COURT OF COMMON PLEAS
DOMESTIC RELATIONS DIVISION
MEDINA COUNTY
Judge Mary R. Kovack
DISSOLUTION CHECKLIST (with children)
PETITIONER COUNSEL:
PETITIONER COUNSEL:
CASE NUMBER: MARRIAGE DATE:
CHILDREN’S NAMES & AGES:______
______
Pursuant to Loc. R. 7.01 (check off if needed and included)
____ PETITION FOR DISSOLUTION
_____ Includes both parties’ names, addresses, dates of birth, marriage date
_____ Includes children’s names and dates of birth
_____ Jurisdiction and venue requirements met
_____ Signed by attorneys/parties
____ WAIVER OF SERVICE executed by both parties
____ IV-D APPLICATION signed by the obligee
____ CHILD CUSTODY AFFIDAVIT
____ Certificates of attendance for parenting seminar ____ H _____ W
____ An original SEPARATION AGREEMENT executed by the parties (Italicized portion may appear in shared parenting plan)
_____ Personal property division addressed (including vehicles)
_____ Real property division addressed
_____ Financial division of property addressed (accounts, investments, life insurance, etc.)
_____ Pension division addressed
_____ If applicable, must address QDRO and court’s jurisdiction over them
_____ Liabilities and debt division addressed
_____ Spousal support addressed - including jurisdiction
_____ Spousal support must have an effective date and must address duration
_____ Mandatory CSEA language
_____ Disclosure statement
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_____ Health insurance addressed
_____ Child support addressed and mandatory language included
_____ Child support must have an effective date and termination language
_____ Guidelines child support is mandatory and if deviation, must have explanation
_____ Must address arrearages if applicable
_____ Must address tax exemptions
_____ Must incorporate a parenting plan designating a residential parent, unless shared parenting plan is incorporated and sets forth companionship schedule
_____ If refers to Court’s standard companionship schedule, must be attached
_____ Must address intent to relocate, access to school and medical records
____ CHILD SUPPORT WORKSHEET
____ An Original Shared Parenting Plan executed by the parties, if applicable
_____ Must set forth children’s living arrangements, companionship time and school district
_____ Italicized provisions appear in the plan
____ JUDGMENT ENTRY/DECREE OF DISSOLUTION
_____ Includes both parties’ names, addresses, dates of birth, marriage date
_____ Includes names and dates of birth of the minor children
_____ Jurisdiction and venue requirements met
_____ Contains date of hearing
_____ Signed by attorneys/parties
_____ Contains mandatory CSEA language if applicable
_____ Contains mandatory health insurance language
_____ Statement that wife wishes to be restored to former name, if applicable
_____ Payment of court costs and attorney fees
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