MEDINA COUNTY COURT OF COMMON PLEAS

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					                MEDINA COUNTY COURT OF COMMON PLEAS
                     DOMESTIC RELATIONS DIVISION
                        JUDGE MARY R. KOVACK

         DOCUMENTS CHECKLIST IN PARENTAGE CASES


PARENTAL RIGHTS (CUSTODY)
       Administrative Order Establishing Paternity or Acknowledgment Affidavit (if new case)
       Complaint to Establish Parental Rights or Motion to Modify Parental Rights
       Affidavit of Child Custody Information
       Service Instructions
       Filing Fee ($75.00) or Poverty Affidavit

PARENTING TIME (VISITATION, COMPANIONSHIP)
    Administrative Order Establishing Paternity or Acknowledgment Affidavit (if new case)
    Motion
    Affidavit of Child Custody Information
    Service Instructions
    Filing Fee ($75.00) or Poverty Affidavit

ESTABLISH OR MODIFY CHILD SUPPORT
     Administrative Order Establishing Support (if a new case)
     Motion
     Service Instructions
     Filing Fee ($75.00) or Poverty Affidavit
     Financial Documents (such as tax returns and pay stubs) Bring to hearing

SHOW CAUSE (CONTEMPT)
    Motion
    Summons
    Order to Appear (Court will fill in date)
    Service Instructions
    Filing Fee ($75.00) or Poverty Affidavit

GRANDPARENT POWER OF ATTORNEY OR CARETAKER AFFIDAVIT
    Completed packet (can be obtained at Juvenile Court, Civil Office)
                  MEDINA COUNTY COURT OF COMMON PLEAS
                       DOMESTIC RELATIONS DIVISION
                          JUDGE MARY R. KOVACK

                         FILING COURT DOCUMENTS
GENERAL INFORMATION: A filing fee of $75.00 is required for most actions,
payable by cash, check, credit card or money order. If you cannot pay the fee, you may
fill out a Poverty Affidavit and make arrangements to pay monthly, provided a lawyer
who you are paying does not represent you.

Follow the attached checklist for the action you want to file, and mail or bring in all the
listed paperwork. You will receive copies of everything you file. Incomplete
paperwork may mean the matter will not go forward.

If you have questions and want to speak with somebody at Court, you may call (330)
725-9740 and press 0. Court staff can answer questions, but cannot offer legal advice.

Domestic Relations Court maintains a Legal Resource Center, located in the court on the
second floor of the Old Courthouse. The center includes books, forms and computer
programs. If you want help with legal procedures, volunteer lawyers are available at the
center during scheduled hours. Check the court’s website for dates and times at
www.medinadomesticrelations.org and choose Community Services from the menu. The
staff attorney for the Legal Resource Center can be reached at 330-764-8896.

COMPLAINT/MOTION: If the case has not been filed in this Court before, the person
filing is the Plaintiff. Leave the case number blank.

If there is a prior case file in Juvenile Court or Domestic Relations Court, follow the way
it was captioned previously, including the case number.

Check or write in the action you want to file. Write out what you are asking the Court to
do clearly in the Explanation. Sign your name and print your address and telephone
number.

If the Document Checklist states that you need a copy of an Administrative Order, you
should be able to get it from the Child Support Enforcement Agency (CSEA) in the
county that issued the order.

INSTRUCTIONS FOR SERVICE: Fill in the other party’s name and complete address,
including zip code. On the “Papers to Be Served” line, write in the title of all the
documents you want sent to the other party. Sign the instructions.

If you receive a Notice of Failure of Service from the Court, you are responsible for filing
new instructions. Your case cannot proceed until all parties are served with the
documents.
AFFIDAVIT OF CHILD CUSTODY INFORMATION: This form must be notarized.
Fill in your own information and as much of the other person’s information as you can.
You must complete questions 1, 2, 3 and 4 with as much information as possible.

If you answer any of questions 5, 6, 7, 8 or 9 by indicating you have information, you
must provide specific information in the space provided on page 3. Include the name of
the case, the name of the court that is handling the case and the case number if that
information is relevant.
                      IN THE COURT OF COMMON PLEAS
                           DOMESTIC RELATIONS
                           MEDINA COUNTY, OHIO



______________________________                   CASE NO.
______________________________
______________________________
Plaintiff/Petitioner 1                           JUDGE MARY R. KOVACK
        v.
______________________________
______________________________                   COMPLAINT/MOTION FOR
______________________________
Defendant/Petitioner 2                           ___________________________




Now comes ____Plaintiff_____Defendant____Petitioner and requests that the Court
issue an Order for the following:

_____ Establishment or modification of residential parent and legal custodian

_____ Establishment or modification of parenting time, companionship or visitation

_____ Establishment or modification of Shared Parenting Plan

_____ Show cause (contempt) for ___________________________________________

_____ Establishment or modification of child support

______Establishment of paternity

_____ Other ___________________________________________________________
                       EXPLANATION FOR FILING
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________


                                                    ______________________________
                                                    Signature
                                                    ______________________________
                                                    ______________________________
                                                    ______________________________
                                                    Address and telephone number


                          INSTRUCTIONS FOR SERVICE


Please serve _______________________________(other party) at the following address:




Papers to be Served [PLEASE BE SPECIFIC]: _________________________________



As follows:
              ____Certified mail and regular mail

              ____Personal service (provide a description of person to be served)



________________________________________________________________________
                                   IN THE COURT OF COMMON PLEAS
                                     DOMESTIC RELATIONS DIVISION
                                        MEDINA COUNTY, OHIO

DECLARATION UNDER UNIFORM CHILD CUSTODY                                      Case No. ____________________
JURISDICTION AND ENFORCEMENT ACT (UCCJEA)

I, (full legal name)________________________________________, being sworn according to law, certify
that
these proceedings involve the custody of a child, or children and the following statements are true:

1. [ ] I am requesting the court to not disclose my address or that of the child(ren). My address is confidential
pursuant to ORC 3127.23(D) and should be placed under seal in that the health, safety, or liberty of myself
and/or the child(ren) would be jeopardized by the disclosure of the identifying information.

2. (Number): ___________ Minor Child(ren) are subject to this proceeding as follows:
(Insert the information requested below. The residence information must be given for the last FIVE years.)

  a. Child's name                                   Place of birth                          I Date of birth         Sex
    Period of residence                                         Person child lived with (name & address)        Relationship
                                     Address 
          To Present
                                     Confidential


              to


              to


              to


              to



 a. Child's name                                    Place of birth                              Date of birth       Sex
  Period of residence                                         Person child lived with (name & address)          Relationship
                                   Address 
          to Present
                                   Confidential
                               -

              to


              to
              to


              to

  a. Child's name                                 Place of birth                        Date of birth          Sex
  Period of residence                                      Person child lived with (name & address)       Relationship
                                   Address 
          to Present
                                   Confidential
                               -

            To


            To


            To


            To



b.  Additional children are listed on an attached addendum. (Provide all information for additional children
on an attachment.)

3. Participation in custody proceeding(s): (Check only one)
 _____ I HAVE NOT participated as a party, witness, or in any capacity in any other litigation, in this or
any
other state, concerning the custody of or visitation (parenting time) with any child subject to this proceeding.

 _____ I HAVE participated as a party, witness, or in any capacity in any other litigation, in this or any other
state, concerning the custody of or visitation (parenting time) with any child subject to this proceeding.
Explain:
a. Name of each child
b. Type of proceeding
c. Court and state
d. Date of court order or judgment (if any):

4. Information about custody proceeding(s): (Check only one)
 _____ I HAVE NO INFORMATION of any proceedings that could affect the current proceeding, including
any proceedings relating to custody, domestic violence or protection orders, dependency, neglect or abuse
allegations, or that a parent or any member of their household has been convicted of a sexually oriented
offense or adoptions concerning any child subject to this proceeding.

______ I HAVE THE FOLLOWING INFORMATION concerning proceedings that could affect the current
proceeding, including any proceedings relating to custody, domestic violence or protection orders,
dependency, neglect or abuse allegations, convictions of a sexually oriented offense or adoptions
concerning any child subject to this proceeding, other than set out in item 3. Explain:
a. Name of each child
b. Name of parent or member of household
c. Type of proceeding
d. Court and state
e. Date of court order or judgment (if any):



5. Persons not a party to this proceeding: (Check only one)
_____ I DO NOT KNOW OF ANY PERSON not a party to this proceeding who has physical custody or
claims to have custody or visitation rights with respect to any child subject to this proceeding.

 _____ I KNOW THAT THE FOLLOWING NAMED PERSON(S) not a party to this proceeding has/have
physical custody or claim(s) to have custody or visitation rights with respect to any child subject to this
proceeding:
(See next page)
a. Name and address of person
_____________________________________________________________
(    ) has physical custody     ( ) claims custody rights            ( ) claims visitation rights
Name of each child
_______________________________________________________________________

b. Name and address of person
_____________________________________________________________
( ) has physical custody      ( ) claims custody rights ( ) claims visitation rights
Name of each child
_______________________________________________________________________

c. Name and address of person
_____________________________________________________________
(    ) has physical custody       ( ) claims custody rights   ( ) claims visitation rights
Name of each child
_______________________________________________________________________

6.    Knowledge of prior child support proceedings: (Check only one)
______ The child(ren) described in this affidavit are NOT subject to existing child support order(s) in this or
any state or territory

______ The child(ren) described in this affidavit ARE subject to the following existing child support order(s):
 a. Name of each child
__________________________________________________________________________
b. Type of proceeding
___________________________________________________________________________
c. Court and address
____________________________________________________________________________
d. Date of court order or judgment (if
any):___________________________________________________________
e. Amount of child support paid and by
whom:________________________________________________________
7. I acknowledge that I have a continuing duty to advise this Court of any custody, visitation, child
support, or guardianship proceeding (including dissolution of marriage, child neglect, or
dependency) concerning the child(ren) in this state or any other state about which information is
obtained during this proceeding.

I certify that a copy of this document was (Check only one) ( ) mailed ( ) faxed and mailed
( ) hand delivered to the person(s) listed below on (date ____________________________________)

Other party or his/her attorney:
Name:_____________________________________________Address:____________________________
_______
City, State, Zip:_______________________________________ Fax Number
_____________________________

I understand that I am swearing or affirming under oath to the truthfulness of the statements made in this
affidavit and that the punishment for knowingly making a false statement includes fines and/or
imprisonment.

Dated:___________________
          ____________________________________________________
                                                Signature of Party
Printed name: _______________________________________
Address:____________________________________________
City, State, Zip: ______________________________________
Phone:_________________Fax:_______________

STATE OF OHIO
COUNTY OF _____________________________
Sworn to or affirmed and signed before me
on_______________________by______________________________


____________________________________________
Notary Public

				
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