Part X · General Provisions

Rule 86. Effective Date

Amended July 1, 2025 (current) Contains Deadlines

(A) Original rules The Ohio Rules of Civil Procedure originally took effect July 1, 1970, pursuant to Article IV, Section 5 of the Ohio Constitution. Some rules have been amended in succeeding years, again pursuant to the Constitution.

(B) Effective date of amendments Amendments to these rules filed hereafter by the Supreme Court with the General Assembly pursuant to Article IV, Section 5 of the Ohio Constitution, and not thereafter the subject of a concurrent resolution of disapproval, shall take effect on the following first day of July. They shall govern all proceedings in actions brought after they take effect and also all further proceedings in actions then pending, except to the extent that their application in a particular action pending when the amendments take effect would not be feasible or would work injustice, in which event the former procedure applies. APPENDIX OF FORMS FORMS 1 THROUGH 20: GENERAL CIVIL FORMS APPENDIX OF FORMS (See Rule 84) INTRODUCTORY STATEMENT The forms which follow are intended for illustration only. They are limited in number inasmuch as no attempt is made to furnish a manual of forms. The forms are expressly declared by Rule 84 to be sufficient under the rules. Departures from the forms shall not void papers which are otherwise sufficient, and the forms may be varied when necessary to meet the facts of a particular case. Where appropriate, the forms assume that the action has been brought in the Court of Common Pleas, Franklin County, Ohio. FORM 1. CAPTION AND SUMMONS COURT OF COMMON PLEAS _____________ COUNTY, OHIO __________________ ) Case No. _________________ [Street Address] ) Judge ____________________ [City, State Zip] ) Plaintiff ) v. ) SUMMONS __________________ ) [Street Address] ) [City, State Zip] ) Defendant ) To the following named defendant(s): Name: Address: ________________________________ ________________________________ ________________________________ You have been named as a defendant in this Court. The Plaintiff(s) has filed a lawsuit against you. A copy of the Complaint is attached. The Plaintiff's attorney and that attorney's address are: ____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ You must deliver to the Plaintiff's attorney (or the Plaintiff if not represented by an attorney) a written Answer to the Complaint within 28 days; Civil Rule 5 explains the ways that you may deliver the Answer ( http://www.supremecourt.ohio.gov/LegalResources/Rules/civil/Civil Procedure.pdf ). You must then file a copy of the Answer with this Court within three days after you serve it on the Plaintiff(s). If you fail to serve and file an Answer, the Court may enter judgment against you for the relief requested in the Complaint. You may wish to hire an attorney to represent you. Because this is a civil suit, the Court cannot appoint an attorney for you. If you need help to find a lawyer, contact a local bar association and request assistance. Date: _______________________________ Clerk: _________________________ Note The caption above designates the particular paper as a "SUMMONS." The particular pleading or paper should contain an appropriate designation, thus: "COMPLAINT," "ANSWER," etc. A more specific designation in a caption is also appropriate, thus: "MOTION TO INTERVENE AS A DEFENDANT." * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ***Multilingual notice: You have been named as a defendant in this Court. You must file an answer within 28 days; if you fail to answer, the Court may enter judgment against you for the relief stated in the Complaint. Seek assistance from both an interpreter and an attorney. Your inability to understand, write, or speak English will not be a defense to possible judgment against you. 1. Spanish (US) ***Aviso multilingüe: Este Tribunal lo ha declarado como acusado. Debe presentar una respuesta en un plazo de 28 días. Si no contesta en dicho plazo, el Tribunal podrá dictar sentencia en su contra por el amparo que se detalla en la demanda. Solicite la ayuda de un intérprete y de un abogado. Su incapacidad para comprender, escribir o hablar inglés no se considerará como defensa ante una posible sentencia en su contra. 2. Somali ***Ogeysiis luqadda badan ah: Waxaa laguu magacaabay sida eedeysane gudaha Maxkamadan. Waa in aad ku soo gudbisaa jawaab 28 maalmood gudahood; haddii aad ku guuldareysto jawaabta, Maxkamada laga yaabo in ay gasho xukun adiga kaa soo horjeedo ee ka nasashada lagu sheegay Cabashada. Raadi caawinta ka timid labadaba turjubaanka iyo qareenka. Karti la'aantaada aad ku fahmo, ku qoro, ama ku hadasho Af Ingiriisiga ma noqon doonto difaacida xukunkaaga suuralka ah ee adiga kugu lidka ah. 3. Russian ***Уведомление на разных языках: Вы были названы в качестве ответчика в данном суде. Вы должны предoставить ответ в течение 28 дней; если Ваш ответ не будет получен, суд может вынести решение против Вас и удовлетворить содержащиеся в жалобе требования. Воспользуйтесь услугами переводчика и адвоката. Тот факт, что Вы не понимаете английскую речь и не можете читать и писать по-английски, не является препятствием для возможного вынесения судебного решения против Вас. 4. Arabic ًﯾﻮﻣ ﺎ ؛ وإذا ﻟﻢ ﺗﻘﻢ ﺑ ﺎﻟﺮد، ﻘﺪ ﻓ ﺗﺼﺪر اﻟﻤﺤﻜﻤﺔ ﺣﻜﻤً ﺎ ﺿﺪك ﺑﺎﻟﺘﻌﻮﯾﺾ ﻓﻠﻦ ﺗ ُ ﻌﺪ ﻋﺪم ﻗﺪرﺗﻚ ﻋﻠﻰ ﻓﮭﻢ اﻟﻠﻐﺔ اﻹﻧﺠﻠﯿﺰﯾﺔ أو ﻛﺘﺎﺑ ﮭﺎﺘ أو ﺗﺤﺪﺛ ﮭﺎ 5. Chinese (Simplified) *** 多語版本通知：您在本法庭已被列为被告。您必须于 28 日内递交答辩状；如果没有递交答辩状，法庭会针对诉状中声明的补救措施对您作出不利判决。请向口译人员和律师寻求帮助。您无法理解、书写或说英语的情况不能作为对您可能作出不利判决的辩护理由。 INSTRUCTIONS FOR PERSONAL OR RESIDENCE SERVICE To:___________________________________________________________________________ You are instructed to make personal--residence [cross out one] service upon defendant(s) ______________________________________________________________________________

(name) at ____________________________________________________________________________ (address for service if different from body of summons). ______________________________________________________________________________ Special instructions for server:_____________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * RETURN OF SERVICE OF SUMMONS

(PERSONAL) Fees Service$__________ Mileage $__________ Copy $__________ Docket $__________ Return $__________ Total $__________ I received this summons on _______, 20, at _________ o'clock, __.m., and made personal service of it upon ___________________________________by locating him -- them (cross out one) and tendering a copy of the summons and accompanying documents, on _____________, 20 ___. __________________________________________________ Sheriff -- Bailiff -- Process Server By _______________________________________________ Deputy * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * RETURN OF SERVICE OF SUMMONS

(RESIDENCE) Fees Service$__________ Mileage $__________ Copy $__________ Docket $__________ Return $__________ Total $__________ I received this summons on _______, 20, at _________ o'clock, __.m., and made residence service of it upon ___________________________________by leaving it at his - - their (cross out one) usual place of residence with _______________, a person of suitable age and discretion then residing therein, a copy of the summons, a copy of the complaint and accompanying documents, on _____________, 20 ___. __________________________________________________ Sheriff -- Bailiff -- Process Server By _______________________________________________ Deputy * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * FORM 2. COMPLAINT ON A PROMISSORY NOTE COURT OF COMMON PLEAS FRANKLIN COUNTY, OHIO A.B., Plaintiff )

(address) ) v. ) No.______________ C.D., Defendant )

(address) ) COMPLAINT 1. Defendant on or about _____________, 20, executed and delivered to plaintiff a promissory note, a copy of which is hereto attached as Exhibit A. 2. Defendant owes to plaintiff the amount of said note and interest. Wherefore plaintiff demands judgment against defendant for the sum of ________dollars, interest, and costs. ___________________________________ (Attorney for Plaintiff) ___________________________________

(Address) ___________________________________ 1. The pleader should follow the form above if he has possession of a copy of the note. The pleader should attach a copy of the note to the pleading. See Rule 10(D). 2. Under the rules free joinder of claims is permitted. See Rule 8(E) and Rule 18. Consequently the claims set forth in each and all of the following forms may be joined with this complaint or with each other. Ordinarily each claim should be stated in a separate division of the complaint, and the divisions should be designated as counts successively numbered (i.e., COUNT ONE, COUNT TWO, etc.). See Rule 10(B). In particular the rules permit alternative and inconsistent pleading. See Rule 8(E)(2). 3. The attorney must sign the pleading. See Rule 11. The pleading need not be verified. See Rule 11. [Effective: July 1, 1970.] FORM 2A. COMPLAINT ON A PROMISSORY NOTE (REASON FOR OMISSION OF COPY STATED) 1. Defendant on or about_______________, 20____, executed and delivered to plaintiff a promissory note [in the following words and figures: (here set out the note verbatim)] or [whereby defendant promised to pay plaintiff or order on________________, 20 , the sum of __________ dollars with interest thereon at the rate of _____ percent per annum]. 2. Plaintiff is unable to attach a copy of the said note because (here set out the reason for failure to attach the note). 3. Defendant owes to plaintiff the amount of said note and interest. Wherefore (etc. as in Form 2). 1. The pleader states why, under Rule 10(D), he is unable to attach a copy of the note. 2. If pleader can set forth the note verbatim from information at hand, he may do so. 3. Or pleader may plead the legal effect of the note, he being unable to attach a copy of the note. 4. This type form may be used in other situations whenever pleader is required to attach a copy of an instrument, but a copy of the instrument is not available to him. [Effective: July 1, 1970.] FORM 3. COMPLAINT ON AN ACCOUNT Defendant owes plaintiff _____________ dollars according to the account hereto annexed as Exhibit A. Wherefore (etc. as in Form 2). [Effective: July 1, 1970.] FORM 4. COMPLAINT FOR GOODS SOLD AND DELIVERED Defendant owes plaintiff __________ dollars for goods sold and delivered by plaintiff to defendant between_________, 20_______, and______________, 20_____. Wherefore (etc. as in Form 2). This form may be used where the action is for an agreed price or for the reasonable value of the goods. [Effective: July 1, 1970.] FORM 5. COMPLAINT FOR MONEY LENT Defendant owes plaintiff _____________ dollars for money lent by plaintiff to defendant on______________, 20____. Wherefore (etc. as in Form 2). [Effective: July 1, 1970.] FORM 6. COMPLAINT FOR MONEY PAID BY MISTAKE Defendant owes plaintiff ____________ dollars for money paid by plaintiff to defendant by mistake on_____________, 20____, under the following circumstances: [here state the circumstances with particularity--see Rule 9(B) ]. Wherefore (etc. as in Form 2). [Effective: July 1, 1970.] FORM 7. COMPLAINT FOR MONEY HAD AND RECEIVED Defendant owes plaintiff ____________ dollars for money had and received from one G.H. on____________, 20_____, to be paid by defendant to plaintiff. Wherefore (etc. as in Form 2). [Effective: July 1, 1970.] FORM 8. COMPLAINT FOR NEGLIGENCE 1. On_____________, 20_____, in a public highway called Street in, Ohio, defendant negligently drove a motor vehicle against plaintiff who was then crossing said highway. 2. As a result plaintiff was thrown down and had his leg broken and was otherwise injured, was prevented from transacting his business, suffered great pain of body and mind, and incurred expenses for medical attention and hospitalization in the sum of one thousand dollars. Wherefore plaintiff demands judgment against defendant in the sum of __________ dollars and costs. Since contributory negligence is an affirmative defense, the complaint need contain no allegation of due care of plaintiff. [Effective: July 1, 1970.] FORM 9. COMPLAINT FOR NEGLIGENCE WHERE PLAINTIFF IS UNABLE TO DETERMINE DEFINITELY WHETHER THE PERSON RESPONSIBLE IS C.D. OR E.F. OR WHETHER BOTH ARE RESPONSIBLE AND WHERE HIS EVIDENCE MAY JUSTIFY A FINDING OF WILFULNESS OR OF RECKLESSNESS OR OF NEGLIGENCE A.B., Plaintiff )

(address) ) No. __________ v. ) C.D. and E.F., Defendants ) COMPLAINT

(addresses) ) 1. On , 19 , in a public highway called Street in , Ohio, defendant C.D. or defendant E.F., or both defendants C.D. and E.F. wilfully or recklessly or negligently drove or caused to be driven a motor vehicle against plaintiff who was then crossing said highway. 2. As a result plaintiff was thrown down and had his leg broken and was otherwise injured, was prevented from transacting his business, suffered great pain of body and mind, and incurred expenses for medical attention and hospitalization in the sum of one thousand dollars. Wherefore plaintiff demands judgment against C.D. or against E.F. or against both in the sum of ______ dollars and costs. [Effective: July 1, 1970.] FORM 10. COMPLAINT FOR CONVERSION On or about , 19 , defendant converted to his own use ten bonds of the Company (here insert brief identification as by number and issue) of the value of dollars, the property of plaintiff. Wherefore plaintiff demands judgment against defendant in the sum of dollars, interest, and costs. [Effective: July 1, 1970.] FORM 11. COMPLAINT FOR SPECIFIC PERFORMANCE OF CONTRACT TO CONVEY LAND 1. On our about , 19 , plaintiff and defendant entered into an agreement in writing a copy of which is hereto annexed as Exhibit A. 2. In accord with the provisions of said agreement plaintiff tendered to defendant the purchase price and requested a conveyance of the land, but defendant refused to accept the tender and refused to make the conveyance. 3. Plaintiff now offers to pay the purchase price. Wherefore plaintiff demands (1) that defendant be required specifically to perform said agreement, (2) damages in the sum of one thousand dollars, and (3) that if specific performance is not granted plaintiff have judgment against defendant in the sum of dollars. Note The demand for relief seeks specific performance as well as ancillary damages resulting from the delay. In addition the demand for relief seeks damages in a certain sum if the court finds it impossible to grant specific performance as where, in the interim, defendant has conveyed the property to a purchaser for value without notice. [Effective: July 1, 1970.] FORM 12. COMPLAINT ON CLAIM FOR DEBT AND TO SET ASIDE FRAUDULENT CONVEYANCE UNDER RULE 18(B) A.B., Plaintiff )

(address) ) No. _________ v. ) C.D. and E.F., Defendants ) COMPLAINT

(addresses) ) 1. Defendant C.D. on or about executed and delivered to plaintiff a promissory note, a copy of which is hereto annexed as Exhibit A. 2. Defendant C.D. owes to plaintiff the amount of said note and interest. 3. Defendant C.D. on or about conveyed all his property, real and personal [or specify and describe] to defendant E.F. for the purpose of defrauding plaintiff and hindering and delaying the collection of the indebtedness evidenced by the note above referred to. Wherefore plaintiff demands:

(1) That plaintiff have judgment against defendant C.D. for dollars and interest; (2) that the aforesaid conveyance to defendant E.F. be declared void and the judgment herein be declared a lien on said property; (3) that plaintiff have judgment against the defendants for costs. [Effective: July 1, 1970.] FORM 13. COMPLAINT FOR INTERPLEADER AND DECLARATORY RELIEF 1. On or about , 19 , plaintiff issued to G.H. a policy of life insurance, a copy of which is attached as Exhibit A, whereby plaintiff promised to pay to K.L. as beneficiary the sum of dollars upon the death of G.H. The policy required the payment by G.H. of a stipulated premium on , 19 , and annually thereafter as a condition precedent to its continuance in force. 2. No part of the premium due , 19 , was ever paid and the policy ceased to have any force or effect on , 19 . 3. Thereafter, on , 19 , G.H. and K.L. died as the result of a collision between a locomotive and the automobile in which G.H. and K.L. were riding. 4. Defendant C.D. is the duly appointed and acting executor of the will of G.H.; defendant E.F. is the duly appointed and acting executor of the will of K.L.; defendant X.Y. claims to have been duly designated as beneficiary of said policy in place of K.L. 5. Each of defendants, C.D., E.F., and X.Y. is claiming that the abovementioned policy was in full force and effect at the time of the death of G.H.; each of them is claiming to be the only person entitled to receive payment of the amount of the policy and has made demand for payment thereof. 6. By reason of these conflicting claims of the defendants, plaintiff is in great doubt as to which defendant is entitled to be paid the amount of the policy, if it was in force at the death of G.H. Wherefore plaintiff demands that the court adjudge:

(1) That none of the defendants is entitled to recover from plaintiff the amount of said policy or any part thereof.

(2) That each of the defendants be restrained from instituting any action against plaintiff for the recovery of the amount of said policy or any part thereof.

(3) That, if the court shall determine that said policy was in force at the death of G.H., the defendants be required to interplead and settle between themselves their rights to the money due under said policy, and that plaintiff be discharged from all liability in the premises except to the person whom the court shall adjudge entitled to the amount of said policy.

(4) That plaintiff recover its costs. [Effective: July 1, 1970.] FORM 14. MOTION TO DISMISS, PRESENTING DEFENSES OF FAILURE TO STATE A CLAIM, OF LACK OF SERVICE OF PROCESS, AND OF LACK OF JURISDICTION UNDER RULE 12(B) COURT OF COMMON PLEAS FRANKLIN COUNTY, OHIO A.B., Plaintiff )

(address) ) No. _________ v. ) C.D. Corporation, Defendant ) MOTION TO DISMISS

(address) ) The defendant moves the court as follows: 1. To dismiss the action because the complaint fails to state a claim against defendant upon which relief can be granted. 2. To dismiss the action or in lieu thereof to quash the return of service of summons on the grounds (a) that the defendant is a corporation organized under the laws of Delaware and was not and is not subject to service of process within this state, and (b) that the defendant has not been properly served with process in this action, all of which more clearly appears in the affidavits of M.N. and X.Y. hereto attached as Exhibit A and Exhibit B, respectively. 3. To dismiss the action on the ground that the court lacks jurisdiction because [here state the reasons why the court lacks jurisdiction]. ___________________________________ (Attorney for Defendant) ___________________________________

(Address) ___________________________________ SERVICE OF COPY A copy hereof was served upon X.Y., attorney for plaintiff, by mailing it to him on June 1, 19 [or set forth other method of service upon X.Y.]. ___________________________________ (Attorney for Defendant) 1. The form gives various examples of defenses which may be raised by motion under Rule 12(B). 2. Whether the motion should be accompanied by a notice of hearing on the motion or whether the motion should be accompanied by a memorandum brief depends upon the rules of a particular local court. See Rule 7(B) and the rules of the local court regarding motion practice. 3. All papers after the original pleading required to be served upon an opposite party shall have endorsed thereon, when filed with the court, a statement setting forth the date and method of service. See Rule 5. [Effective: July 1, 1970; amended effective July 1, 1971.] FORM 15. ANSWER PRESENTING DEFENSES UNDER RULE 12(B) A.B., Plaintiff )

(address) ) No. __________ v. ) C.D. and E.F., Defendants ) ANSWER, COUNTERCLAIM,

(addresses) ) AND CROSS-CLAIM FIRST DEFENSE The complaint fails to state a claim against defendant C.D. upon which relief can be granted. SECOND DEFENSE If defendant C.D. is indebted to plaintiff for the goods mentioned in the complaint, he is indebted to him jointly with G.H. G.H. is alive, is a resident of this state, is subject to the jurisdiction of this court and can be made a party but has not been made one. THIRD DEFENSE Defendant C.D. admits the allegation contained in paragraphs 1 and 4 of the complaint; alleges that he is without knowledge or information sufficient to form a belief as to the truth of the allegations contained in paragraph 2 of the complaint; and denies each and every other allegation contained in the complaint. FOURTH DEFENSE The right of action set forth in the complaint did not accrue within years next before the commencement of this action. COUNTERCLAIM [Here set forth any claim as a counterclaim in the manner in which a claim is pleaded in a complaint.] CROSS-CLAIM AGAINST DEFENDANT M.N. [Here set forth the claim constituting a cross-claim against defendant M.N. in the manner in which a claim is pleaded in a complaint.] ___________________________________ (Attorney for Defendant, C.D.) ___________________________________

(Address) ___________________________________ (Service of Copy as in Form 14) 1. The above form contains examples of certain defenses provided for in Rule 12(B). The first defense challenges the legal sufficiency of the complaint. It is a substitute for a motion to dismiss; that is, under former practice the issue raised by the first defense would have been raised by demurrer, and under present practice the same issue might have been raised by motion at the option of the defendant. See Rule 12(B). 2. The second defense embodies the old plea in abatement. The decision thereon, however, may, for example, well provide under Rule 19(A) or Rule 21 for the citing in of the party rather than an abatement of the action. 3. The third defense is an answer on the merits. 4. The fourth defense is one of the affirmative defenses provided for in Rule 8(C). 5. The answer also includes a counterclaim and a cross-claim. See Rule 12(B). [Effective: July 1, 1970.] FORM 16. SUMMONS AGAINST THIRD-PARTY DEFENDANT COURT OF COMMON PLEAS FRANKLIN COUNTY, OHIO A.B., Plaintiff )

(address) ) v. ) C.D., Defendant and Third-Party ) No. ___________ Plaintiff )

(address) ) SUMMONS v. ) E.F., Third-Party Defendant )

(address) ) To the above-named Third-Party Defendant: You are hereby summoned and required to serve upon , plaintiff's attorney whose address is and upon , who is attorney for C.D., defendant and third-party plaintiff, and whose address is , an answer to the third-party complaint which is herewith served upon you within twenty-eight days after the service of this summons upon you exclusive of the day of service. If you fail to do so, judgment by default will be taken against you for the relief demanded in the third-party complaint. There is also served upon you herewith a copy of the complaint of the plaintiff which you may but are not required to answer. Your answer to the third-party complaint and your answer to the plaintiff's complaint must also be filed with the court. ___________________________________ (Clerk of Court) By ______________________ Deputy Clerk Dated _______________________________ It may be necessary, depending upon when the third-party complaint is served, to seek leave of court by motion to bring in a third-party defendant. See Rule 14(A). [Effective: July 1, 1970.] FORM 16A. COMPLAINT AGAINST THIRD-PARTY DEFENDANT COURT OF COMMON PLEAS FRANKLIN COUNTY, OHIO A.B., Plaintiff )

(address) ) v. ) C.D., Defendant and Third-Party ) No. ___________ Plaintiff )

(address) ) THIRD-PARTY COMPLAINT v. ) E.F., Third-Party Defendant )

(address) ) 1. Plaintiff A.B. has filed against defendant C.D. a complaint, a copy of which is hereto attached as Exhibit A. 2. [Here state the grounds upon which C.D. is entitled to recover from E.F., all or part of what A.B. may recover from C.D. The statement should be framed as in an original complaint.] Wherefore C.D. demands judgment against third-party defendant E.F. for all sums [make appropriate change where C.D. is entitled to only partial recovery over against E.F.] that may be adjudged against defendant C.D. in favor of plaintiff A.B. ___________________________________ (Attorney for C.D., Third-Party Plaintiff) ___________________________________

(Address) ___________________________________ It is necessary to comply with Rule 5 regarding service of third-party papers on plaintiff. [Effective: July 1, 1970.] FORM 17. MOTION TO INTERVENE AS A DEFENDANT UNDER RULE 24 COURT OF COMMON PLEAS FRANKLIN COUNTY, OHIO A.B., Plaintiff )

(address) ) No. v. ) C.D., Defendant ) MOTION TO INTERVENE

(address) ) AS A DEFENDANT E.F., Applicant for Intervention )

(address) ) E.F. moves for leave to intervene as a defendant in this action in order to assert the defenses set forth in his proposed answer, of which a copy is hereto attached, on the ground that [here insert the appropriate grounds of intervention]. (Attorney for E.F., Applicant for Intervention)

(Address) (Adopted eff. 7-1-70) Note (Amended Effective July 1, 1999) It is necessary that a motion to intervene be accompanied by a pleading as required in Civ.R. 24(C). It is also necessary to comply with Civ.R. 5 regarding service of the motion on the parties to the action. FORM 18. JUDGMENT ON JURY VERDICT COURT OF COMMON PLEAS FRANKLIN COUNTY OHIO A.B., Plaintiff )

(address) ) No. ____________ v. ) C.D., Defendant ) JUDGMENT

(address) ) This action came on for trial before the Court and a jury, and the issues having been duly tried and the jury having duly rendered its verdict, It is ordered and adjudged [that the plaintiff A.B. recover of the defendant C.D. the sum of , with interest thereon at the rate of percent as provided by law, and his costs of action.] [that the plaintiff take nothing, that the action be dismissed on the merits, and that the defendant C.D. recover of the plaintiff A.B. his costs of action.] Dated at , Ohio, this day of , 19 ___________________________________ Judge, Court of Common Pleas Journalized this day of , 19 ______________________________ Clerk of Court By Deputy Clerk This form is illustrative of the judgment to be entered upon the general verdict of a jury. It deals with the cases where there is a general jury verdict awarding the plaintiff money damages or finding for the defendant, but is adaptable to other situations of jury verdict. [Effective: July 1, 1970.] FORM 19. JUDGMENT ON DECISION BY THE COURT COURT OF COMMON PLEAS FRANKLIN COUNTY, OHIO A.B., Plaintiff )

(address) ) No. ___________ v. ) C.D., Defendant ) JUDGMENT

(address) ) This action came on for [trial] [hearing] before the Court, and the issues having been duly [tried] [heard] and a decision having been duly rendered, It is ordered and adjudged [that the plaintiff A.B. recover of the defendant C.D. the sum of , with interest thereon at the rate of percent as provided by law, and his costs of action.] [that the plaintiff take nothing, that the action be dismissed on the merits, and that the defendant C.D. recover of the plaintiff A.B. his costs of action.] Dated at , Ohio, this day of , 19 ___________________________________ Judge, Court of Common Pleas Journalized this day of , 19 _______________________________ Clerk of Court By ____________________________ Deputy Clerk This form is illustrative of the judgment to be entered upon a decision of the court. It deals with the cases of decisions by the court awarding a party only money damages or costs, but is adaptable to other decisions by the court. [Effective: July 1, 1970.] FORM 20. CIVIL FEE WAIVER AFFIDAVIT AND ORDER IN ____________________________________________ _______________________________________________ Plaintiff, vs. Defendant. ) ) ) ) ) ) ) ) CASE NO. JUDGE FINANCIAL DISCLOSURE / FEE- WAIVER AFFIDAVIT AND ORDER Pursuant to R.C. 2323.311, the below-named Applicant requests that the Court determine that the Applicant is an indigent litigant and be granted a waiver of the prepayment of costs or fees in the above captioned matter. The Applicant submits the following information in support of said request. Personal Information Applicant's First Name Applicant's Last Name Applicant's Date of Birth Last 4 Digits of Applicant's SSN Applicant's Address Other Persons Living in Your Household First Name Last Name Is this person a child under 18? Relationship (Spouse or Child) ☐ Yes ☐ No ☐ Yes ☐ No ☐ Yes ☐ No Public Benefits I receive the following public benefits and my gross income, including the cash benefits marked below, does not exceed 187.5% of the federal poverty guidelines. Place an "X" next to any benefits you receive. Ohio Works First 1 : ___ SSI 2 : ___ Medicaid 3 : ___ Veterans Pension Benefit : ___ SNAP / Food Stamps : ___ Monthly Income I am NOT able to access my spouse's income ☐ Applicant Spouse (If Living in Household) Total Monthly Income Gross Monthly Employment Income, including Self-Employment Income (Before Taxes) $ $ $ Unemployment, Worker's Compensation, Spousal Support (If Receiving) $ $ $ TOTAL MONTHLY INCOME $ $ Liquid Assets Type of Asset Estimated Value Cash on Hand $ Available Cash in Checking, Savings, Money Market Accounts $ Stocks, Bonds, CDs $ Other Liquid Assets $ Total Liquid Assets $ Monthly Expenses Column A Column B Type of Expense Amount Type of Expense Amount Rent / Mortgage / Property Tax / Insurance $ Insurance (Medical, Dental, Auto, etc.) $ Food / Paper Products/Cleaning Products/Toiletries $ Child or Spousal Support that You Pay $ Utilities (Heat, Gas, Electric, Water / Sewer, Trash) $ Medical / Dental Expenses or Associated Costs of Caring for a Sick or Disabled Family Member $ Transportation / Gas $ Credit Card, Other Loans $ Phone $ Taxes Withheld or Owed $ Child Care $ Other (e.g. garnishments) $ Total Column A Expenses $ Total Column B Expenses $ TOTAL MONTHLY EXPENSES (Column A + Column B) I, ______________________________________, hereby certify that the information I have provided on (Print Name) this financial disclosure form is true to the best of my knowledge and that I am unable to prepay the costs or fees in this case. ____________________________________ Signature NOTARY PUBLIC: Sworn to before me and signed in my presence this ______ day of __, 20, in ___________________ County, Ohio. ____________________________________ Notary Public (Signature) ____________________________________ Notary Public (Printed) My Commission expires: If available, an individual duly authorized to administer this oath at the Clerk of Court's Office will do so at no cost to the Applicant. ____________________________________________________________________________________________ ORDER ☐ Upon the request of the Applicant and the Court's review, the Court finds that the Applicant IS an indigent litigant and GRANTS a waiver of the prepayment of costs or fees in this matter. Pursuant to R.C. 2323.311(B)(3), upon the filing of a civil action or proceeding and the affidavit of indigency under division (B)(1) of this section, the clerk of the court shall accept the action, motion, or proceeding for filing. ☐ Upon the request of the Applicant and the Court's review, the Court finds that the Applicant is NOT an indigent litigant and DENIES a waiver of the prepayment of costs or fees in this matter. Applicant is granted thirty (30) days from the issuance of this Order to make the required advance deposit or security. Failure to do so within the time allotted may result in dismissal of the applicant's filing. IT IS SO ORDERED ________________________________________________ ________________________ Judge / Magistrate Date [Effective: April 15, 2020; amended effective April 15, 2022; July 1, 2023.] APPENDIX R.C. 2323.311(B)

(4) A judge or magistrate of the court shall review the affidavit of indigency as filed pursuant to division (B)(2) of this section and shall approve or deny the applicant's application to qualify as an indigent litigant. The judge or magistrate shall approve the application if the applicant's gross income does not exceed one hundred eighty-seven and five-tenths per cent of the federal poverty guidelines as determined by the United States department of health and human services for the state of Ohio and the applicant's monthly expenses are equal to or in excess of the applicant's liquid assets as specified in division (C)(2) of section 120-1-03 of the Administrative Code, as amended, or a substantially similar provision. If the application is approved, the clerk shall waive the advance deposit or security and the court shall proceed with the civil action or proceeding. If the application is denied, the clerk shall retain the filing of the action or proceeding, and the court shall issue an order granting the applicant whose application is denied thirty days to make the required advance deposit or security, prior to any dismissal or other action on the filing of the civil action or proceeding.

(6) Nothing in this section shall prevent a court from approving or affirming an application to qualify as an indigent litigant for an applicant whose gross income exceeds one hundred eighty-seven and five-tenths per cent of the federal poverty guidelines as determined by the United States department of health and human services for the state of Ohio, or whose liquid assets equal or exceed the applicant's monthly expenses as specified in division (C)(2) of section 120-1-03 of the Administrative Code, as amended, or a substantially similar provision.

1 Ohio Works First Income Limit: 50% FPL (R.C. 5107.10(D)(1)(a))

2 SSI Income Limit: cannot have countable income that exceeds the Federal Benefit Rate (FBR). 2019 FBR: $771 monthly for single disabled individual; $1157 monthly for disabled couple (20 CFR 416.1100)

3 Medicaid Income Limit: Modified Adjusted Gross Income (MAGI):138% FPL (OAC 5160:1-4-01;

42 USC 1396a(a)(10)(A)(i)(VIII)) Aged, Blind or Disabled: $791 for single person; $1177 for disabled couple 4 Veterans Pension Benefit Income Limit: $13,535 annually / $1,127 monthly for a single person; $17,724 annually / $1,477 monthly for a veteran with one dependent 5 Supplemental Nutrition Assistance Program (SNAP) Income Limit: 130% FPL for assistance groups with nondisabled/nonelderly member; 165% FPL for elderly and disabled assistance groups (OAC 5101:4-4-11; Food Assistance Change Transmittal No. 61) FORMS 1 THROUGH 32: DOMESTIC RELATIONS FORMS Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 1 AFFIDAVIT OF BASIC INFORMATION, INCOME, AND EXPENSES Approved under Ohio Civil Rule 84 Amended: June 1, 2021 IN THE COURT OF COMMON PLEAS ______________________________ DIVISION ______________________________ COUNTY, OHIO Plaintiff/Petitioner 1 vs./and Case No. Judge Magistrate Defendant/Petitioner 2 AFFIDAVIT OF BASIC INFORMATION, INCOME, AND EXPENSES Affidavit of _____________________________________ Date of marriage Date of separation SECTION I – BASIC INFORMATION Plaintiff/Petitioner 1 Defendant/Petitioner 2 Date of Birth _____________________________ Date of Birth ______________________________ Last 4 Digits of Social Security # XXX-XX-_____ Last 4 Digits of Social Security # XXX-XX-______ Phone Number___________________________ Phone Number___________________________ Email Address___________________________ Email Address____________________________ Is an interpreter needed?  Yes or  No If yes, explain: ___________________________ Is an interpreter needed?  Yes or  No If yes, explain: ___________________________ Health:  Good  Fair  Poor If health is not good, please explain: Health:  Good  Fair  Poor If health is not good, please explain: 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. Do not leave any category blank. For each item, if none, put "NONE." 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. Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 1 AFFIDAVIT OF BASIC INFORMATION, INCOME, AND EXPENSES Approved under Ohio Civil Rule 84 Amended: June 1, 2021 SECTION II – INCOME A. YEARLY INCOME, OVERTIME, COMMISSIONS, AND BONUSES FOR PAST THREE YEARS Plaintiff/Petitioner 1 Year Defendant/Petitioner 2 $ $ $ $__________________ $__________________ $__________________ $__________________ 3 years ago  20 Base yearly income $__________________ 2 years ago  20 $__________________ Last year  20 Yearly overtime, commissions, and/or bonuses $__________________ 3 years ago  20 $__________________ 2 years ago  20 $__________________ Last year  20 B. COMPUTATION OF CURRENT INCOME Plaintiff/Petitioner 1 Defendant/Petitioner 2 Base Yearly Income $ $ Average yearly overtime, commissions, and/or bonuses over last 3 years (from part A) $ $ Education: ( Check highest level achieved )  Grade School  High School  Associate  Bachelor's  Post Graduate Education: ( Check highest level achieved )  Grade School  High School  Associate  Bachelor's  Post Graduate Other Technical Certifications: Active Member of the U.S. Military  Yes  No Other Technical Certifications: Active Member of the U.S. Military  Yes  No Plaintiff/Petitioner 1 Defendant/Petitioner 2 Employed Date of Employment Name of Employer Payroll Address Payroll City, State, Zip Scheduled Paychecks Per Year  Yes  No  Yes  No _______________________ _______________________ _______________________ _______________________ _______________________ _______________________ _______________________ _______________________  12  24  26  52  12  24  26  52 Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 1 AFFIDAVIT OF BASIC INFORMATION, INCOME, AND EXPENSES Approved under Ohio Civil Rule 84 Amended: June 1, 2021 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) and/or public assistance Social Security or Veteran's benefits received for child(ren)  Based on parent's disability  Based on child's disability Child support you receive from a child support enforcement agency or court order for minor and/or dependent child(ren) not of the marriage or relationship $ $ $ $ $ $ $ $ $ $ $ $ $ $ SECTION III – CHILDREN AND HOUSEHOLD RESIDENTS Minor and/or dependent child(ren) who is/are adopted or born from this marriage or relationship: Name Date of birth Living with Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 1 AFFIDAVIT OF BASIC INFORMATION, INCOME, AND EXPENSES Approved under Ohio Civil Rule 84 Amended: June 1, 2021 In addition to the above child(ren): Plaintiff/Petitioner 1 has other minor biological or adopted child(ren). Defendant/Petitioner 2 has other minor biological or adopted child(ren). There is/are adult(s) in your household. SECTION IV – EXPENSES List monthly expenses below for your present household. A. MONTHLY HOUSING EXPENSES Rent or first mortgage (including taxes and insurance) $ Second mortgage / equity line of credit $ Real estate taxes (if not included above) $ Renter or homeowner 's insurance (if not included above) $ Homeowner or condominium association fee $ Utilities ° Electric $ ° Gas, fuel oil , propane $ ° Water and sewer $ ° Telephone and/or cell phone $ ° Trash collection $ ° Cable / satellite television $ ° Internet service $ Cleaning $ Lawn service and/or snow removal $ Other: ______________________________________________________ $ ______________________________________________________ $ TOTAL MONTHLY: $ B. OTHER MONTHLY LIVING EXPENSES Food ° Groceries (including food, paper, cleaning products, toiletries , and other) $ ° Restaurant $ Transportation ° Vehicle loan , lease $ ° Vehicle maintenance $ ° Gasoline $ Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 1 AFFIDAVIT OF BASIC INFORMATION, INCOME, AND EXPENSES Approved under Ohio Civil Rule 84 Amended: June 1, 2021 ° Parking , public transportation $ Clothing ° Clothes (other than child ( ren ) 's) $ ° Dry cleaning and laundry $ Personal grooming ° Hair and nail care $ ° Other: ____________________________________________________ $ Other: _______________________________________________________ $ TOTAL MONTHLY: $ C. MONTHLY MINOR CHILD-RELATED EXPENSES (for child(ren) of the marriage or relationship) Work and/or education-related child care $ Other child care $ Extraordinary parenting time travel cost $ School tuition $ School lunches $ School supplies $ Extracurricular activities and lessons $ Clothing $ Child(ren)'s allowances $ Special and extraordinary needs of child(ren) (not included elsewhere) $ Other: $ TOTAL MONTHLY: $ D. MONTHLY INSURANCE PREMIUMS Life $ Auto $ Health $ Disability $ Other: $ TOTAL MONTHLY: $ Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 1 AFFIDAVIT OF BASIC INFORMATION, INCOME, AND EXPENSES Approved under Ohio Civil Rule 84 Amended: June 1, 2021 E. MONTHLY WORK AND EDUCATION EXPENSES FOR SELF Mandatory work expenses (union dues, uniforms, or other) $ Additional income taxes paid (not deducted from wages) $ Tuition $ Books, fees, and other $ College loan $ Other: ______________________________________________________ $ ______________________________________________________ $ TOTAL MONTHLY: $ F. MONTHLY HEALTH CARE EXPENSES (not covered by insurance) Physicians $ Dentists and orthodontists $ Optometrists and opticians $ Prescriptions $ Other: $ TOTAL MONTHLY: $ G. MISCELLANEOUS MONTHLY EXPENSES Extraordinary obligations for other minor/handicapped child(ren) [for child(ren) who were not born of this marriage or relationship and were not adopted by these parties] $ Child support for child(ren) who were not born of this marriage or relationship and were not adopted by these parties $ Expenses paid for adult child(ren) or other dependent(s) $ Spousal support paid to former spouse(s) $ Subscriptions and books $ Charitable contributions $ Memberships (associations and clubs) $ Travel and vacations $ Pets $ Gifts $ Attorney fees $ Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 1 AFFIDAVIT OF BASIC INFORMATION, INCOME, AND EXPENSES Approved under Ohio Civil Rule 84 Amended: June 1, 2021 Other: _______________________________________________________ $ _______________________________________________________ $ TOTAL MONTHLY: $ H. MONTHLY INSTALLMENT PAYMENTS INCLUDING BANKRUPTCY PAYMENTS ( Do not repeat expenses already listed. ) Examples: car, credit card, rent-to-own, or cash advance payments To whom paid Purpose Balance due Monthly payment $ $ $ $ $ $ $ $ $ $ $ $ TOTAL MONTHLY: $ GRAND TOTAL MONTHLY EXPENSES (Sum of A through H): $ Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 1 AFFIDAVIT OF BASIC INFORMATION, INCOME, AND EXPENSES Approved under Ohio Civil Rule 84 Amended: June 1, 2021 OATH OR AFFIRMATION ( Do not sign until Notary Public is present ) I, (print name) , swear or affirm that I have read this Affidavit and, to the best of my knowledge and belief, the facts and information stated in this Affidavit 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 STATE OF _____________________ ) ) SS COUNTY OF ___________________ ) Sworn to or affirmed before me by this day of , . Signature of Notary Public Printed Name of Notary Public Commission Expiration Date: _____________ (Affix seal here) Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 2 AFFIDAVIT OF PROPERTY AND DEBT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 IN THE COURT OF COMMON PLEAS ______________________________ DIVISION ______________________________ COUNTY, OHIO Plaintiff/Petitioner 1 vs./and Defendant/Petitioner 2 AFFIDAVIT OF PROPERTY AND DEBT Affidavit of _________________________________ I. REAL ESTATE INTERESTS Address Present Fair Market Value 1.__________________________ __________________________ $ 2.__________________________ __________________________ $ TOTAL SECTION I: REAL ESTATE INTERESTS: II. OTHER ASSETS Category Description A. Vehicles and Other Certificate of Title Property (Include model and year of automobiles, trucks, motorcycles, boats, motors, motor homes, trailers, ATVs, snowmobiles, jet skis, etc.) 1. ____________________________ _____________________________ 2. ____________________________ _____________________________ Instructions: Check local court rules to determine when this form must be filed. List ALL OF YOUR PROPERTY AND DEBTS, THE PROPERTY AND DEBTS OF YOUR SPOUSE, AND ANY JOINT PROPERTY OR DEBTS. You must provide the most recent value for each asset and balance owed for each debt. Do not leave any category blank. For each item, if none, put "NONE." If you do not know exact figures for any item, give your best estimate, and put "EST." space is needed, add additional pages. Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 2 AFFIDAVIT OF PROPERTY AND DEBT Approved under Ohio Civil Rule 84 Amended: XXXX, 2021 Category Description 3. ____________________________ _____________________________ 4. ____________________________ _____________________________ 5. ____________________________ _____________________________ 6. ____________________________ _____________________________ B. Financial Accounts (Include checking, savings, CDs, POD accounts, money market accounts, etc.) 1. ____________________________ _____________________________ 2. ____________________________ _____________________________ 3. ____________________________ _____________________________ 4. ____________________________ _____________________________ C. Pensions & Retirement Plans (Include profit-sharing, IRAs, 401(k) plans, etc. Describe each type of plan) 1. ____________________________ _____________________________ 2. ____________________________ _____________________________ 3. ____________________________ _____________________________ 4. ____________________________ _____________________________ D. Publicly Held Stocks, Bonds, Securities & Mutual Funds (Name of company and number of shares) 1. ____________________________ _____________________________ 2. ____________________________ _____________________________ 3. ____________________________ _____________________________ 4. ____________________________ _____________________________ Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 2 AFFIDAVIT OF PROPERTY AND DEBT Approved under Ohio Civil Rule 84 Amended: XXXX, 2021 Category Description E. Closely Held Stocks & Other Business Interests and Name of Company (Type of ownership and number of shares) 1. ____________________________ _____________________________ 2. ____________________________ _____________________________ F. Life Insurance (Company Name and Term or Whole Life) (Insured Life) 1. ____________________________ _____________________________ 2. ____________________________ _____________________________ 3. ____________________________ _____________________________ 4. ____________________________ _____________________________ G. Furniture & Household Goods, Furnishings, and Appliances 1. ____________________________ _____________________________ 2. ____________________________ _____________________________ 3. ____________________________ _____________________________ 4. ____________________________ _____________________________ H. Safe Deposit Box (Give location and contents) 1. ____________________________ _____________________________ 2. ____________________________ _____________________________ 3. ____________________________ _____________________________ 4. ____________________________ _____________________________ I. All Other Assets Not Listed Above (including jewelry, art, tools, firearms, and other collectibles) (If necessary, attach additional pages) 1. ___________________________ _____________________________ 2. ___________________________ _____________________________ Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 2 AFFIDAVIT OF PROPERTY AND DEBT Approved under Ohio Civil Rule 84 Amended: XXXX, 2021 III. SEPARATE PROPERTY CLAIMS Separate property includes, but is not limited to, property owned before marriage and gifts or inheritances to only one spouse. Description 1. ____________________________ _____________________________ 2. ____________________________ _____________________________ 3. ____________________________ _____________________________ 4. ____________________________ _____________________________ TOTAL SECTION III: SEPARATE PROPERTY CLAIMS: IV. DEBT List ALL OF YOUR DEBTS, your spouse's debts, and any joint debts. Do not leave any category blank. For each item, if none, put "NONE." If you don't know exact figures for any item, give your best estimate, and put "EST." is needed to explain, please attach an additional page with the explanation and identify which question you are answering. Type Name of Creditor A. Secured Debt (Mortgages, Car, etc.) 1. __________________________ _________________________ 2. __________________________ _________________________ 3. __________________________ _________________________ 4. __________________________ _________________________ 5. __________________________ _________________________ B. Unsecured Debt (Credit cards, medical bills, other debts) 1. __________________________ _________________________ 2. __________________________ _________________________ 3. __________________________ _________________________ Uniform Domestic Relations Form – Affidavit 2 AFFIDAVIT OF PROPERTY AND DEBT Approved under Ohio Civil Rule 84 Amended: XXXX, 2021 Type Name of Creditor 4. __________________________ _________________________ 5. __________________________ _________________________ V. BANKRUPTCY Filed by Date of Filing 1. __________________________ _________________________ 2. __________________________ _________________________ OATH OR AFFIRMATION (Do not sign until Notary Public is present) I, (print name) , swear or affirm that I have read this Affidavit and, to the best of my knowledge and belief, the facts and information stated in this Affidavit 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 STATE OF _____________________ ) ) SS COUNTY OF ___________________ ) Sworn to or affirmed before me by this day of , . __________________________________ Signature of Notary Public __________________________________ Printed Name of Notary Public (Affix seal here) Commission Expiration Date: ___________ Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 3 PARENTING PROCEEDING AFFIDAVIT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 IN THE COURT OF COMMON PLEAS DIVISION COUNTY, OHIO Plaintiff/Petitioner 1 vs./and Defendant/Petitioner 2/Respondent Instructions: Check local court rules to determine when this form must be filed. By law, this affidavit must be filed and served with any Complaint, Petition or Motion regarding the allocation of parental rights and responsibilities, parenting time, custody, or visitation. 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. PARENTING PROCEEDING AFFIDAVIT (R.C. 3127.23(A)) Affidavit of ONLY CHECK THE FOLLOWING BOX IF YOU BELIEVE THAT THE HEALTH, SAFETY, OR LIBERTY OF YOURSELF OR YOUR CHILD(REN) WOULD BE JEOPARDIZED BY THE DISCLOSURE OF YOUR ADDRESS OR IDENTIFYING INFORMATION. YOU ACKNOWLEDGE THAT THE COURT MAY CONDUCT A HEARING REGARDING THE BASIS FOR YOUR REQUEST. Pursuant to R.C. 3127.23(D), I allege that my health, safety, or liberty or that of my child(ren) would be jeopardized by the disclosure of identifying information to my spouse or the public. Therefore, I request that my address be placed under seal. I have marked the corresponding box next to each address I am requesting to be sealed. 1.

(Number) : _______ Minor child(ren) is/are subject to this case as follows: Insert the information requested below for all minor or dependent children of the parties. You must list the residences for all places where the children have lived for the last a. Child's name _____________________________________________ Place of birth ________________________ Date of residence Address Confidential Person child lived with (name and address) ___________________ to present ___________________________________ ___________________________________ ___________________ to _________________ ___________________________________ ___________________________________ Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 3 PARENTING PROCEEDING AFFIDAVIT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 ___________________ to _________________ ___________________________________ ___________________________________ ___________________ to _________________ ___________________________________ ___________________________________ b. Child's name _____________________________________________ Place of birth ________________________ Check this box if the information below is the same as in Section 1(a). Skip to the next question. Date of residence Address Confidential Person child lived with (name and address) ___________________ to present ___________________________________ ___________________________________ ___________________ to _________________ ___________________________________ ___________________________________ ___________________ to _________________ ___________________________________ ___________________________________ ___________________ to _________________ ___________________________________ ___________________________________ c. Child's name _____________________________________________ Place of birth ________________________ Check this box if the information below is the same as in Section 1(a). Skip to the next question. Date of residence Address Confidential Person child lived with (name and address) ___________________ to present ___________________________________ ___________________________________ ___________________ to _________________ ___________________________________ ___________________________________ ___________________ to _________________ ___________________________________ ___________________________________ ___________________ to _________________ ___________________________________ ___________________________________ d. Additional children are listed on Attachment 1(d). (Provide requested information for additional children on an attachment labeled 1(d).) Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 3 PARENTING PROCEEDING AFFIDAVIT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 2 . 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. Explain : a. Name of each child: __________________________________________________________________ b. Type of case: _______________________________________________________________________ c. Court and State: ____________________________________________________________________ d. Date and court order or judgment (if any): ________________________________________________ 3 . Information about custody case(s): ( Check only one box I HAVE NO INFORMATION of any 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 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, other than listed in Paragraph 2. Explain : a. Name of each child: _________________________________________________________________ b. Type of case: ______________________________________________________________________ c. Court and State: ____________________________________________________________________ d. Date and court order or judgment (if any): ________________________________________________ 4 . Information about criminal convictions: 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 5. Persons not a party to this case: ( Check only one box I DO NOT KNOW OF ANY PERSON not a party to this case who has physical custody have custody or visitation rights with respect to any child subject to this case.

I KNOW THAT THE FOLLOWING NAMED PERSON(S) custody or claim(s) to have custody or visitation rights with respect to any child subject to this case. Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 3 PARENTING PROCEEDING AFFIDAVIT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 a. Name/Address of Person: _________________________________________________________ has physical custody claims custody rights Name of each child: ______________________________________________________________ b. Name/Address of Person: _________________________________________________________ has physical custody claims custody rights Name of each child: ______________________________________________________________ c. Name/Address of Person: _________________________________________________________ has physical custody claims custody rights Name of each child: ______________________________________________________________ 6. I understand that I have a continuing duty to advise this Court of any custody, visitation, parenting time, divorce, dissolution of marriage, separation, neglect, abuse, dependency, guardianship, parentage, termination of parental rights, or protection order from domestic violence case concerning the children about whom information is obtained during this case. OATH OR AFFIRMATION ( Do not sign until Notary Public is present I, (print name) best of my knowledge and belief, the facts and information stated in this Affidavit are true, accurate, and complete.

I understand that if I do not tell the truth, I may be subject to penalties for perjury. STATE OF _____________________ ) ) SS COUNTY OF ___________________ ) Sworn to or affirmed before me by _________________________this ____day of __________,. Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 4 HEALTH INSURANCE AFFIDAVIT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 IN THE COURT OF COMMON PLEAS DIVISION COUNTY, OHIO Plaintiff/Petitioner 1 vs./and Defendant/Petitioner 2 HEALTH INSURANCE AFFIDAVIT Affidavit of ____________________________________ Is/are your child(ren) currently enrolled in a government- provided program (i.e. Healthy Start/ Medicaid)? Is/are your child(ren) enrolled in an individual (non-group or COBRA) health insurance plan? Is/are your child(ren) enrolled in a plan found through the exchange/Affordable HealthCare Marketplace? Is/are your child(ren) enrolled in a health insurance plan through a group (employer or other organization)? If your child(ren) is/are not enrolled, does/do he/she/they have health insurance available through a group (employer or other organization)? Does the available insurance cover primary care services within 30 miles of the children's home? Under the available insurance, what is the annual premium you pay for family coverage? $ ________________ $ ________________ Name of group (employer or organization) that provides health insurance Address Phone Number _ _______________________ _ _______________________ _ _______________________ _ _______________________ _ _______________________ _ _______________________ _ _______________________ ________________________ Instructions: Check local court rules to determine when this form must be filed. This affidavit is used to disclose health insurance coverage that is available for children of the relationship. It is also used to determine child support. If more space is needed, add additional pages. Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 4 HEALTH INSURANCE AFFIDAVIT Approved under Ohio Civil Rule 84 Amended: June 1, 2021 OATH OR AFFIRMATION (Do not sign until Notary Public is present) I, (print name) , swear or affirm that I have read this Affidavit and, to the best of my knowledge and belief, the facts and information stated in this Affidavit are true, accurate, and complete.

(A) Motion and Affidavit Affidavit under Civ.R. 75(N) and/or under R.C. 3109.043 to request the temporary orders checked here. Check only those that apply. THE OTHER PARTY HAS FOURTEEN (14) DAYS FROM THE DATE ON WHICH THIS MOTION IS SERVED TO FILE A COUNTER AFFIDAVIT AND SERVE IT UPON THE PARTY WHO FILED THE MOTION. ( See below )

(B) Counter Affidavit Movant files this Counter Affidavit in response to a Motion and Affidavit. Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 5 MOTION AND AFFIDAVIT OR COUNTER AFFIDAVIT FOR TEMPORARY ORDERS WITHOUT ORAL HEARING Approved under Ohio Civil Rule 84 Amended: June 1, 2021 Complete the following information, whether filing Motion and Affidavit or Counter Affidavit. ( Check all that apply)

1 . The parties are living separately. Date of separation is . The parties are living together. The parties have no minor children. ( The parties have (a) minor child(ren) who was/were born from or adopted during this relationship. ( List child(ren) here ) Name In addition to the above child(ren), Movant has __________________ other biological or adopted minor child(ren). Other party has _______________ other biological or adopted minor child(ren). There is/are __________________ adult(s) in Movant's household. 2. Movant's child(ren) attend(s) school in: _________________________________ public school district Other: ( Explain ) All children do not attend school in the same district. ( 3. Movant requests to be named the temporary residential parent and/or legal custodian of the child(ren): ( Specify child(ren) if request is not for all child(ren) Movant does not object to the other parent or party being named the temporary residential parent and/or legal custodian of the child(ren): ( 4. Movant has reached an agreement regarding parenting time (companionship or visitation) with the other parent or party as follows: Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 5 MOTION AND AFFIDAVIT OR COUNTER AFFIDAVIT FOR TEMPORARY ORDERS WITHOUT ORAL HEARING Approved under Ohio Civil Rule 84 Amended: June 1, 2021 Movant wishes to exercise the following parenting time (companionship or visitation): Movant wishes for the other parent or party to exercise the following parenting time (companionship or visitation): Movant requests that the other parent or party's parenting time (companionship or visitation) be supervised: ( Explain the reason for request Name of an appropriate supervisor 5.

A Court or agency has made a child support order concerning the child(ren). Name of Court/Agency Date of Order SETS No. 6. Movant requests the Court to order the other parent or party to pay: $ $ $ The following debts and/or expenses: 7. Movant requests the Court order the following other relief: 8. Movant is willing to attend mediation. Movant is not willing to attend mediation. Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 5 MOTION AND AFFIDAVIT OR COUNTER AFFIDAVIT FOR TEMPORARY ORDERS WITHOUT ORAL HEARING Approved under Ohio Civil Rule 84 Amended: June 1, 2021 9. Movant requests the following Court services. ( State specific reasons why Court services are required. OATH OR AFFIRMATION ( Do not sign until Notary Public is present I, (print name)_________________________________________, swear or affirm that I have read this Affidavit and, to the best of my knowledge and belief, the facts and information stated in this Affidavit are true, accurate, and complete. I understand that if I do not tell the truth, I may be subject to penalties for perjury. STATE OF _______________ ) ) SS COUNTY OF _____________ ) Sworn to or affirmed before me by ________________________this _________day of ______________, _________. Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 5 MOTION AND AFFIDAVIT OR COUNTER AFFIDAVIT FOR TEMPORARY ORDERS WITHOUT ORAL HEARING Approved under Ohio Civil Rule 84 Amended: June 1, 2021 NOTICE OF HEARING ( Check with local Court to obtain a hearing date and time and for scheduling procedure You are hereby given notice that this Motion for Temporary Orders will come before the Court for consideration on Affidavits only, without oral testimony, before Judge/Magistrate ___________________________________, at _________________ a.m./p.m. on ______________________, 20. CERTIFICATE OF SERVICE ( Check the boxes that apply I delivered a copy of the: Motion and Affidavit or On:

(Date) To: (Print name of other party's attorney or, if there is no attorney, print name of the party) At: (Print address or fax number) By: As instructed in the Request for Service (Uniform Domestic Relations Form 31/Uniform Juvenile Form 10) filed with the Clerk of Courts Regular U.S. Mail Fax Hand Delivery Other: Supreme Court of Ohio Uniform Domestic Relations Form 6 COMPLAINT FOR DIVORCE WITHOUT CHILDREN Approved under Ohio Civil Rule 84 IN THE COURT OF COMMON PLEAS ___________________________ DIVISION ___________________________ COUNTY, OHIO Name Street Address City, State and Zip Code Plaintiff vs. Name Street Address City, State and Zip Code Defendant WARNING: This form is not a substitute for the benefit of the advice of legal counsel. It is highly recommended that you consult an attorney. Instructions: This form is used to request a divorce if you and your spouse do not have (a) minor child(ren), adult child(ren) attending high school, or child(ren) with disabilities. Check to determine if you meet the residency requirement to file in this county. A Request for Service (Uniform Domestic Relations Form 31/Uniform Juvenile Form 10) must be filed with this form. The Court may require additional forms to accompany this document. You must check the requirements of the county in which you file. IF ANY OF THE ABOVE CONTACT INFORMATION CHANGES. COMPLAINT FOR DIVORCE WITHOUT CHILDREN Now comes Plaintiff and states as follows: 1. Plaintiff has been a resident of the State of Ohio for at least six (6) months immediately before filing this Complaint. 2. Plaintiff has been a resident of immediately before filing this Complaint; OR Defendant resides in 3. Plaintiff and Defendant were married on in Supreme Court of Ohio Uniform Domestic Relations Form 6 COMPLAINT FOR DIVORCE WITHOUT CHILDREN Approved under Ohio Civil Rule 84 4. Neither party is pregnant OR a party is pregnant. Any child(ren) born from or adopted during this marriage or relationship, is/are now adults and none are mentally or physically disabled and incapable of supporting or maintaining themselves. Military Service: Neither Plaintiff nor Defendant is an active-duty servicemember of the United States military. Plaintiff and/or Defendant is an active-duty servicemember of the United States military. 7. Plaintiff is entitled to a divorce from Defendant based upon the following grounds: ( Plaintiff and Defendant are incompatible. Plaintiff and Defendant have lived separate and apart without cohabitation and without one (1) year. Plaintiff or Defendant had a Husband or Wife living at the time of the marriage. Defendant has been willfully absent for one (1) year. Defendant is guilty of adultery. Defendant is guilty of extreme cruelty. Defendant is guilty of fraudulent contract. Defendant is guilty of gross neglect of duty. Defendant is guilty of habitual drunkenness. Defendant is imprisoned in a state or federal correctional institution at the time of filing this Complaint. Defendant procured a divorce outside this state by virtue of which Defendant has been released from the obligations of the marriage, while those obligations remain binding on Plaintiff.

8 Plaintiff and Defendant are owners of real estate and/or personal property. Plaintiff requests that a divorce be granted from Defendant. Plaintiff further requests that the Court determine an equitable division of property and debts and order the following: ( Defendant pay spousal support; Plaintiff be restored to the former name of: Defendant pay Plaintiff's attorney fees; Defendant pay the Court costs of the proceeding; and any further relief deemed proper. Supreme Court of Ohio Uniform Domestic Relations Form 7 COMPLAINT FOR DIVORCE WITH CHILDREN Approved under Ohio Civil Rule 84 Amended: June 1, 2021 IN THE COURT OF COMMON PLEAS ______________________________ DIVISION ______________________________ COUNTY, OHIO Name Street Address City, State and Zip Code Plaintiff vs. Name Street Address City, State and Zip Code Defendant WARNING: This form is not a substitute for the benefit of the advice of legal counsel. It is highly recommended that you consult an attorney. Instructions: This form is used to request a divorce if you and your spouse have (a) minor child(ren), adult child(ren) attending high school, or child(ren) with disabilities, and/or a party is pregnant. Check to determine if you meet the residency requirement to file in this county. A Request for Service (Uniform Domestic Relations Form 31/Juvenile Form 10) and a Parenting Proceeding Affidavit (Uniform Domestic Relations Form - Affidavit 3) must be filed with this form. The Court may require additional forms to accompany this document. You must check the requirements of the county in which you file. YOU MUST UPDATE THE CLERK OF COURTS IF ANY OF THE ABOVE CONTACT INFORMATION CHANGES. COMPLAINT FOR DIVORCE WITH CHILDREN Now comes Plaintiff and states as follows: 1. Plaintiff has been a resident of the State of Ohio for at least six (6) months immediately before filing this Complaint. 2. Plaintiff has been a resident of immediately before filing this Complaint; OR The Defendant resides in Supreme Court of Ohio Uniform Domestic Relations Form 7 COMPLAINT FOR DIVORCE WITH CHILDREN Approved under Ohio Civil Rule 84 Amended: June 1, 2021 3. Plaintiff and Defendant were married on _____________________________________ (date of marriage) in ______________________________________________________________(city or county, and state). 4. Neither party is pregnant OR a party is pregnant. 5. Check all that apply : (If more space is needed, add additional pages) The following child(ren) was/were born of the parties' relationship prior to the marriage: Name of Child The following child(ren) was/were born from or adopted during this marriage: Name of Child The following child(ren) was/were born from or adopted during this marriage or relationship and is/are mentally or physically disabled and will be incapable of supporting or maintaining themselves: Name of Child The following child(ren) is/are subject to an existing order of parenting or support of another Court or agency: Name of Child One party is not the parent of the following child(ren) who was/were born during the marriage: Name of Child 6. Military Service: Neither Plaintiff nor Defendant is an active-duty servicemember of the United States military. Plaintiff and/or Defendant is an active-duty servicemember of the United States military. Supreme Court of Ohio Uniform Domestic Relations Form 7 COMPLAINT FOR DIVORCE WITH CHILDREN Approved under Ohio Civil Rule 84 Amended: June 1, 2021 7. Plaintiff is entitled to a divorce from Defendant based upon the following grounds: ( Plaintiff and Defendant are incompatible. Plaintiff and Defendant have lived separate and apart without cohabitation and without interruption for one (1) year. Plaintiff or Defendant had a Husband or Wife living at the time of the marriage. Defendant has been willfully absent for one (1) year. Defendant is guilty of adultery. Defendant is guilty of extreme cruelty. Defendant is guilty of fraudulent contract. Defendant is guilty of gross neglect of duty. Defendant is guilty of habitual drunkenness. Defendant is imprisoned in a state or federal correctional institution at the time of filing this Complaint. Defendant procured a divorce outside this state by virtue of which Defendant has been released from the obligations of the marriage, while those obligations remain binding on Plaintiff. 8. Plaintiff and Defendant are owners of real estate and/or personal property. Plaintiff requests that a divorce be granted from Defendant. Plaintiff further requests that the Court determine an equitable division of property and debts and order the following: ( Plaintiff be designated the residential parent and legal custodian of the following minor child(ren): _________________________________________________________________________________; Defendant be designated the residential parent and legal custodian of the following minor child(ren): _________________________________________________________________________________; the non-residential parent be granted specific parenting time; Plaintiff and Defendant be granted shared parenting of the following minor child(ren): __________________________________________________________________________________ pursuant to a Shared Parenting Plan (Uniform Domestic Relations Form 20), which Plaintiff will prepare and file with the Court; Defendant pay child support, cash medical support, and health care expenses; Defendant pay spousal support; Plaintiff be restored to the former name of ____________________________________________; Defendant pay Plaintiff's attorney fees; Defendant pay the Court costs of the proceeding; and any further relief deemed proper. Supreme Court of Ohio Uniform Domestic Relations Form 8 COUNTERCLAIM FOR DIVORCE WITHOUT CHILDREN Approved under Ohio Civil Rule 84 IN THE COURT OF COMMON PLEAS ______________________________ DIVISION ______________________________ COUNTY, OHIO Name Street Address City, State and Zip Code Plaintiff vs. Name Street Address City, State and Zip Code Defendant WARNING: This form is not a substitute for the benefit of the advice of legal counsel. It is highly recommended that you consult an attorney. Instructions: After a Complaint has been filed, this form is used by a Defendant to request a divorce if you and your spouse do not have (a) minor child(ren), adult child(ren) attending high school, or child(ren) with disabilities.

A Request for Service (Uniform Domestic Relations Form 31/Juvenile Form 10) must be filed with this form. The Court may require additional forms to accompany this document. You must check the requirements of the county in which you file. YOU MUST UPDATE THE CLERK OF COURTS IF ANY OF THE ABOVE CONTACT INFORMATION CHANGES. COUNTERCLAIM FOR DIVORCE WITHOUT CHILDREN Now comes Defendant and states as follows: 1. Plaintiff filed a Complaint for Divorce or a Complaint for Legal Separation. 2. Plaintiff alleged proper jurisdiction and venue. 3. Plaintiff and Defendant were married on in (IIHFWLYH'DWH 6HSWHPEHU Supreme Court of Ohio Uniform Domestic Relations Form 8 COUNTERCLAIM FOR DIVORCE WITHOUT CHILDREN Approved under Ohio Civil Rule 84 4. Neither party is pregnant OR a party is pregnant. Any child(ren) born from or adopted during this marriage or relationship is/are are now adults and none are mentally or physically disabled and incapable of supporting or maintaining themselves. Military Service: Neither Plaintiff nor Defendant is an active-duty servicemember of the United States military. Plaintiff and/or Defendant is an active-duty servicemember of the United States military. 7. Defendant is entitled to a divorce from Plaintiff based upon the following grounds: ( Plaintiff and Defendant are incompatible. Plaintiff and Defendant have lived separate and apart without cohabitation and without interruption for one (1) year. Plaintiff or Defendant had a Husband or Wife living at the time of the marriage. Plaintiff has been willfully absent for one (1) year. Plaintiff is guilty of adultery. Plaintiff is guilty of extreme cruelty. Plaintiff is guilty of fraudulent contract. Plaintiff is guilty of gross neglect of duty. Plaintiff is guilty of habitual drunkenness. Plaintiff is imprisoned in a state or federal correctional institution at the time of filing the Complaint. Plaintiff procured a divorce outside this state by virtue of which Plaintiff has been released from the obligations of the marriage, while those obligations remain binding on Defendant. 8. Plaintiff and Defendant are owners of real estate and/or personal property. Defendant requests that a divorce be granted from Plaintiff. Defendant further requests that the Court determine an equitable division of property and debts and order the following: ( Plaintiff pay spousal support; Defendant be restored to the former name of ____________________________________________; Plaintiff pay Defendant's attorney fees; Plaintiff pay the court costs of the proceeding; and any further relief deemed proper. (IIHFWLYH'DWH 6HSWHPEHU Supreme Court of Ohio Uniform Domestic Relations Form 8 COUNTERCLAIM FOR DIVORCE WITHOUT CHILDREN Approved under Ohio Civil Rule 84 CERTIFICATE OF SERVICE ( Check the boxes that apply Defendant delivered a copy of the Counterclaim for Divorce without Children. On: