C-19, REV. 1/05
IN THE COURT OF COMMON PLEAS DIVISION OF DOMESTIC RELATIONS BUTLER COUNTY, OHIO Judge Sharon L. Kennedy Judge Eva D. Kessler
: Plaintiff / 1st Petitioner
Case No. _______________
: Defendant / 2nd Petitioner
Judge: __________________
WAIVER OF COURT NOTIFICATION OF INTENT TO RELOCATE
I am a parent of the following minor child(ren): Name Name Name Date of Birth _____________________ Date of Birth______________________ Date of Birth _____________________
I have been notified by my former spouse that he/she intends to relocate from: ___________________________________________ (present address) to: ______________________________________________ (new address)
I hereby waive any right I may have to be sent a copy of the Notice of Intent to Relocate Form submitted to the court by my former spouse. Date: ________________ Parent Signature