COURT OF COMMON PLEAS

DIVISION OF DOMESTIC RELATIONS

HAMILTON COUNTY, OHIO

:
Plaintiff	Case No.
:
Address	Judge.
:
City, State, and Zip Code	Magistrate
:
vs
:
COMPLAINT FOR CHILD SUPPORT, MEDICAL EXPENSES, TAX EXEMPTION, OR OTHER CHILD-RELATED EXPENSES
Defendant	:
Address	:
City, State, and Zip Code

I, , (name) am the Plaintiff on this case and parent of the following child(ren):

Name	Birth Date:
Name	Birth Date:
Name	Birth Date:
Name	Birth Date:

2.	The Defendant, , is the parent of the	child(ren).

The parents of the child(ren) are married or divorced. Date of Marriage:

A copy of documentation providing proof of marital status is attached.

4.	The child(ren) has/have resided in County, Ohio since , (date residence established) as set out in the Affidavit in Compliance with 3127.23 of the Ohio Revised Code.

5.	The parent-child relationship has has not (select one) been established. If it has been established, a copy of the order establishing the parent-child relationship or other supporting documentation is attached. A copy of the child(ren)’s birth certification is also attached.

6.	The following Court has issued an order about the following child(ren):

7.	No Court has issued an order about the following child(ren):

8.	I request that the Court order my right to receive support or my obligation to provide support for the minor child(ren) as follows (check all that apply):

The amount of child support to be paid each month. I request the Court order:

.

The person responsible for providing health insurance for the child(ren). I request the Court order: .

The amount of non-insured health care expenses of the minor child(ren) that I have to pay. I request the Court order

.

The person who can claim the child(ren) as tax dependents. I request the Court order:

.

Other child-related expenses. I request the Court order:

.

9.	It would be in the best interest of the child(ren) to have orders as requested for the following reasons: .

Plaintiff’s Signature	Date

CERTIFICATE OF SERVICE

I hereby certify that a copy of the foregoing Complaint has been served by Certified Mail/Personal Service/Ordinary U.S. Mail to:

Name
Address
City	State	Zip Code
On this date: