COURT OF COMMON PLEAS

DIVISION OF DOMESTIC RELATIONS

HAMILTON COUNTY, OHIO

Name:	:	Date

Address:	:	Case No.

:	File No.

-vs/and-	:	CSEA No.

Name:	:	Judge

Address	:	Magistrate

MOTION TO REVIEW AGENCY

(CSEA) DECISION

Now comes (Plaintiff/Defendant) and requests the court to schedule a hearing for the

purpose of reviewing an administrative decision issued by the Hamilton County Child Support

Enforcement Agency. The reason for this request is as follows:

Type of CSEA Decision being reviewed:

Default/Medical Mistake of Fact

Administrative Review/Modification

____________________________________

Signature

Address

City State Zip Code

Notice of Hearing

Notice is hereby given that a hearing for (type of Hearing) has been scheduled on (date) at (time) for (length) before	in Room . Said hearing will take place at 800 Broadway, Cincinnati, Ohio.

Certificate of Service

I hereby certify that a copy of the foregoing motion has been served by Certified Mail/Personal Service/Ordinary U.S. Mail to the Hamilton County CSEA and to

Plaintiff/Defendant

at the above captioned address on the day of , 20 .