COURT OF COMMON PLEAS

DIVISION OF DOMESTIC RELATIONS

HAMILTON COUNTY, OHIO

ANNUAL GUARDIAN AD LITEM COMPLIANCE STATEMENT

Name:

Attorney Number:

For Compliance Year:

Attached to this statement is proof of attendance of at least 6 hours of specific continuing education.

By signature below, I certify that I am unaware of any circumstances that would disqualify me from serving as a Guardian Ad Litem in any court. I also certify that I have provided an updated resume to the Dispute Resolution Department with any substantive changes or any changes to name, address, telephone number and electronic mail address.

I understand that the Compliance Statement shall be submitted to the Dispute Resolution Department by January 1.

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Signature

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Date

Date submitted to the Dispute Resolution Department: