Ohio > County (Court Of Common Pleas) > Clermont > Domestic Relations
Information For Parenting Proceeding Affidavit 10.01-F - Ohio
| Information For Parenting Proceeding Affidavit Form. This is a Ohio form and can be used in Domestic Relations Clermont County (Court Of Common Pleas) . |
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FORM 10.01-F COURT OF COMMON PLEAS DIVISION OF DOMESTIC RELATIONS CLERMONT COUNTY, OHIO __________________________________ Petitioner v. : : Case No. ___________________ Judge : Magistrate : : : Kathleen M. Rodenberg ___________________ __________________________________ Respondent INFORMATION FOR PARENTING PROCEEDING AFFIDAVIT (R.C. 3127.23(A)) Filed with Petition for Domestic Violence Civil Protection Order Instructions: By law, an affidavit must be filed and served with the first pleading filed by each party in every parenting (custody/visitation) proceeding in this Court, including a Petition for Domestic Violence. Each party has a continuing duty while this case is pending to inform the Court of any parenting proceeding concerning the child(ren) in any other court in this or any other state. If more space is needed, add additional pages. I (full legal name) ____________________________________, being sworn according to law, certify these cases involve the custody of a child or children and the following statements are true: I request that the court not disclose my current address or that of the child(ren). My address is confidential pursuant to R. C. 3127.23(D) and should be placed under seal to protect the health, safety, or liberty of myself and/or the child(ren). 2. _____ Minor child(ren) are subject to this case as follows: Insert the information requested below for all minor or dependent children of this marriage. You must list the residences for all places where the children have lived for the last FIVE (5) years. a. Child's Name: _______________________ Place of Birth: Male Female Relationship 1. _____________________ Date of Birth: _______________________ Sex: Period of Residence Check if Confidential Address Confidential? Address Confidential? Address Confidential? Address Confidential? _______ to present _______ to ________ _______ to ________ _______ to ________ Person(s) With Whom Child Lived (name & address) ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ ___________________________ __________ __________ __________ __________ Amended: April 1, 2011 American LegalNet, Inc. www.FormsWorkFlow.com b. Child's Name: _______________________ Place of Birth: _____________________ Date of Birth: _______________________ Sex: Male Female Check this box if the information requested below would be the same as in subsection 2a and skip to the next question. Period of Residence Check if Person(s) With Whom Child Lived Relationship Confidential (name & address) Address ___________________________ _______ to present Confidential? ___________________________ __________ Address ___________________________ _______ to ________ Confidential? ___________________________ __________ Address ___________________________ _______ to ________ Confidential? ___________________________ __________ Address ___________________________ _______ to ________ Confidential? ___________________________ __________ c. Child's Name: _______________________ Place of Birth: _____________________ Date of Birth: _______________________ Sex: Male Female Check this box if the information requested below would be the same as in subsection 2a and skip to the next question. Period of Residence Check if Person(s) With Whom Child Lived Relationship Confidential (name & address) Address ___________________________ _______ to present Confidential? ___________________________ __________ Address ___________________________ _______ to ________ Confidential? ___________________________ __________ Address ___________________________ _______ to ________ Confidential? ___________________________ __________ Address ___________________________ _______ to ________ Confidential? ___________________________ __________ IF MORE SPACE IS NEEDED FOR ADDITIONAL CHILDREN, ATTACH A SEPARATE PAGE AND CHECK THIS BOX . 3. Participation in custody case(s): (Check only one box.) I HAVE NOT participated as a party, witness, or in any capacity in any other case, in this or any other state, concerning the custody of, or visitation (parenting time), with any child subject to this case. I HAVE participated as a party, witness, or in any capacity in any other case, in this or any other state, concerning the custody of, or visitation (parenting time), with any child subject to this case. For each case in which you participated, give the following information: a. Name of each child: _________________________________________________________________ __________________________________________________________________________________ b. Type of case: ______________________________________________________________________ c. Court and State: ____________________________________________________________________ d. Date and court order or judgment (if any): ______________________________________________ __________________________________________________________________________________ IF MORE SPACE IS NEEDED FOR ADDITIONAL CUSTODY CASES, ATTACH A SEPARATE PAGE AND CHECK THIS BOX . PAGE 2 OF FORM 10.01-F: INFORMATION FOR PARENTING PROCEEDING AFFIDAVIT (R.C. 3127.23(A) Amended: April 1, 2011 American LegalNet, Inc. www.FormsWorkFlow.com 4. Information about other custody case(s) that could affect this case: (Check only one box.) I HAVE NO INFORMATION about any other civil case that could affect the current case, including any cases relating to custody, domestic violence or protection orders, dependency, neglect or abuse allegations or adoptions concerning any child subject to this case. I HAVE THE FOLLOWING INFORMATION concerning other civil cases that could affect the current case, including any cases relating to custody, domestic violence or protection orders, dependency, neglect or abuse allegations or adoptions concerning a child subject to this case. Do not repeat cases already listed in Paragraph 3. Explain: a. Name of each child: _________________________________________________________________ ___________________________________________________________________________________ b. Type of case: _________________________________________________________________ c. Court and State: _________________________________________________________________ d. Date and court order or judgment (if any): _______________________________________________ _________________________________________________________________________
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