MOTION FOR CONTEMPT ADAMS COUNTY, OHIO

MOTION FOR CONTEMPT ADAMS COUNTY, OHIO This packet of forms is intended to help you file a Motion for Contempt against a person who has violated an Order of the Adams County Domestic Relations Court. If you are filing a Motion for Contempt in a Domestic Relations Court case, the following forms must be filed FORMS YOU MUST COMPLETE Form Form Name Purpose and Instructions OH Sup. Ct. DR Form 21 Motion for Contempt Required to request contempt of a court order regarding parenting time, support, or other orders issued in the divorce decree or parenting time order. OH Sup. Ct. DR Show Cause Order, Notice and Instructions to the Required when filing a Motion Form 22 OH Sup. Ct. Affidavit 1/ Local Form 5 OH Sup. Ct. Affidavit 3 OH Sup. Ct. DR Form 26 Clerk Affidavit of Income and Expenses* Parenting Proceeding Affidavit* Explanation of Health Care Bills for Contempt. Complete this form IF the case involves spousal support or child support Complete this form IF the case involves custody or visitation of minor child(ren). Tells the Court where the children have lived for the last five years and the names of the adults responsible for their care during this five year period. (or since birth if under age 5). Complete this form IF you are claiming the other party has not paid health care bills. Local Form 12 Poverty Affidavit Tells the Court that you cannot afford to prepay the filing fee. You must sign at the Clerk s Office. OH Sup. Ct. Form 28 OH Sup. Ct. Form 27 Request for Service IF you do not know your spouse s address AND you are filing a poverty affidavit, you must check the box for Other on this form and write in posting so the clerk will serve by posting. Waiver of Service of Summons Required because the other party must be served with your Motion. This form tells the Court where to send the copies to the other party. Complete this form IF the other party agrees to waive service of the Motion(s) by signing this form.

Affidavit for Service* Use this ONLY if you do not know the other party s current address. Legal Notice for Service by Posting Use this form ONLY if you do not know the other party s current address. Provide this form to the Clerk of Court for posting in the courthouse. *Affidavits must be signed in front of a Notary who will administer an Oath INSTRUCTIONS All forms must either be typed or printed in ink. You must fill out the forms completely before filing them with the court. The court staff will not help you complete the forms. Make (1) copy of the following documents o Poverty Affidavit Make three (3) copies of all other forms Take the original and all copies to the Clerk of the Adams County Common Pleas Court (2 nd floor, 110 West Main Street, West Union, Ohio) NOTE If you did not complete the poverty affidavit, the filing fee is $ File all the documents you filled out EXCEPT the Show Cause Order, Notice and Instructions to the Clerk. After you have filed your documents, provide the Clerk with the Show Cause Order, Notice and Instructions to be filled out and signed by the Judge. The Clerk will give this form to the Judge to fill out, then file and have sent out to all parties for service. Once you file the forms, the Clerk will send you notice of any court dates. You must attend all of these court dates. NOTE If you move, call the Clerk with your new address IF YOU ARE FILING THE MOTION FOR CONTEMPT, THEN YOU MUST ATTEND THE COURT HEARING.

IN THE MATTER OF IN THE COURT OF COMMON PLEAS Division COUNTY, OHIO A Minor Name Case No. Street Address City, State and Zip Code Judge Plaintiff/Petitioner vs. Magistrate Name Street Address City, State and Zip Code Defendant/Petitioner Instructions This form is used to request the enforcement of a court order and hold the other party in contempt for violating the court order. A Request for Service (Uniform Domestic Relations Form 28) and a proposed Show Cause Order, Notice and Instructions to the Clerk (Uniform Domestic Relations Form 22) must be filed with this Motion. Check local court procedures. MOTION FOR CONTEMPT AND AFFIDAVIT I, (name), request an order for (other party s name) to appear and show cause why he/she should not be held in contempt for violating a court order and a finding of contempt for violating the court order regarding the following (check all that apply) 1. Interference with parenting time or other parenting orders filed on (date). 2. Failure to pay child support, as required by the order filed on (date) and the total arrearage owed is $ (Bring to the hearing an up-to-date printout from the County Child Support Enforcement Agency showing the amount of the child support owed to you.) 3. Failure to pay spousal support, as required by the order filed on (date) and the total arrearage owed is $ Uniform Domestic Relations Form 21 Uniform Juvenile Form 3 MOTION FOR CONTEMPT AND AFFIDAVIT Page 1 of 2 Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46 Effective Date 7/1/2013

(Bring to the hearing an up-to-date printout from the County Child Support Enforcement Agency or other independent proof showing the amount owed to you.) 4. Payment or reimbursement of health care expenses incurred for the minor child(ren). Attach an Explanation of Health Care Bills (Uniform Domestic Relations Form 26) and bring to the hearing the following documents a. Copies of each bill for which you seek reimbursement; b. Proof of payment by you. Proof of payment may include a receipt for payment signed by the health care provider, a copy of a cancelled check, or a copy of a credit card statement verifying the amount paid; and c. Explanation of Benefits forms showing payment made by the health insurance carrier. 5. Failure to comply with the Court's orders of (date) regarding (check all that apply) Transfer of real estate, as follows Payment of debt, as follows Refinance of debt, as follows Distribution of personal property, as follows Other (specify) 6. Costs and any other relief as necessary and proper are also requested. Your Signature Telephone number at which the Court may reach you or at which messages may be left for you OATH (Do not sign until Notary is present.) I, (name), swear or affirm that I have read this document and, to the best of my knowledge and belief, the facts and information stated in this document are true, accurate and complete. I understand that if I do not tell the truth, I may be subject to penalties for perjury. Your Signature Sworn before me and signed in my presence this day of,. Notary Public My Commission Expires Uniform Domestic Relations Form 21 Uniform Juvenile Form 3 MOTION FOR CONTEMPT AND AFFIDAVIT Page 2 of 2 Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46 Effective Date 7/1/2013

IN THE COURT OF COMMON PLEAS Division COUNTY, OHIO IN THE MATTER OF A Minor Name Case No. Street Address City, State and Zip Code Judge Plaintiff/Petitioner Magistrate vs./and Name Street Address City, State and Zip Code Defendant/Petitioner Instructions This form is used to bring the other party to Court to defend his/her failure to follow the court order. A Motion for Contempt and Affidavit (Uniform Domestic Relations Form 21) must be filed with this order. SHOW CAUSE ORDER, NOTICE AND INSTRUCTIONS TO THE CLERK TO PLAINTIFF/PETITIONER TO DEFENDANT/PETITIONER You are hereby ORDERED to appear and show cause why you should not be held in contempt for failure to obey the court order as described in the Motion you are now receiving. Uniform Domestic Relations Form 22 Uniform Juvenile Form 4 SHOW CAUSE ORDER, NOTICE AND INSTRUCTIONS TO THE CLERK Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46 Effective Date 7/1/2013 Page 1 of 3

COURT (The Court will complete this part.) You are ORDERED to appear in the Division, in Courtroom County Common Pleas Court located at on at o clock and show cause why you should not be held in contempt of this Court. NOTICE 1, Failure to appear as ordered may result in the issuance of a bench warrant for an immediate arrest. 2. Failure to appear may result in an immediate income withholding or deduction. 3. You have the right to be represented by an attorney. 4. If you cannot afford an attorney, you must apply for a public defender or appointed counsel, as appropriate, within three business days after receipt of this show cause order. 5. A continuance may not be granted to obtain counsel if you have made no good faith effort to secure one. 6. If found guilty, you may be sentenced as follows a. First offense a fine of not more than $250.00 and/or a definite term of imprisonment of not more than thirty days in jail or both. b. Second offense a fine of not more than $500.00 and/or a definite term of imprisonment of not more than sixty days in jail or both. c. Third offense a fine of not more than $1,000.00 and/or a definite term of imprisonment of not more than ninety days in jail or both. 7. The court may grant you limited driving privileges under 4510.021 of the Revised Code if your driver s license was suspended based on a notice issued by a child support enforcement agency because you are in default under a child support order or you have failed to comply with a subpoena or warrant issued by a court or agency with respect to a proceeding to enforce a child support order. You must request limited driving privileges and your request must be accompanied by a recent copy of your driver s abstract driving record from the registrar of motor vehicles. JUDGE/MAGISTRATE Uniform Domestic Relations Form 22 Uniform Juvenile Form 4 SHOW CAUSE ORDER, NOTICE AND INSTRUCTIONS TO THE CLERK Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46 Effective Date 7/1/2013 Page 2 of 3

1 INSTRUCTIONS TO THE CLERK You are directed to serve this Order along with the Motion for Contempt and Affidavit to the Defendant/Petitioner or Plaintiff/Petitioner by Certified Mail, Return Receipt Requested Issuance to Sheriff of County, Ohio for Personal or Residence service Other (specify) JUDGE/MAGISTRATE Uniform Domestic Relations Form 22 Uniform Juvenile Form 4 SHOW CAUSE ORDER, NOTICE AND INSTRUCTIONS TO THE CLERK Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46 Effective Date 7/1/2013 Page 3 of 3

COURT OF COMMON PLEAS COUNTY, OHIO Plaintiff/Petitioner v./and Case No. Judge Magistrate Defendant/Petitioner Instructions Check local court rules to determine when this form must be filed. This affidavit is used to make complete disclosure of income, expenses and money owed. It is used to determine child and spousal support amounts. Do not leave any category blank. Write none where appropriate. If you do not know exact figures for any item, give your best estimate, and put EST. If you need more space, add additional pages. SECTION I - INCOME Affidavit of Date of marriage AFFIDAVIT OF INCOME AND EXPENSES (Print Your Name) Husband Date of separation Wife Employed Yes No Yes No Employer Payroll address Payroll city, state, zip Scheduled paychecks per year 12 24 26 52 12 24 26 52 A. YEARLY INCOME, OVERTIME, COMMISSIONS AND BONUSES FOR PAST THREE YEARS Husband Wife Base yearly income $ 3 years ago 20 $ $ 2 years ago 20 $ $ Last year 20 $ Yearly overtime, commissions and/or bonuses $ 3 years ago 20 $ $ 2 years ago 20 $ $ Last year 20 $ Uniform Domestic Relations Form Affidavit 1 Affidavit of Income and Expenses Approved under Ohio Civil Rule 84 Effective Date July 1, 2010 Page 1 of 7

B. COMPUTATION OF CURRENT INCOME Husband Wife Base yearly income $ $ Average yearly overtime, commissions and/or bonuses over last 3 years (from part A) $ $ Unemployment compensation $ $ Disability benefits Workers Compensation Social Security Other $ $ Retirement benefits Social Security Other $ $ Spousal support received $ $ Interest and dividend income (source) Other income (type and source) $ $ $ $ TOTAL YEARLY INCOME $ $ Supplemental Security Income (SSI) or public assistance $ $ Court-ordered child support that you receive for minor and/or dependent child(ren) not of the marriage or relationship $ $ Uniform Domestic Relations Form Affidavit 1 Affidavit of Income and Expenses Approved under Ohio Civil Rule 84 Effective Date July 1, 2010 Page 2 of 7

SECTION II CHILDREN AND HOUSEHOLD RESIDENTS Minor and/or dependent child(ren) who are adopted or born of this marriage or relationship Name Date of birth Living with In addition to the above children there is/are in your household adult(s) other minor and/or dependent child(ren). SECTION III EXPENSES List monthly expenses below for your present household. A. MONTHLY HOUSING EXPENSES Rent or first mortgage (including taxes and insurance) $ Real estate taxes (if not included above) $ Real estate/homeowner s insurance (if not included above) $ Second mortgage/equity line of credit $ Utilities o Electric $ o Gas, fuel oil, propane $ o Water and sewer $ o Telephone $ o Trash collection $ o Cable/satellite television $ Cleaning, maintenance, repair $ Lawn service, snow removal $ Other $ $ TOTAL MONTHLY $ Uniform Domestic Relations Form Affidavit 1 Affidavit of Income and Expenses Approved under Ohio Civil Rule 84 Effective Date July 1, 2010 Page 3 of 7

B. OTHER MONTHLY LIVING EXPENSES Food o Groceries (including food, paper, cleaning products, toiletries, other) $ o Restaurant $ Transportation o Vehicle loans, leases $ o Vehicle maintenance (oil, repair, license) $ o Gasoline $ o Parking, public transportation $ Clothing o Clothes (other than children s) $ o Dry cleaning, laundry $ Personal grooming o Hair, nail care $ o Other $ Cell phone $ Internet (if not included elsewhere) $ Other $ C. MONTHLY CHILD-RELATED EXPENSES (for children of the marriage or relationship) TOTAL MONTHLY $ Work/education-related child care $ Other child care $ Unusual parenting time travel $ Special and unusual needs of child(ren) (not included elsewhere) $ Clothing $ School supplies $ Child(ren) s allowances $ Extracurricular activities, lessons $ School lunches $ Other $ TOTAL MONTHLY $ Uniform Domestic Relations Form Affidavit 1 Affidavit of Income and Expenses Approved under Ohio Civil Rule 84 Effective Date July 1, 2010 Page 4 of 7

D. INSURANCE PREMIUMS Life $ Auto $ Health $ Disability $ Renters/personal property (if not included in part A above) $ Other $ E. MONTHLY EDUCATION EXPENSES Tuition TOTAL MONTHLY $ o Self $ o Child(ren) $ Books, fees, other $ College loan repayment $ Other $ F. MONTHLY HEALTH CARE EXPENSES (not covered by insurance) $ TOTAL MONTHLY $ Physicians $ Dentists $ Optometrists/opticians $ Prescriptions $ Other $ G. MISCELLANEOUS MONTHLY EXPENSES $ TOTAL MONTHLY $ Extraordinary obligations for other minor/handicapped child(ren) (not stepchildren) $ Child support for children who were not born of this marriage or relationship and were not adopted of this marriage $ Spousal support paid to former spouse(s) $ Subscriptions, books $ Entertainment $ Charitable contributions $ Memberships (associations, clubs) $ Uniform Domestic Relations Form Affidavit 1 Affidavit of Income and Expenses Approved under Ohio Civil Rule 84 Effective Date July 1, 2010 Page 5 of 7

Travel, vacations $ Pets $ Gifts $ Bankruptcy payments $ Attorney fees $ Required deductions from wages (excluding taxes, Social Security and Medicare) (type) $ Additional taxes paid (not deducted from wages) (type) $ Other $ $ TOTAL MONTHLY $ H. MONTHLY INSTALLMENT PAYMENTS (Do not repeat expenses already listed.) Examples car, credit card, rent-to-own, cash advance payments To whom paid Purpose Balance due Monthly payment $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ TOTAL MONTHLY $ GRAND TOTAL MONTHLY EXPENSES (Sum of A through H) $ Uniform Domestic Relations Form Affidavit 1 Affidavit of Income and Expenses Approved under Ohio Civil Rule 84 Effective Date July 1, 2010 Page 6 of 7

OATH (Do not sign until notary is present.) I, (print name), swear or affirm that I have read this document and, to the best of my knowledge and belief, the facts and information stated in this document are true, accurate and complete. I understand that if I do not tell the truth, I may be subject to penalties for perjury. Your Signature Sworn before me and signed in my presence this day of,. Notary Public My Commission Expires Uniform Domestic Relations Form Affidavit 1 Affidavit of Income and Expenses Approved under Ohio Civil Rule 84 Effective Date July 1, 2010 Page 7 of 7

COURT OF COMMON PLEAS COUNTY, OHIO Plaintiff/Petitioner v./and Case No. Judge Magistrate Defendant/Petitioner/Respondent Instructions Check local court rules to determine when this form must be filed. 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 Dissolutions, Divorces and Domestic Violence Petitions. 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. Check and complete ALL THAT APPLY PARENTING PROCEEDING AFFIDAVIT (R.C. 3127.23(A)) Affidavit of (Print Your Name) 1. 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 years. a. Child s Name Place of Birth Date of Birth Sex Male Female Check if Period of Residence Person(s) With Whom Child Lived Confidential (name & address) Address to present Confidential? Relationship to to to Address Confidential? Address Confidential? Address Confidential? Uniform Domestic Relations Form Affidavit 3 Parenting Proceeding Affidavit Approved under Ohio Civil Rule 84 Effective Date July 1, 2010 Page 1 of 4

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 Confidential Person(s) With Whom Child Lived (name & address) Relationship to to to to present Address Confidential? Address Confidential? Address Confidential? Address 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 Confidential Person(s) With Whom Child Lived (name & address) Relationship to to to to present Address Confidential? Address Confidential? Address Confidential? Address 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 Uniform Domestic Relations Form Affidavit 3 Parenting Proceeding Affidavit Approved under Ohio Civil Rule 84 Effective Date July 1, 2010 Page 2 of 4

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. 4. Information about other civil case(s) that could affect this case (Check only one box.) I HAVE NO INFORMATION about any 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 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) IF MORE SPACE IS NEEDED FOR ADDITIONAL CASES, ATTACH A SEPARATE PAGE AND CHECK THIS BOX. 5. Information about criminal case(s) List all of the criminal convictions, including guilty pleas, for you and the members of your household for the following offenses any criminal offense involving acts that resulted in a child being abused or neglected; any domestic violence offense that is a violation of R.C. 2919.25; any sexually oriented offense as defined in R.C. 2950.01; and any offense involving a victim who was a family or household member at the time of the offense and caused physical harm to the victim during the commission of the offense. Name Case Number Court/State/County Convicted of What Crime? IF MORE SPACE IS NEEDED FOR ADDITIONAL CASES, ATTACH A SEPARATE PAGE AND CHECK THIS BOX. Uniform Domestic Relations Form Affidavit 3 Parenting Proceeding Affidavit Approved under Ohio Civil Rule 84 Effective Date July 1, 2010 Page 3 of 4

6. Persons not a party to this case who has physical custody or claims to have custody or visitation rights to children subject to this case (Check only one box.) I DO NOT KNOW OF ANY PERSON(S) not a party to this case who has/have physical custody or claim(s) to have custody or visitation rights with respect to any child subject to this case. I KNOW THAT THE FOLLOWING NAMED PERSON(S) not a party to this case has/have physical custody or claim(s) to have custody or visitation rights with respect to any child subject to this case. a. Name/Address of Person Has physical custody Claims custody rights Claims visitation rights Name of each child b. Name/Address of Person Has physical custody Claims custody rights Claims visitation rights Name of each child c. Name/Address of Person Has physical custody Claims custody rights Claims visitation rights Name of each child OATH (Do Not Sign Until Notary is Present) I, (print name), swear or affirm that I have read this document and, to the best of my knowledge and belief, the facts and information stated in this document are true, accurate and complete. I understand that if I do not tell the truth, I may be subject to penalties for perjury. Your Signature Sworn before me and signed in my presence this day of,. Notary Public My Commission Expires Uniform Domestic Relations Form Affidavit 3 Parenting Proceeding Affidavit Approved under Ohio Civil Rule 84 Effective Date July 1, 2010 Page 4 of 4

Name of Child Case No. Instructions This form is used when you are claiming the other party has not paid health care bills. Use a separate form for each child. A Motion for Contempt and Affidavit (Uniform Domestic Relations Form 21) and a Show Cause Order, Notice and Instructions to the Clerk (Uniform Domestic Relations Form 22) must be filed. You must bring copies of health care bills, Explanation of Benefits forms, and proof of payment to the hearing. Be prepared to indicate the amount owed to you, service providers, collection agencies, or other entities. If more space is needed, add additional pages. EXPLANATION OF HEALTH CARE BILLS Date of Treatment Name of Service Provider (e.g., Doctor, Dentist, Therapist, Hospital) & Services Provided Total Bill Date Bill Sent to Other Party Amount Insurance Paid Amount You Paid Amount Paid by Other Party Amount of Unpaid Bill Amount Due from Other Party Your Signature Date Total Amount of Claim $ Uniform Domestic Relations Form 26 Uniform Juvenile Form 8 EXPLANATION OF HEALTH CARE BILLS Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46 Effective Date 7/1/2013

IN THE ADAMS COUNTY COURT OF COMMON PLEAS DOMESTIC RELATIONS DIVISION, PLAINTIFF v. CASE NUMBER JUDGE BRETT M. SPENCER MAGISTRATE JAMES W. SCHLUETER DEFENDANT I, being duly sworn sayeth POVERTY AFFIDAVIT 1. I am a party in the foregoing action; 2. I am without the funds or assets to give security or a cash deposit to secure costs at this time. 3. I understand that I must inform the court if my financial situation should change before the disposition of my case; 4. I understand that I am subject to criminal charges for providing false information; 5. I understand that if it is determined by the court, that I was not entitled to the suspended deposit/costs that were provided to me, I may be required to reimburse the county for the costs; 6. I understand that the court will ultimately determine which party will be responsible for the payment of costs in this case, unless costs are waived. Affiant Sworn before me and subscribed in my presence this day of, 20. Notary Public

IN THE COURT OF COMMON PLEAS Division COUNTY, OHIO IN THE MATTER OF A Minor Name Case No. Street Address Judge City, State and Zip Code Plaintiff/Petitioner Magistrate vs./and Name Street Address City, State and Zip Code Defendant/Petitioner Instructions This form is used when you want to request documents to be served on the other party. You must indicate the requested method of service by marking the appropriate box. REQUEST FOR SERVICE TO THE CLERK OF COURT Please serve the following documents on the following parties as I have indicated below Defendant/Petitioner at the address shown above. Certified Mail, Return Receipt Requested Issuance to Sheriff of County, Ohio for Personal or Residence service Other (specify) Uniform Domestic Relations Form 28 Uniform Juvenile Form 10 REQUEST FOR SERVICE Page 1 of 2 Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46 Effective Date 7/1/2013

Plaintiff/Petitioner at the address shown above. Certified Mail, Return Receipt Requested Issuance to Sheriff of County, Ohio for Personal or Residence service Other (specify) County Child Support Enforcement Agency (provide address below) Certified Mail, Return Receipt Requested Issuance to Sheriff of County, Ohio for Personal or Residence service Other (specify) Other (address) Certified Mail, Return Receipt Requested Issuance to Sheriff of County, Ohio for Personal or Residence service Other (specify) SPECIAL INSTRUCTIONS TO SHERIFF Your Signature Uniform Domestic Relations Form 28 Uniform Juvenile Form 10 REQUEST FOR SERVICE Page 2 of 2 Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46 Effective Date 7/1/2013

IN THE COURT OF COMMON PLEAS Division COUNTY, OHIO IN THE MATTER OF A Minor Plaintiff/Petitioner Case No. Street Address Judge City, State and Zip vs. Magistrate Defendant/Respondent/Petitioner Street Address City, State and Zip Code WAIVER OF SERVICE OF SUMMONS I, (name), acknowledge that I am the Petitioner Plaintiff Defendant Respondent (select one) and that I have received a copy of the following documents filed or to be filed by the other party Complaint for Parentage Complaint Motion (select one) for Allocation of Parental Rights and Responsibilities (Custody) Complaint Motion (select one) for Parenting Time (Companionship and Visitation) Complaint Motion (select one) for Establishment or Change of Child Support Journal Entry and Findings of Fact Supporting Child Support Deviation Health Insurance Affidavit Complaint for Divorce with Children Complaint for Divorce without Children Separation Agreement Shared Parenting Plan Parenting Plan Petition for Dissolution Agreed Judgment Entry, Magistrate s Decision, Order, and/or Magistrate s Order Affidavit of Income and Expenses Uniform Domestic Relations Form 27 Uniform Juvenile Form 9 Page 1 of 2 WAIVER OF SERVICE OF SUMMONS Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46 Effective Date 7/1/2013

Affidavit of Property Parenting Proceeding Affidavit Motion for Contempt and Affidavit Motion and Affidavit or Counter Affidavit for Temporary Orders with Oral Hearing Other (specify) I waive service of summons of said document by the Clerk of Court. Date Your Signature Telephone number at which the Court may reach you or at which messages may be left for you Uniform Domestic Relations Form 27 Uniform Juvenile Form 9 Page 2 of 2 WAIVER OF SERVICE OF SUMMONS Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46 Effective Date 7/1/2013

IN THE COURT OF COMMON PLEAS, ADAMS COUNTY, OHIO DOMESTIC RELATIONS DIVISION Case No. vs. Plaintiff, Defendant. JUDGE SPENCER Magistrate Schlueter AFFIDAVIT FOR SERVICE PURSUANT TO O.R.C. 4.4(A)(2) I, being first duly sworn and cautioned, depose and state as follows 1. I have filed for a contempt and am not able to prepay the filing fees; 2. I do not know the current address of the plaintiff/defendant (circle one); 3. I have made efforts to determine the plaintiff s/defendant s (circle one) current address but have been unable to do so; 4. The plaintiff s/defendant s (circle one) residence cannot be learned with reasonable effort 5. The plaintiff s/defendant s (circle one) last known mailing address is Affiant STATE OF OHIO, COUNTY OF, SS Sworn to before me and signed in my presence this day of,20.

IN THE COURT OF COMMON PLEAS ADAMS COUNTY, OHIO Case No. JUDGE BRETT M. SPENCER Plaintiff MAGISTRATE JAMES W. SCHLUETER vs. LEGAL NOTICE FOR SERVICE BY POSTING Defendant To Plaintiff/Defendant Plaintiff/Defendant (circle one) has brought this action naming you as a party in the above named Court by filing a Motion for contempt on the day of, 20 in the Adams County Court of Common Pleas, Division of Domestic Relations, located at the Courthouse, West Union, Ohio. The object of the Motion is that Plaintiff/Defendant (circle one) be granted a contempt against you and for any other relief whether at law or equity which this Court shall deem proper and just. The Plaintiff/Defendant knew your last address to be. You are required to answer the Motion within twenty-eight (28) days after the last publication of this office, which will be posted at the required location for six successive weeks. The date last posted will be, 20. Page 1 of2

In case of your failure to answer or otherwise respond as permitted by the Ohio Rules of Civil Procedure within the time stated, judgment will be rendered against you for the relief demanded in the Motion. Plaintiff/Defendant (circle one) Clerk of Courts Page 2 of2

Preparing Your Case If you do decide to represent yourself, you need to manage all aspects of your case. Familiarize yourself with the local court rules. Rules and procedures vary slightly from court to court, and you need to know the rules that apply in the court that will hear your case. Obtain a copy of the local rules from your court. Make sure your filings and documents conform to local standards. Generic forms and sample filings are available in books and on the internet. However, these generic documents may not conform to the standards of the court that will hear your case. To make sure that your documents will be accepted, ask your court for forms and sample filings. Respond to all inquiries on time. During trial preparations, you may receive inquiries from the court or the opposing party. For example, the opposing party may be entitled to discovery to learn about evidence or testimony you plan to introduce (you may be entitled to the same). If you fail to respond to such inquiries, you may limit your ability to present your case. Rules about admissible evidence are complicated. There are many possible reasons that evidence or testimony you think is relevant and important may not be admissible in court. Since questions about what evidence is admissible are legal questions that are often contested, neither court staff nor the judge may answer them ahead of time. This can be frustrating for non-attorneys if your case will involve contested evidence, consider again whether you need an attorney. Make sure evidence you plan to use will be acceptable and available in court. If your case will involve evidence documents, pictures, cost estimates, receipts, or other items you must prepare it for court use. In particular, you must bring at least three copies of all documents (for the court, for the opposing party, and for yourself); and be able to verify that documents are what you say they are or contain accurate information. Make sure any witnesses are prepared and available in court. If your case will involve testimony from witnesses, you need to work with them before you and they appear in court. Make sure your witnesses know what you will ask, and instruct them to answer truthfully. And remember that your witnesses must be present at your trial (they may not, for example, prepare written statements or appear by telephone); and prepared to answer questions from the opposing party or his or her attorney. When you decide to represent yourself, you take on full responsibility for your case. You need to handle legal questions as well as deadlines, documents, evidence, witnesses, and any other issues that may come up. Even a seemingly simple case can demand a lot of your time and attention. In the Courtroom At the trial or hearing itself, you need to present your case in its strongest way. Here are some simple tips Make a good impression. Dress appropriately. Arrive on time with all your materials. Respect the court. Stand when the judge enters or leaves the courtroom and when you speak to the judge. Address the judge as Your Honor. Respect the opposing party. Never argue with the opposing party in front of the judge. Use respectful terms of address. Speak clearly and succinctly. Be prepared to state your case in a few sentences. Listen carefully and answer questions directly. Be prepared. Courts are very busy. You want to present your case in the strongest way, but you also want to help the proceedings move efficiently. The better prepared you are, the better the case will go. The Role of the Judge Your case will be heard and decided by a judge (or a magistrate). Keep in mind that the role of the judge is to be an impartial referee in the dispute between you and the opposing party. Among other things, this means that The judge may not help you present your case. Helping you by pointing out possible mistakes or by letting you know what you need to do next would be unfair to the opposing party. When you represent yourself, you take on the full responsibility of presenting your case. The judge may not speak with you about your case when the opposing party is not present. This is true even if the issue you want to speak with the judge about seems like a simple procedural question. Again, such communications would be unfair to the opposing party. The judge will decide the case on the basis of the facts presented in court and the applicable law. The judge may only consider the facts as they are presented in court, through evidence and testimony. You need to make sure that all facts supporting your case are properly presented. The judge also needs to follow the laws that apply. Sometimes the law dictates which facts the judge may and may not consider. You need to make sure that you present the facts that the law requires or permits.

Legal Advice It is always a good idea to consult with an attorney and be represented by an attorney in court. The law is complex. Attorneys are trained professionals who understand the law and how it relates to your case. Even matters that initially look simple may raise complicated issues. Your interests will be best protected by a legal professional. Attorneys can be expensive, but consider this What might you lose if your case goes badly? Paying for an attorney may be a good investment. Meet with several attorneys to discuss your case and their fees don t let one consultation make up your mind. You may qualify for legal aid or help from legal clinics or other programs be sure to investigate the resources in your community. Ohio courts and judges will provide a fair hearing for your case whether or not you are represented by an attorney, and it is your right to represent yourself if you so choose. When you bring a case to court without the help of an attorney, you are taking on a complex task that is normally done by highly trained professionals. You may do yourself a disservice. Asking Court Staff Court staff may not give legal advice. You may have questions that court staff are not permitted to answer. Court staff may not provide you with legal research; tell you what sorts of claims to file or what to put on forms; tell you what to say in court; give an opinion about how a judge is likely to decide your case; give you information that they would not give to the opposing party; tell you about a judge s decision before it is issued by the judge. Court staff may answer questions about how the court works; explain terms used in the court process; give you information from your case file; provide you with court forms and sample filings and documents. Court staff are there to help those who use the court. They can usually tell you how to do things, but may not advise you about what you ought to do. Please be courteous to staff and respect the limits on what they may do for you. REPRESENTING YOURSELF IN COURT A CITIZENS GUIDE For help with finding an attorney, you might turn to your local bar association. Your local bar association is Prepared by Ohio Judicial Conference 65 South Front Street www.ohiojudges.org Columbus, OH 43215-3431

Representing Yourself in Court? How to Use Photographs, Letters, Business Records, and Other Evidence to Help Prove Your Case What is Evidence? Evidence is anything you use to prove your claim. Evidence can be a photograph, a letter, documents or records from a business, and a variety of other things. All evidence that is properly admitted will be considered by the judge. Your case probably will be decided by a judge. If there is a jury, it will look at admitted exhibits during its deliberations. For example In a request for change of custody, the child s school records could be introduced as evidence that the child s grades have dropped or he/she has missed a significant amount of school while living with the other parent. In a domestic violence or stalking civil protection order case, a photograph of any injury you suffered or a threatening letter written by your abuser may help your case. In a divorce case, a copy of tax return documents or documents showing who has title to a car may be introduced as evidence.

Why Use Evidence? Ø Evidence is more believable and trustworthy than what a person says. For example, in a domestic violence case, if you say that your ex-boyfriend has left you threatening messages but he testifies that this is an absolute lie, the judge may not know whom to believe. However, if you submit a tape recording of one of these messages the judge will be more likely to believe you. Ù Evidence may make something easier to understand. A picture is worth a thousand words. Some things are hard to explain in words, while a drawing or photograph is descriptive and clear. How Do I Present Evidence to the Court? Each court is different, but in most courts, you can t just walk into court with a photograph or document and show it to the judge or jury. There are many things you must do before the court will even look at the evidence you have. Further, there are many different types of evidence, and the rules for using each type of evidence are different. Once you follow these rules, your evidence will be admitted. Steps to Follow to Admit Evidence º Before you ever go to court, think about the evidence you want to use to prove your case. Mark each piece of evidence with an exhibit number (attach a sticker labeled Exhibit 1, Exhibit 2, etc.) Exhibit 1 º Bring these marked Exhibits with you to court. When you want to show the court one of the exhibits, do the following things ì Show the exhibit to the other party or the other party s attorney. í Then lay the foundation for the evidence. To do this, you must show that the evidence is relevant to your case and authentic (not a forgery). Depending upon what you want the court to consider, follow the rules listed in this pamphlet for laying the foundation - explaining why and how the exhibit is connected to your case. Ú Either you or your witness must testify about the exhibit. Û Ask the court to admit the exhibit into evidence. The other party or attorney may object to the exhibit for some reason. Try to answer these objections as best you can. If you can t, let the judge decide. Ü If there are no objections from the other party, or the judge has ruled in your favor, ask the court to admit the Exhibit into evidence.

Laying the Foundation for Photographs 1. Explain why a photo is connected to your case. For example This photo shows the injury I suffered after my ex-boyfriend punched and kicked me. 2. Explain how you know about what is in the photo. For example I had my sister take this photograph within 2 hours after the incident occurred and went to get the film developed myself the following day. 3. Explain that the photo is timely. For example At the bottom right-hand corner of the photo is the date on which it was taken. As you can see, the photo was taken on the same day that the incident occurred, which is also the same day the police arrested my ex-boyfriend. 4. Explain that the photo fairly and accurately shows what is depicted in the photo as it appeared on the date relevant to your case. For example This photo is a fair and accurate depiction of how my face and side looked two hours after the incident and for the next two weeks. Foundation for Letters 1. Explain why the letter is connected to your case. For example This is the letter that I received from my ex-boyfriend shortly before he beat me up." 2. Explain when and how you got the letter. For example This letter was shoved under the door to my apartment some time before 6 p.m. on Wednesday, January 2, 2001. I found it on the floor when I came home from work that day. TIP When using photographs, it is best to use color photos and enlarge them, if possible. 3. Prove that the signature is that of a party to the case. Ways to prove this Explain to the court that you are familiar with the other party s signature, how you came to know that person s signature, and that it is your opinion that the signature on the letter is the other party s signature.

Call a witness who is familiar with the party s signature, and ask the witness Do you know the other party in this case? Are you familiar with the party s signature? How? Then show them the letter and ask Is this the other party s signature? Call the person who signed the letter. Show the witness the document, and ask the witness if that is his or her signature. (Only do this if you think they will admit to it). 4. Explain that the letter is in the same condition now as when you received it. ( The letter was kept in a safe place and nothing has been changed since I received it. ) Laying the Foundation for Documents and Records From Businesses 1. Explain how the document or record is related to your case. 2. Call a witness from the business/agency that produced the record, ask the witness what his or her responsibilities are at the business/agency and how he or she is involved in record keeping. 3. Show the witness the record and ask him/her if it is a record from the business/agency. 4. Ask the witness Was the record made by a person with knowledge of the acts or events appearing on it. Was the record made at or near the time of the acts or events appearing on it. Is it the regular practice of the business/agency to make such a record, and Was the record kept in the course of a regularly conducted business activity. TIPS Do not read anything from the letter until the court has admitted it into evidence. If the other party objects to the letter saying that it is hearsay, respond by saying The letter shows the letter writer s state of mind. TIP If the record is certified (a statement is attached to the record stating that it is in fact a record from a public agency or it has an agency seal on it) you do not need to do anything before you show it to the judge. Just let the judge know it is certified. Created by NAPIL Equal Justice Fellow, Ohio State Legal Services Association 1/2001 OSLSA

In addition to the forms in this packet, you may find additional forms and informational pamphlets to help you on the internet at the following website www.ohiolegalhelp.org Click on Statewide Forms and Information Locate and click on the legal area that you would like to review use the search this site box if you are not sure which area to review You can also search this website to learn how to access the local legal services program for your area