COURT OF COMMON PLEAS
DIVISION OF DOMESTIC RELATIONS
HAMILTON COUNTY. OHIO
Petitioner	:	Case No.
Address (Safe mailing address)	:	Judge/Magistrate
City, State, Zip Code	:
MOTION TO MODIFY OR TERMINATE
v.	:	DOMESTIC VIOLENCE OR DATING VIOLENCE
CIVIL PROTECTION ORDER OR CONSENT
:	AGREEMENT
Respondent	(R.C. 3113.31)
:
Address
:
City, State, Zip Code
IF YOU ARE ASKING FOR YOUR ADDRESS TO BE KEPT CONFIDENTIAL, PLEASE PUT A MAILING ADDRESS WHERE YOU CAN SAFELY RECEIVE MAIL. IF YOU ARE A PARTICIPANT IN THE SECRETARY OF STATE’S ADDRESS CONFIDENTIALITY PROGRAM, PLEASE USE THE P.O. BOX ADDRESS GIVEN TO YOU. THIS FORM IS A PUBLIC RECORD.
Petitioner Respondent moves this Court to modify or terminate the following Order:
Domestic Violence Civil Protection Order granted on
Dating Violence Civil Protection Order granted on
Consent Agreement Domestic Violence Civil Protection Order approved on
Consent Agreement Dating Violence Civil Protection Order approved on
In the original proceeding, I was the Petitioner Respondent.
1.	The terms of the civil protection order or consent agreement to be modified or terminated are:
2.	The reasons for the modification or termination are:
3.	Court fees cannot be assessed against Petitioner for filing a Motion to Modify or Terminate Civil Protection Order or Consent Agreement, which is in connection with a previously issued or approved protection order or consent agreement, pursuant to R.C. 3113.31(J)(1).
Respectfully submitted,
SIGNATURE OF PETITIONER/RESPONDENT
Safe mailing address where the Court may send the moving party (YOU) mail. If you are a participant in the Secretary of State’s address confidentiality program, please use the P.O. Box address given to you.
Signature of Attorney for Petitioner/Respondent (if applicable)
Name
Address
Attorney Registration
Attorney’s Telephone
Attorney’s Fax
Attorney’s Email
IN THE COURT OF COMMON PLEAS
HAMILTON	COUNTY, OHIO
Petitioner	:	Case No.
v.	:	Judge/Magistrate
Respondent	:
REQUEST FOR SERVICE
TO THE CLERK OF COURT:
Pursuant to Civ.R. 65.1(C)(4), please serve Petitioner Respondent a copy of the Motion and any other accompanying documents to the address below and as follows:
Personal service	Certified Mail, Return Receipt Requested
Other (specify)
Other (address):
Personal Service	Certified Mail, Return Receipt Requested
Other (specify)
SPECIAL INSTRUCTIONS TO SHERIFF:
Signature of Attorney OR Petitioner / Respondent
RETURN OF SERVICE
Respondent was served on	.
Officer and Badge Number	Law Enforcement Agency
Date
CLERK’S CERTIFICATE OF MAILING
Service of Process was sent by	this	day of
.
Attest:	Deputy Clerk