendant Petitioner-Wife Petitioner-Husband DEFENDANT / PETITIONER DOB: SSN: Other Party (Specify Name and Address) Drivers License Number: Name: Residence Address: Address: Residence Phone: PAYOR: Employer/Income Withholder/Financial Institution: Mailing Address (if Different): A ddress: Health Insurer: Address: Employer Identification Number of Financial Institution Account Number Policy Number: The court has issued a support order. Therefore, the following notices and orders shall issue. It is ORDERED, ADJUDGED, AND DECREED that the Insurer do the following: 1. Any insurer that receives a copy of an order or notice described in sections 3119.30, 3119.41 or 3119.41 of the Revised Code shall comply with it in accordance with Revised Code sections 3119.30 to 3119.58, regardless of the residence of the children. An insurer that provides health insurance coverage for the children who are the subject of a child support order in accordance with the child support order or an order issued under R.C. 3119.41, or a notice issue pursuant to R.C. 3119.44 shall reimburse the parent who is designated to receive reimbursement in the child support order as stated on page one of this order, for covered out-of-pocket medical, optical, hospital, dental, or prescription expenses incurred on behalf of the children. It is further ORDERED, ADJUDGED AND DECREED tha t: (Check applicable box in paragraphs 2 through 5) [ ] 2. The obligor under the child support order shall obtain health insurance coverage for the children if coverage is available at a reasonable cost through a group health contract, or plan offered by the obligors employer or through any other group policy, contract, or plan available to the obligor, and if it is not available for a more FORM 1 3/01 Page 1 of 3 ALSO COMPLETE ODHS FORMS 4047 & 4048 American LegalNet, Inc. www.USCourtForms.com <<<<<<<<<********>>>>>>>>>>>>> 2reasonable cost through a group policy, contract, or plan available to the obligee. [ ] 3. The obligee shall obtain health insurance coverage for the children if coverage is available through a group policy, contract, or plan offered by the obligees employer or through any other group policy, contract, or plan available to the obligee, and if it is available at a more reasonable cost than coverage is available to the obligor. [ ] 4. If health insurance coverage for the children is not available at a reasonable cost through a group policy, contract, or plan offered by the obligors or obligees employer or through any other group policy, contract, or plan available to the obligor or obligee, the obligor and the obligee shall share liability for the cost of the medical and health care needs of the children, under an equitable formula established by the Court; and if, after the issuance of the o rder, health insurance coverage for the children becomes available at a reasonable cost through a group policy, contract, or plan offered by the obligors or obligees employer or through any other group policy, contract, or plan available to the obligor or obligee, the obligor or obligee to whom the coverage becomes available shall immediately inform the Court. [ ] 5. Both the obligor and the obligee shall obtain health insurance coverage for the children if health insurance coverage i s available for the children at a reasonable cost to both the obligor and obligee and dual coverage by both parents would provide for coordination of medical benefits without unnecessary duplication of coverage. It is further ORDERED, ADJUDGED AND DECREED that: 6. All parties to this order are hereby ordered to notify the FCCSEA in writing of any change in your name, current mailing address, current residence address, current residence telephone number, current drivers license number, and of any changes to that information. Until further notice, all parties shall notify the FCCSEA of any change in information immediately after the change occurs. A WILLFUL FAILURE TO SUPPLY THE FRANKLIN COUNTY CHILD SUPPORT ENFORCEMENT AGENCY WITH ALL CHANGES IS CONTEMPT OF COURT. 7. The obligor shall immediately notify the FCCSEA in writing of any change in your income source and of the availability of any other sources of income that can be the subject of withholding or deduction, the nature of any new employment or income source and the name, business address and telephone number of the new employer or income source. Additionally, if support is being deducted from the obligors financial account, the obligor shall immediately notify the FCCSEA in writing of any change in the status of the account from which the support is being deducted or the opening of a new account with any financial institution or the commencement of employment including self-employment, the nature of the new account opened at a financial institution and the name and business address of that financial institution. If support is being deducted from a financial account, upon commencement of employment the obligor may request that the court or the FCCSEA cancel its deduction notice and issue a withholding notice to collect support amounts. 8. An obligor who fails to comply with a child support order issued under R.C. 3119.30 or an order issued under R.C. 3119.41, is liable to the obligee for any medical expenses incurred as a result of the failure to comply with the order. An obligee who fails to comply with a child support order issued in accordance with R.C. 3119.30, or an order issued under R.C 3119.41, is liable to the obligor for any medical expenses incurred as a result of failure to comply with the order. 9. Whoever violates an order issued under R.C. 3119.30 or an order issued under R.C. 3119.41may be punished as for CONTEMPT under R.C. Chapter 2705. If an obligor is found in contempt under that chapter for failing to comply with
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