COURT OF COMMON PLEAS

DIVISION OF DOMESTIC RELATIONS

Name:
Address:
-vs/and-
Name:
Address:

HAMILTON COUNTY, OHIO

Date
Case No.
Judge
Magistrate

JOINT REQUEST FOR

POST-DECREE MEDIATION

Now come and , by agreement, who hereby request the following:

Post-Decree Parenting Mediation ($150.00)

Post-Decree Parenting Mediation with child financial matters ($200.00)

Post-Decree Financial Mediation ($300.00)

Post-Decree Financial and Parenting Mediation ($350.00)

Please provide a brief description of the issues you wish to mediate:

We understand the above cost is the cost for post-decree mediation. This cost is separate from any additional court costs.

Signature - Plaintiff/Petitioner 1	Signature - Defendant/Petitioner 2
Phone Number	Phone Number
Email Address	Email Address