'
COURT OF COl\Ii\ION PLEAS
DIVISION OF DOMI':STIC RELATIONS
HAMn,TON COUNTY, OHIO
MELISSA HENDON DETERS
Plaintiff
DR1302234
Date:
Case i'/o.
File No.
CSEA No.
Judge
VS.
age 9
age 20
age 23
age ::.24-'--
is residing
is residing
is residing
is residing
with ..:...1
with..:...1
with
with
_
_
_
(1)1 Yes_ No
Employed?
.......... Estimate
Base yearly wages
......................... Yearly Averages, Overtime, Commission
$202,800
$290.628.00
Ycs_ No (2)
Estimare
& Bonus Income
Employer
Payroll Address
City, State, Zip
Scheduled Paychecks Per Year
Unemployment Benefits
Workers' Compensation
Social Security or Other Disability Benefits
List Source in Section D-2
Spousal Support Received
Interest/Dividend Income
List Source in Section 0-2
Public Assistance or
Income Supplement Security
Other Income Received
list Source in Section IIl-B
TOTAL YEARLY INCOME
Wife
$50.000.00
""$O"-'.-".OO~
12
$0.00
$0.00
$0.00
$0.00
$0.00
SO.OO
$0.00
$50.000.00
"
Husband (I)
Wife (2)
ANNUAL
INCOME,
Base Income
Overtime.
and/or
Bonuses
""$0"-'-.0"-'0"--__
""$0""'-.0""'0"-__
$0.00
SO.OO
SO
per year
per year
per year
$0.00
per year
per year
SECTION
II
OVERTIME
AND BONUSES
(Past Three Years)
Base Income
2010
20 II
year 3
year 2
year I
Overtime,
and/or
Bonuses
=$O~.O=O
_
=SO"-,.",,oO~ __
""$0=.0""'0'---__
$0.00
$0.00
$0.00
MOST RECENT
2012
YEAR
"D.JUST;\,I ENTS
.............. Court Ordered Support Paid for other child(ren)
. $0.00
........ Court ordered Spousal Support Paid to a Fonner Spouse
. $0.00
..... Number of Other Dependant Children living with the Party
.
(Excluding Unadopted Step Children)
......... Child Support Received for Other Dependent Children
""$
Indicated Immediately Above
... Health Insurance Premium Paid by Party ifChildrcn Included .. $0.00
For Post Decree Modifications Only
Gross Income of Current Spouse or
$
............. Other Contributor in Household
.
AFFIANT'S MONTHLY
per year
per year
--'p""e::..r..r.V"'C<lO!.r
per ycar
per year
EXl)ENSES
List expenses below for your present household. There are .L adults and
A. Housing
l . Rent or Mortgage (including taxes & insurance)
2. Utilities
a. Gas & Electric
b. Water & Sewer
c. Telephone (excluding long distance)
d. Trash Collection
e. Cable Television
3. Other: Security System
Homeowner A$sociation Fees
TOTAL HOUSISC
,
,
,
13.Other
I. Car Repairs & License
2. Insurance: Car
3. Medical Expenses (not covered by insurance
4. Clothing
5. Grocery Items (to include food, laundry & cleaning products/toiletries,
etc.)
6. Child Related Expenses
a. (employment related only)
b. Other:
7. Gasoline & Oil
8. Other: Car PaYment for Joe and Jonathan
l\10NTHL Y TOT AL .............
, .. ,...............................................
EARI~ED
I.
children in my household.
$3,127.37
=$"'-27'-'8=.5"-'7'---~$.i;!o83""..!.18~
_
_
"'-$:::..3....,10::..:..0"'0"-"'-$"'-0
_
_
""$2"'6"'0::..:..9""5"--
""$..:..;18::..:.."'00"'--
""S6""0"".0"'0"'--
""S4"-'.
....
13""'8""'.0.!....7
",S,,-9
0"".-"-0"'-0
2=.;5~
=.S=.2"'-'l5'-'..0"'0"--
_
_
_
::::S..!,47.!..!8:..:..
"'-S-'-'I.""50"""'0~.OO=-
"'"S-'-'1..=.2"'-00~.""'0"'-0
""$4~8"-'2.,;.0~8"-""SO""'-.",-,OO~
"'$.:..72""0""."'00"-
_
_
_
"'$'"'-tl9"-'S""'.- .4"-8"--
""$5"->.,3=8=3~.8;..:..1
PI!.2
C. MONTHLY
INSTALLMENT
(Do not list expenses previously
TO WHOM PAID
PAYMENTS
listed in Section B)
PURPOSE
Credit
Credit
Credit
Credit
Credit
Credit
Buick
Passat
Card
Card
Card
Card
Card
Card
Loan
Loan
7,855.36
MONTHLY
PAYMENT
$500.00
$500.00
14,195.19
9.500.00
S500.00
34,000.00
$1,000.00
BALANCE
DUE
11,403.79
$500.00
$125.00
$41\3.00
$155.37
$3,763.37
$18,486.75
GRANO
TOTAL
MONTHLY
EXPENSES
SECTION
III
FINANCIAL
DISCLOSURE
A. list all funds on deposit in any and all accounts in any bank, savings & loan, credit union, regulated investment
company, mutual fund or other financial institution. Account includes any of the following: checking, certificate of
deposit ("CD"), investment, savings, individual retirement ("IRA"), stock option, etc. Attach additional pages if
needed.
Account No.
Name(s) on Accounts
Balance Date of
Name and Address of
this Affidavit
Financial Institution
xxx586
Joseph Deters
S;
Fifth Third Bank
xxx500
Huntington
Bank
xxx400
Huntington
Bank
xxx06n
Melissa Deters
Melissa Deters
Huntington
Bank
xxx760
Melissa Deters
Income or Benefits
Per Month
NONE
DR 7.3 (Revised
Identifying Description
(Account No., Claim No., etc.)
0710112001)
per
;;
SECTION
OTHER
IV
ASSETS
Value
S
2. List any lump sum income (bonus, gifts, inheritance, etc.) in excess of $500, expected to be received within the next
six months, not otherwise listed in this affidavit. Attach additional pages if needed.
Source NONE
Value "'$
_
Addrcss
_
Affiant states that the information
contained
Atfi nt:
______
iAMgd H, MO~KOWnt.
Att5I'il8i d UJ11I
,,"aTARY
DR 7J (Revised 07/01(2001)
, 2o~3
'I
D. OPTIONAL
(Additional Monthly Expenses)
Complete if an award of spousal support is at issue or in the event that you are seeking a significant deviation from the
child support schedule.
""$""0.""0""0
2.
,""$0"'.""0"'-0
"",,
Extraordinary Visitation-Related Travel Expenses
3. Extraordinary Obligations to other children, minor and handicapped,
4. Mandatory Deduction from Wages (Not taxes, Social Security
5. Hair Care, Dry Cleaning
6. Newspapers, Periodicals, and Books
7. Child Care (not employment
related)
,
" .. "
8. Children'S School Lunch Program
9. Children's Allowances, Activities
10. Tuition (lor Minor Children or Sell)
II. Entertainment
12. Contributions
13. Additional Taxes Paid (not from wages
14. Memberships (Associations, Clubs)
15. Travel, Vacations
16. Water Softener
17. Housing Repairs
18. Housekeeping Services
19. Lawn Service
20. Other (Specify)
School supplies
Gift,
Sorority
Pets
Mary Elyse Deter Rent
Cable for Boys
TOTAL OTHER
not step-children
_
_
.$""0"".""00"'--
.$""O~.""OO"'--
.$""2::...4!.-"2"--'.5'--':0~
""$0"".""00"'-
"'$-"0'-".0...,0'--
.$""..:...10"".""00"-
"
.,,$-'--70"--'0"'-.0""0"--
"'S""1.L.!.4"'66""'.:<,0"'0
.$"'-4-'-'5:<.!0'-'-.0"'-'0~
""$...,10...,0'-".0""0'--
""$0"'.:.=,0""0
.$-:<.""78~.-"-00"-.$=2=0"-'0'-'-.0""0"--
""$0"".""00"'--
""$....,10..,0""'.0""0"-""'$.:..;10""0""'.0""0'-.$"'-'-'IR.:..,:4"".0""'0'--
_
_
(D)
%-,$-'-'15"".0=-0"-.$""2""'5""'0"".0-"--0
$25.00
$685.00
""$-'--"8..,0"".0""'0'-EXPENSES
$5.201.50
1\!.5
,I
~.,
HENDON
Date:
DETERS
Case No.
DR13
a2234
vs.
File No.
JOSEPH THlWDORE
Defendant
DETERS
CSEA No.
Judge
AFFIDAVIT
fN COMPLIANCE WITH
REVISED CODE
Melissa Hendon Deters discloses the following information under oath and represents that it is true to the best
of Wife knowledge and belief based upon what is reasonably ascertainable:
I.[ 1 [ am requesting the court to not disclose my address or that of the child named below. I am claiming tiH1I
my address is confidential pursuant [Q Ohio Revised Code 3127 .23(D) and should be placed under seal in that the health,
safety, or liberty of myself and/or the child would be jeopardized by the disclosure of the identifying information. I
understand that a hearing will be held to determine whether the information can be disclosed based on my claim.
2. The name(s) and the present addressees), or the whereabouts,
DOB 5/8/04
<1.
u C')
~u-\...'
('oJ
7!.
lWve
participated,
~\.J'J
~u
of all persons with whom the child have lived during the past 5 years are:
Address] es)
11976 Stonemark Lane Loveland, Ohio 45140
15 W. FourthStreet #503, Cincinnati, Ohio 452Q2
3737 Hazel Avenue Cins;innati, Ohio 45212
I have listed below the court, the case number, and kind of case:
0, . Case Num~
0~
d. ex.
c:;.
5. I have not participated as a party, a witness, or in any way in some court action in this or another state
cercemint:i
custody, support, care of or visitation or parenting time with these same child.
1j3~
~o:?
Names
Melissa Deters and Marv Elyse Deters
J oseoh Deters
Jonathan T. Deters and Joseph S. Deters
~ ~ ~
ofthe
~ U-!..:N""o.!!:~~
~
Name of Court
_
Kind orCase
6. I do not know of any proceedings that could affect this proceeding. including proceedings lor
enforcement 0 f chi ld custody determinations, relating to domestic violence or protection orders, to adjudicate the
child as an abused, neglected, or dependent child, seeking termination of parental rights, or adoptions. If I do know,
T have listed the information here:
_
7. The following persorus) are not parties to this case and (a) have physical custody of the child or (b) claim
to be a parent of the child or (c) claim to have custody, visitation or parenting time rights regarding the child. (If
None, write "None" on a line below)
Name
None
8. By signing below, I understand that I have a duty to inform the court if I get any information about any
parenting proceeding or court case filed in another court about this same child that may affect this proceeding.
in my presence this ~
day of IV.::>""~;Y"\
'Ee (,"20~.
0 R 1 3 0 2 '2 3 4
Case No.
Deters
Plalntitf
File No.
CSE,' 1'.'0.
.JlId~e
GHOUP
.
_y<:s
...x no
__ yes
.x no
* . * ....
..
IIE,\LTH
*" .
INSlmANCE
,'FrIOA
*****.**.*;fr
PL\l1\TIFF
"IT
**
DEFE:"DANT
Available
through
Other
employment
group
_ yes -X no
'.Iumana
"'AME
I~SURER'S
_no
~yc"S
plan
--r"I
t.QJl~~
'
ADDRESS
~.
'-'
'AM\!
,",'UMBER
I\lonthly
premium
Monthly
(Indicate
of lndividuul
premium
of Family
"0" if available
AI
r-
7047S6
Plan (employee
share)
Plnn (employee
N
N~""
rn
l>
-..g
COVERACES
Summarize
;A~
-"-0
~ ~
health maintenance
organization,
(f);:U
ere
necessary.
[ J No
( J Yes
J Self
[ J Dependent
[ J Yes
children
[ J Y..-:;
ofthe
Is coverage
presently
in effect?
Who is covered?
[XjYL'S
) No
[X)
[X )
marriage
Self
DC-Pl'l1dl'l11
children
of the marriage
[ )1\'0
Is u pnrtlcipanr
card nvnilabtc?
[X J Yes
J No
[ ) No
Is a prescription
card uvuiluhlc?
[X j Yes
INo
li:mploycr's
Ins. Ccordlnatnr's
4~~~
Numh('J"
COIlR,\
Joseph
COHm!!" will be
'I1H,XX]O/'l:
Deters
Defendant
Sworn
[0
Illy
presence hy Plaintitfthis
20J.3....
"-,
~~(T1
co-puymcrus,
<
'3 n:z:
1--
share)
no cOSI 10 party)
;~--I
., pI::O
__ I_:u:'~
-<
Lcxingt{1O.Ky40512-POLIC\'
~.J
DR624
EFF.10/08
Name of parties
Husband
and
Wife
Order No.
Case No.
1
t8J
The following parent was designated as residential parent and legal custodian:
mother
father
shared
Column I
Column II
Column III
Father
Mother
Combined
INCOME:
1.
income,
or commissions) .......................................
281,220
49.992
Mother
$
$
$
$
AVERAGE
.............
during the current calendar year will meet or exceed the amount
that is the lower of the average of the three years or the year 1
amount. If. however, there exists
reasonable
expectation
that
calendar year will be less than the lower of the average of the 3
years or the year 1 emount, include only the amount reasonably
$
_ .............
..............
For self-employment
income:
...................
individual
4.
compensation
HUSband'&
Wile
Pogo 1
Order No.
Case No.
5.
Column II
Column III
Father
Mother
Combined
disability insurance
Column I
benefits
, .,
$._~ __
..:.O
....::.0
$__
..:.0
..:..:1
B:..:0:..c,D:..:D:..::.D
Mother:
Alimony from this relationship
7.
180,000
a. Total annual gross income (Add lines 18, 1b, 2d, and 3-6)
b. Health insurance maximum (Multiply line 78 by 5%), ,
ADJUSTMENTS
Adjustment
B.
281 ,220
14,061
$_----=2.::..29:.,:, 9:..:9:...::c2
$
1:...:12.:.5:.::..::.
TO INCOME:
for minor children bom to or adopted by either
parent and another parent who are living with this parent;
adjustment does not apply to stepchildren
(number of
9.
Annual court-ordered
10,
Annual court-ordered
former spouse.
, . , , , ...
,$
" , , , , , .. , ,,$
....::.0
..:.0
-..:.0
-..:.0
--=.O
180,000
, . , . . ..
5,906
, , , , . . . . . . . . . . . . . . . . . . . . . . . ..
185,906
$ __
$__
...:9:.:5c..:,3:.:1~4
228,942
4::.,7:..:6:..::6 $
11,447
, . , ....
, , , , . , , , , . , . , .. , , . , , , ...
11.
be paid , ,
, ,,
, .. ,
1':":"0:..:5:..::.0
12.
.....
, , . , . , ...
13.
14. a. Adjusted annual gross income (Subtract line 13 from line 7a)
....::.0
..::.0
...:1c..:,O:.:5~0
b. Cash medical support maxJmum (If the amount on line 7a, Col. I,
is under 150% of the federal poverty level for an individual,
enter SO on line 14b, Col. I. If the amount on line 7a, Col. I,
is 150% or higher of the federal poverty level for an individual,
multiply the amount on line 14a. Col. I, by 5% and enter this
amount on line 14b, Col. I. If the amount on line 7a, Col. II,
is under 150% of the federal poverty level for an individual,
enter SO on line 14b, Col. II. If the amount on line 7a, Col. If,
is 150% or higher of the federal poverty level for an individual,
multiply the amount on /ine 14a, Col. II, by 5% and enter this
amount on line 14b. Col. If.)
15.
, .. $.~ __
,,
, ...............
, ,
$ __
3_24..:..,2_5_6
MO$!o.owitz.I,..I.C
Prepared
by James H,
Moskowitz.
Esq. James
Moskowitz
Inc. v
15.03
1112OO01J
1:03pm
HUSband &
Wile
Pao2
.'
Order No.
Case No.
16.
Column I
Column II
Column III
Father
Mother
Combined
. .. .
29.39
70.61
b. Mother (Divide line 14a. Col. 1/. by line 15, Col. 11/)...........................
17.
on
line 15.
$_~_1_5,-,,-,2_1_8
C. Percenttobeusooonincomeover$150.000.........
18.
17 4.256
10.1453
$~ __ 3_2..:..,8_9_7
9,668
1_7.:..,6_7_9
$~ __ 2-,3-,-.2_2_9
Annual child care expenses for children who are the subject
of this order that are work-, employment training-. or
education-related.
or not
$_~~
__
claimed)
0_
-'-0
insurance for the children who are the subject of this order
(Contributing
estimated by
INSURANCE
1.:..:..2...;..8..;..9
IS PROVIDED:
C. Subtractions;
1.289
d, Subtractions:
_
line 16a times sum of amounts shown on
v,
tlC
Prep.:lIrod
by J<:imc:;
H, Moskowitz.,
Hu~b3l\d.&
\Vita
Pogo 3
Order No.
Case No.
22. OBLIGATION
AFTER ADJUSTMENTS
Column I
Column 11
Father
Mother
IS PROVIDED:
9,668
ACTUAL
ANNUAL
OBLIGATION
WHEN HEALTH
INSURANCE
23.229
IS PROVIDED:
$__
--=9J.;,6:.;6:.::.8
$_---
ADJUSTMENTS
INSURANCE
$__
.;;..0
--=9~,6:.:6:.::.8
$_---
$_---
IS NOT PROVIDED:
Mother (only if obligor or shared parenting)
$.
25. OBLIGATION AFTER ADJUSTMENTS TO CHILD SUPPORT WHEN HEALTH INSURANCE IS NOT PROVIDED:
a. Father: line 18a plus or minus the difference between line
24a minus line 24c
9,137
ACTUAL
a.
ANNUAL
OBLIGATION
WHEN HEALTH
INSURANCE
23,229
IS NOT PROVIDED:
to the parent
,. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
b. Any non-means-tested
9,137
$.
9,137
27. a. Deviation from sole residential parent support amount shown on line 23c if amount would be unjust or inappropriate:
(see section 3119.;?3 of the Revised Code.) (Specific facts and monetary value must be stated.)
i. Sole custody deviation when health insurance is provided
40,000
ii. Sole custody deviation when health insurance NOT is provided
_
_
Order No.
Case No.
b. Deviation from shared parenting order. (see sections 3119.23 and 3119.24 of the Revised Code.) (Specific facts including
amount of time children spend with each parent, ability of each parent /0 maintain adequate housing for children, and
each parent's expenses for children must be stated 10 juslify deviation.)
i. Shared custody deviation when health insurance is provided:
ii. Shared custody deviation when health insurance is NOT provided:
WHEN HEALTH
WHEN HEALTH
INSURANCE IS
INSURANCE IS
OBLIGOR
PROVIDED
NOT PROVIDED
Father/Mother
27a
or 27b) . . . . . . . . . . . . . . . . . . . . . ..
49,668
9,137
FATHER
----'--
29. FOR DECREE: Child support per month (Divide obligor's In 28., by 12)
... before any processing charge
. . . . . . . . . . . . . . . . . . . . . . . . ..
; ..
$
$
$
4,139 $
8_3 $
4.222 $
-.:7....::6'-'.1
1..:..5
..:..7...:.7.c:,6
1,289
$
$
107
2
109
31. FOR DECREE: Cash medical support per month (Divide In 30. by 12)
... before any processing charge
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
Prepared by:
Counsel:
Pro se:
(For motherlfather)
Other.
CSEA:
Worksheet
Mother
Date
Father
Date
0.624 EHecU...,
10108
Moskowitz & Mo,kow;'z, LLC PrOP"od by Jam es H. Moskowllz, Esq. James Moskowitz
Page 5