CSEA Case Designation Form

Summit County Court of Common Pleas Domestic Relations Division Print Form Reset Form CSEA CASE DESIGNATION FORM Case No: SETS No: Instructions: Pursuant to Summit County Court of Common Pleas - Domestic Relations order filed March 1st, 2007, this form must be completed and submitted with any new cause of action filed with the Summit County Clerk of Courts. For Summit County CSEA use only. Case Type: (e.g., Paternity, Support, Mistake of Fact, Modification, Contempt, Termination of Support Order, etc) Plaintiff Information: First Name: Last Name: Address Middle Initial Suffix Defendant Information: First Name: Last Name: Address Middle Initial Suffix City SSN: Telephone: State DoB: Zip City SSN: Telephone: State DoB: Zip (if unrepresented) (if unrepresented) CSEA Proseucting Attorney Information: Prosecutor Name: Ohio Sup Ct # Firm Name: Address Telephone: Defendant Attorney Information: (if known) Attorney Name: Ohio Sup Ct # Firm Name: Address Telephone: City State Zip City State Zip Child Information: 1st Child Name: Address 2nd Child Name: Address 3rd Child Name: Address City City DoB: State Zip City DoB: State Zip DoB: State Zip Check if additional space is needed to list children related to these proceedings. Complete and submit form DR002: Additional Children. Prosecuting Attorney Signature DR Form 006 American LegalNet, Inc. www.FormsWorkFlow.com Rev 1.1 02/06/2013