CUYAHOGA COUNTY DOMESTIC RELATIONS COURT

CASE NO. DR: ______________________

PERSONAL JURISDICTION DETERMINATION

1. Does Defendant/Petitioner-02 have an out-of-state address?� YES � NO

2. Has the Defendant/Petitioner-02 ever lived in Ohio? � YES � NOIf yes, for how long? _____

3. Have the Parties lived in Ohio as a married couple? � YES � NO

4. Is Plaintiff/Petitioner-01 seeking child support or spousal support fromDefendant/Petitioner-02? � YES � NO

SUPPORT DETERMINATION

1. Is either spouse pregnant? � YES � NO

2. Are there minor child(ren) living in Ohio? � YES � NO

3. Is there a Temporary Domestic Relations Court Order forchild/spousal support? � YES � NO

4. Is there a Juvenile Court Order for child support/custody?� YES � NO

5. Is there a CSEA Administrative Order for child support?� YES � NO

6. Is there a current case filed in Bankruptcy Court? � YES � NOIf yes, provide Bankruptcy Court Case Number: ___________Chapter 7 � or Chapter 13 �