Effective April 11, 2005
IN THE COURT OF COMMON PLEAS
DIVISION OF DOMESTIC RELATIONS
MAHONING COUNTY, OHIO
AFFIDAVIT APPLICATION FOR REGISTRATION Case No.:______
OF AN OUT-OFSTATE [ ] CUSTODY [ ] VISITATION
ORDER - UCCJEA
In Re:______
______
Name of child(ren) subject of the attached order Date(s) of birth
(1).I, {full legal name} ______, residing at {list current address}
, being sworn according to law, am petitioning this Court to register the attached out-of -state [ ] custody [ ] visitation order that has been issued by [indicate the court, state or other jurisdiction and date]:
______
[ ] 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 identifying information.
(2). The name(s) and address(es) of any person(s), other than myself, who have been awarded custody or visitation (parenting time) in the attached custody and/or visitation order are as follows {specify}:
Name(s)Relationship to Child(ren)Address
______
______
(3). This order has been registered in the following other jurisdiction(s) or State(s) {specify}:
Jurisdiction/StateRegistration accepted/denied/pending {list only one}
______
______
I understand I am swearing or affirming under oath to the best of my knowledge and belief, the attached order which I am seeking to register is in effect and has not been stayed or modified. I understand if I knowingly make a false statement to this regard I can be fined or imprisoned.
______
Date Petitioner
State of Ohio, County of ______ss:
Sworn to or affirmed and signed before me on this ______by ______
Date Notary Public
My commission expires: ______
NOTICE: Attach two (2) copies of the order sought to be registered with at least one of the orders being certified.
INSTRUCTIONS TO THE CLERK
Please serve a copy of this APPLICATION FOR REGISTRATION OF AN OUT-OF STATE ORDER to the individual(s) listed in item number two (2) by certified U.S. mail.
NOTICE TO RECIPIENT
An application for registration of an out-of-state custody or visitation order has been filed with this court. The registered order is enforceable in the same manner as a custody or visitation order issued by an Ohio court as of the date of registration. If you wish to contest the validity of the registered custody or visitation order, you must request a hearing with this court within thirty (30) days following service of this notice. If you fail to request a hearing to contest the registered custody or visitation order, then the order will be confirmed by this court and you will be precluded from contesting the registration with respect to any matter that could have been asserted.
4/11/05