Uniform Domestic Relations Form – Affidavit 5 (Motion and Affidavit or Counter Affidavit for Temporary Orders Without Oral Hearing)

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Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 5 MOTION AND AFFIDAVIT OR COUNTER AFFIDAVIT FOR TEMPORARY ORDERS WITHOUT ORAL HEARING Approved under Ohio Civil Rule 84 Page 1 of 5 IN THE COURT OF COMMON PLEAS ____________ __________________ DIVISION ______________________________ COUNTY, OHIO Case No. Plaintiff Judge vs. Magistrate Defendant WARNING: This form is not a substitute for the benefit of the advice of legal counsel. It is highly recommended that you consult an attorney. Instructions: Check local court rules to determine when this form must be filed. This form is used to request temporary orders in your divorce or legal separation case. After a party serves a Motion and Affidavit, the other party has 14 days to file a Counter Affidavit and serve it on the party who filed the Motion. The Court may require additional forms to accompany this document. You must check the requirements of the county in which you file. If more space is needed, add additional pages. MOTION A ND AFFIDAVIT O R COUNTE R AFFIDAVIT FOR TEMPORARY ORDERS WITHOUT ORAL HE ARING Check one box below to show whether you are filing a (A) Motion and Affidavit or (B) C ounter Affidavit. (A)Motion and Affidavit (name), the Movant, files this Motion and Affidavit under Civ.R. 75(N) and/or un der R.C. 3109.043 to request the temporary orders checked here. Check only those that apply. Residential parenting rights (custody) Parenting time (companionship or visitation) Child support Spousal support (if married) Payment of debts and/or expenses THE OTHER PARTY HAS FOURTEEN (14) DAYS FROM THE DATE ON WHICH THIS MOTION IS SERVED TO FILE A COUNTER AFFIDAVIT AND SERVE IT UPON THE PARTY WHO FILED THE MOTION. (See below) (B) Counter Affidavit Movant files this Counter Affidavit in response to a Motion and Affidavit . Effective Date: September 21, 2020

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Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 5 MOTION AND AFFIDAVIT OR COUNTER AFFIDAVIT FOR TEMPORARY ORDERS WITHOUT ORAL HEARING Approved under Ohio Civil Rule 84 Page 2 of 5 Complete the following information, whether filing Motion and Affidavit or Counter Affidavit. ( Check all that apply) 1. The parties are living separately. Date of separation is . The parties are living together. The parties have no minor children. (Skip to number 6) The parties have (a) minor child(ren) who was/were born from or adopted during this relationship. (List child(ren) here) Name Date of birth Living with In addition to the above child(ren), Movant has __________________ other biological or adopted minor child(ren). Other party has _______________ other biological or adopted minor child(ren). There is/are __________________ adult(s) in Movant’s household. 2. Movant’s child(ren) attend(s) school in: _________________________________ public school district Other: (Explain) All children do not attend school in the same district. (Explain) 3. Movant requests to be named the temporary residential parent and/or legal custodian of the child(ren): (Specify child(ren) if request is not for all child(ren)) Movant does not object to the other parent or party being named the temporary residential parent and/or legal custodian of the child(ren): (Specify child(ren) if request is not for all child(ren)) 4. Movant has reached an agreement regarding parenting time (companionship or visitation) with the other parent or party as follows: Effective Date: September 21, 2020

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Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 5 MOTION AND AFFIDAVIT OR COUNTER AFFIDAVIT FOR TEMPORARY ORDERS WITHOUT ORAL HEARING Approved under Ohio Civil Rule 84 Page 3 of 5 Movant wishes to exercise the following parenting time (companionship or visitation): Movant wishes for the other parent or party to exercise the following parenting time (companionship or visitation): Movant requests that the other parent or party’s parenting time (companionship or visitation) be supervised: (Explain the reason for request.) Name of an appropriate supervisor 5. A Court or agency has made a child support order concerning the child(ren). Name of Court/Agency Date of Order SETS No. 6. Movant requests the Court to order the other parent or party to pay: $ child support per month $ spousal support per month (only if married) $ attorney fees, expert fees, Court costs The following debts and/or expenses: Other: 7. Movant is willing to attend mediation. Movant is not willing to attend mediation. Effective Date: September 21, 2020

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Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 5 MOTION AND AFFIDAVIT OR COUNTER AFFIDAVIT FOR TEMPORARY ORDERS WITHOUT ORAL HEARING Approved under Ohio Civil Rule 84 Page 4 of 5 8. Movant requests the following Court services. (See local rules of Court for available services.) State specific reasons why Court services are required. Attorney or Self Represented Party Signature __________________________________________ ___ Printed Name ___________________________________________ __ Address ____________________________________________ _ City, State, Zip ________________________________________________________ Phone Number ____________________________________________ _ Fax Number ____________________________________________ _ E-mail ____________________________________________ _ Supreme Court Reg No. (if any) OATH OR AFFIRMATION I, (print name) _________________________________________, swear or affirm that I have read this Affidavit and, to the best of my knowledge and belief, the facts and information stated in this Affidavit are true, accurate, an d complete. I understand that if I do not tell the truth, I may be subject to penalties for perjury. Signature STATE OF _______________ ) ) SS COUNTY OF _____________ ) Sworn to or affirmed before me by ________________________this ___ ______day of ______________, _____. Effective Date: September 21, 2020

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Supreme Court of Ohio Uniform Domestic Relations Form – Affidavit 5 MOTION AND AFFIDAVIT OR COUNTER AFFIDAVIT FOR TEMPORARY ORDERS WITHOUT ORAL HEARING Approved under Ohio Civil Rule 84 Page 5 of 5 NOTICE OF HEARING (Check with local C ourt to obtain a hearing date and time and for scheduling procedure) You are hereby given notice that this Motion for Temporary Orders will come before the Court for consideration on Affidavits only, without oral testimony, before Judge/Magistrate ___________________________________, at _________________ a.m./p.m. on _______________________________, 20_________. CERTIFICATE OF SERVICE (Check the boxes that apply) I delivered a copy of the: Motion and Affidavit or Counter Affidavit On: (Date) , 20 To: (Print name of other party’s attorney or, if there is no attorney, print name of the party) At: (Print address or fax number) By: As instructed in the Request for Service (Uniform Domestic Relations Form 31/Uniform Juvenile Form 10) filed with the Clerk of Courts Regular U.S. Mail Fax Hand Delivery Other: Signature 2020 Effective Date: September 21,