Rule text
(Uniform Domestic Relations Form 24/Uniform Juvenile Form 3) and a Show Cause Order and Notice to the Clerk (Uniform Domestic Relations Form 25/Uniform Juvenile Form 4) must be filed. You must bring copies of health care bills, Explanation of Benefits forms, and proof of payment to the hearing. Be prepared to indicate the amount owed to you, service providers, collection agencies, or other entities. If more space is needed, add additional pages. The Court may require additional forms to accompany this document. You must check the requirements of the county in which you file. Instructions: This form is used when you are claiming the other party has not paid health care bills. Use a separate form for each child. A Motion for Contempt and Affidavit Amended: Page 1 of 1 Other Party Due from Amount of Unpaid Amount Bill Other Party Total Amount of Claim $ You Paid Amount Paid by Amount EXPLANATION OF HEALTH CARE BILLS Insurance Amount Paid Name of Child: Case No. Total Bill Date Bill Sent to Other Party Your Signature Date Treatment Name of Service Provider (e.g., Doctor, Dentist, Therapist, Hospital) & Services Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46 September 21, 2020 Provided