PACKET 1A INSTRUCTIONS FOR FILING A PETITION FOR by ibc17145

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									                                           PACKET 1A

   INSTRUCTIONS FOR FILING A PETITION FOR CUSTODY AND PARENTING TIME

This packet may be used to file a custody and parenting time case providing paternity of the
child(ren) has been established. It includes 15 documents which are listed on page three.
Information regarding establishing paternity is available on the Department of Justice –
Division of Child Support website (listed under Additional Resources); you may wish to
contact an attorney for legal advice.
        Please note: Packets available on the Jackson County website may be numbered
differently than those on the Oregon Judicial Department website. If using both sources be
careful to ensure you are obtaining the correct forms.

                          NOTICE ABOUT THESE INSTRUCTIONS

        These instructions are not a complete statement of the law. They cover
basic procedure for uncomplicated cases. For legal information please talk to a
lawyer, visit the Jackson County Law Library, refer to Jackson Circuit Court
Supplemental Rules and/or refer to the Additional Resources on the last page.
        These instructions may refer to some forms not included in this packet. You
will find those forms on the Oregon Judicial Department or Jackson County Circuit
Court websites, www.courts.oregon.gov/OJD or www.courts.oregon.gov/Jackson.
        Phone numbers and websites referred to are provided on the last page as
“Additional Resources.” They are current as of the date of writing and are
provided as a courtesy. The Oregon Judicial Department and the Jackson County
Court are not responsible for changes to, or the content of, the resources.

                                   GENERAL INFORMATION

        Listed above are the documents you will need to prepare and file to open a case with
the court. A filing fee will be due.
        If you feel you cannot afford to pay the filing fee you may submit the completed
Application for Waiver or Deferral of Fees available in Optional Forms and at the clerk’s
counter. If the fee is waived you do not have to pay the fee. If the fee is deferred the court
will require you pay the fee according to a payment schedule determined by the Accounting
Department and additional fees may be charged. The court may enter a judgment for any
unpaid, deferred fees. If your request for fee waiver/deferral is denied the filing fee is due
at the time the documents are filed.

                                LEGAL ISSUES TO CONSIDER

        Before you fill out your petition you should carefully consider what you are going to
request of the court as it may determine what will be included in the final judgment. The
judgment is the document that finalizes your case and contains your rights and
responsibilities. Oregon law provides that a number of issues must be addressed in the
judgment. Several important issues to consider are explained in the following paragraphs.
Your case may involve additional issues you may wish to add to your petition.

        Custody: Custody of the child(ren) is an extremely important issue. If you do not
come to an agreement regarding custody, the court mediators may be able to assist you.
If you do not reach agreement in mediation, the case will most likely go to trial and the
court will make a determination based on the best interests of the child(ren). For
information about custody you may call Tel-Law or visit the Oregon State Bar’s website.

       Parenting Plan: A parenting plan is required for cases involving a minor child(ren).
The plan sets out the schedule and guidelines for each party’s time with the child(ren). The
parenting plan may include safety provisions for the child(ren) if domestic violence,
substance abuse, child abuse or other circumstances are involved in your case.
       A mediator can help parties create a parenting plan. Information about parenting

INSTRUCTIONS FOR PACKET 1A - PAGE 1 OF 7                                             (01/29/10)
plans is also available at the mandatory parent education class; from the family law
facilitator; or the Jackson County Law Library.
         The Oregon Judicial Department and the State Family Law Advisory Committee have
created a Basic Parenting Plan Guide for Parents (www.courts.oregon.gov/OJD) which
includes information about how to develop a plan; a sample plan; information about
alternative schedules; and the ages and stages of your child(ren) to be considered in
creating a plan. Also provided is a Safety Focused Parenting Plan Guide
(www.courts.oregon.gov/OJD) to help you develop a parenting plan if there are safety
concerns for your child(ren).
         Oregon law (ORS 107.159) prevents either party from moving more than 60 miles
further distant from the other party without giving that party and the court notice of the
move. You may ask the judge to waive this requirement in your petition.

        Child Support: In most cases, the court will order child support if the parties have a
child(ren) and no child support order already exists. If ordered, the amount of support will
be determined by the Child Support Guidelines. The Guidelines have worksheets to help
you determine who should pay support and how much it should be. Note: Support is
typically withheld from wages unless an exception is allowed for direct deposit to the other
party’s checking or savings account, or, if support enforcement services are being provided
to either party, as an electronic payment withdrawal (EPW) or electronic funds transfer
(EFT) to a Department of Justice account. (EPW and EFT are procedures whereby funds are
automatically withdrawn from a checking/savings account as authorized by the account
holder.)
        Information about child support, including the Guidelines and Worksheets, is
available at the Oregon Department of Justice - Division of Child Support website. This
website has a Child Support Calculator which may help you to calculate the amount of child
support which should be paid. You may contact the Oregon Department of Justice - Division
of Child Support, the Jackson County District Attorney’s Office - Family Support Division or
the family law facilitator for assistance in calculating a support amount.
        The party who pays child support may be required to provide for security for
payment of the support, such as life insurance.
        Oregon law requires that the petitioning party submit a certificate stating whether
there are any pending child support proceedings or existing child support orders involving
the parties’ child(ren). To comply with this requirement, fill out and submit the form called
Certificate Re: Pending Child Support Proceedings And/Or Existing Child Support
Orders/Judgments. You are required to attach certified copies of any pre-existing child
support orders (certified copies may be obtained from the clerk of the issuing court).

        Cash Medical Support: You may request that you be reimbursed for out-of-pocket
medical expenses that exceed $250. per child per year or to reimburse for public health care
coverage. Even if you do not request the payment of cash medical support the judge may
order either you or the other party pay it. NOTE: The judge cannot order you or the other
party to pay cash medical support if you or the other party has a dependent child in the
household who is eligible to receive public medical assistance, or if you or the other party is
eligible for public medical assistance yourselves.

       Health Insurance: Oregon law requires that the judgment address the issues of
health insurance and payment of uninsured medical expenses for any minor child(ren).

        Unmarried and Unemancipated Children at Least 18 and Under 21 Years of
Age: Unmarried, unemancipated children who are at least 18 and under 21 years of age
are necessary parties to all family law cases involving support. The petition provides a line
in the heading to write the child(ren)’s name(s). The judgment will indicate how the
child(ren) has been involved in the case. A line is provided underneath the petitioner’s and
respondent’s signatures for such child(ren) to sign if applicable. As a party to the case the
child(ren) must be legally served with all the required documents. After service, the
child(ren) may sign a Waiver of Further Appearance and Consent to Entry of Judgment,
(www.courts.oregon.gov/OJD) Packet 6J if the child(ren) does not choose to participate
further in the case.

INSTRUCTIONS FOR PACKET 1A - PAGE 2 OF 7                                              (01/29/10)
         STEP 1: PREPARING AND FILING YOUR CASE; SERVING THE DOCUMENTS

   PREPARING THE FORMS
   When filling out the forms follow these directions:
   1.) Complete the case captions. You are the petitioner and the other party is the
   respondent. Use full names (first, middle or middle initial, last); be consistent on all forms.
   2.) Most of the forms also require your name, address and phone number. Please print
   that information. You are not required to use your residential address. You may use a
   contact address; however, the court will assume you receive all notices sent to that address.
   If you fear for your safety you may ask your address be confidential. It is your
   responsibility to notify the court in writing of address changes.

   The instructions are broken down into four basic steps. The forms that go with each step
   are listed below.
                                          Steps and Forms
1. Preparing and Filing Your Custody and Parenting Time Case; Serving the Documents
Petition for Custody and Parenting Time
Summons
Certificate re: Pending Child Support Proceedings and/or Existing Child Support Orders/ Judgments
Family Law Confidential Information Form (CIF)
Certificate of Document Preparation
Affidavit of Service
Acceptance of Service
Certificate of Mailing

2. Waiting for a Response
Response Filed                                      No Response Filed
Go to Step 3                                        Ex Parte Motion for Order of Default and Order;
                                                    Affidavit in Support of Motion for Order of
                                                    Default
                                                    Go to Step 4
3. Working Towards Agreement
(Custody/parenting time mediation and parent
education class are required. If the parties
cannot reach an agreement the matter will be
set for hearing/trial.)
4. Finalizing Your Case
Response Filed (If the parties reach agreement      No Response Filed (Use the documents below)
prior to trial use the documents below.)
Motion for Entry of Judgment on Affidavit in Lieu   Motion for Entry of Judgment on Affidavit in Lieu
 of Hearing                                          of Hearing
Petitioner’s Affidavit in Lieu of Hearing in        Petitioner’s Affidavit in Lieu of Hearing in
 Support of Entry of Judgment of Custody,            Support of Entry of Judgment of Custody,
 Parenting Time                                      Parenting Time
General Judgment of Custody, Parenting Time         General Judgment of Custody, Parenting Time
Attachments: Child Support Worksheet, Uniform       Attachments: Child Support Worksheet, Uniform
Support Affidavit, Parenting Plan                   Support Affidavit, Parenting Plan

   HAVING YOUR DOCUMENTS REVIEWED
          You may have your documents reviewed by your attorney or the family law facilitator
   before you file. For information about how to find an attorney you may call the Oregon
   State Bar Lawyer Referral Service. If you are low income you may be able to have your
   documents reviewed for a smaller fee through the Bar’s Modest Means program.




   INSTRUCTIONS FOR PACKET 1A - PAGE 3 OF 7                                              (01/29/10)
FILING THE CASE
         Make two copies of the original documents listed in Step 1 after you have completed
them. Take the originals and both copies to the court clerk, who can witness your signature
(you will need a photo I.D), file the originals and process the copies. One set is for your
records; the other set must be served on the other party. At this time you will pay your
filing fee and/or submit the forms to request to have the fee waived or deferred.
         Some forms say “I certify that this is a true copy” and provide a signature line. Do
not sign this line on the original – only sign the copy to be served on the other party.
         The clerk may give you a number of handouts when you file your documents. The
handouts may include notice regarding mediation; family law guidelines and services; family
law resource list; and possibly, information about local parent education classes. The clerk
may give you two copies of each handout: one for you and one to be served on the other
party.
         Your case will receive a number. Please be prepared to provide the number
when you contact the court for information regarding your case.

HAVING THE RESPONDENT SERVED
        You are required to have the respondent served (have papers delivered to) (a) copies
of the petition and summons and (b) copies of the documents given you by the clerk.
        YOU CANNOT SERVE THE DOCUMENTS YOURSELF. You may have service
completed by the Sheriff in the county where the other party lives; by a private process
server; or by another individual who is a competent person 18 years or older, a resident of
the state where service is made, and not a party nor an attorney for a party. Caution
should be used before asking a friend or relative to serve the papers if the respondent might
react angrily or violently. An Affidavit of Service along with the original summons must be
filed with the court after service has been made.
        The best way to serve the other party is to have the person serving the papers hand
them directly to the respondent (personal service). If personal service cannot be done,
there are other ways to serve the papers including substitute service, office service, and
service by mail (see the table below.) You may ask the Sheriff or a private process server
about these other options or consult an attorney.
                                 Standard Methods of Service

Personal Service       Delivery of papers directly to the other party

Substitute             Delivery of papers to a person living at the other party’s home who is
Service                at least 14 years old. NOTE: If substitute service was made you
                       MUST also mail the documents to the other party’s home address by
                       first class regular mail. A Certificate of Mailing MUST be filed.

Office Service         Delivery of papers to a person who appears to be in charge at the
                       other party’s place of employment (who has a business duty to give
                       the documents to the other party), done during working hours. NOTE:
                        If office service was made you MUST also mail the documents to the
                       other party’s home address by first class regular mail. A Certificate of
                       Mailing MUST be filed.

Service by Mail        Delivery by mailing the documents certified or registered, return-
(Return Receipt        receipt requested, or by Express mail, PLUS mailing of documents to
Requested)             home or business address of the other party by first class regular mail.
                       A Certificate of Mailing MUST be filed.
         If you are not able to have the other party served by any of the methods described
above, you may ask a judge to allow you to use another service method. The judge might
allow you to publish, post or mail the documents. In order to make this request use the
Alternative Form of Service (www.courts.oregon.gov/OJD) Packet 6A.
       If the respondent is willing to accept service, he/she must fill out the Acceptance of
Service, sign it in front of a notary or court clerk, and then file it with the court. It is not
necessary that the respondent agree with what is in the papers, just that he/she is willing to
acknowledge receipt of them.


INSTRUCTIONS FOR PACKET 1A - PAGE 4 OF 7                                               (01/29/10)
SERVING STATE AGENCIES
        If either you or the other party is receiving certain types of public assistance
(Temporary Assistance to Needy Families or the Oregon Health Plan), you are also required
to send a copy of the petition to the Oregon Department of Justice - Division of Child
Support branch office in your county. If you have an juvenile dependency case regarding the
child(ren) you are also required to send a copy of the petition to the Oregon Department of
Human Services – Child Welfare branch office in your county. Addresses will be found under
Additional Resources. Fill out and file the Certificate of Mailing with the court after you
have mailed the copy(ies) of the petition.

COMPLETING THE PARENT EDUCATION CLASS
        The parent education class is mandatory. Contact the mediation office or court clerk
for the schedule; pre-registration is not required. The fee is $20.00 per party and is paid to
the instructor at the time of class. If your filing fee was waived you do not have to pay the
$20.00 fee; if your filing fee was deferred you do have to pay the $20.00 fee. After you
have successfully completed the class the instructor will file a Certificate of Completion with
the court.

TEMPORARY ORDERS
         You may ask the court to make temporary orders which remain in effect until further
order of the court; until the final judgment is signed by a judge; or until the case is
dismissed.
        You may use the Status Quo Order Application available in Optional Forms
to ask the court to order that neither parent change the child(ren)’s usual place of residence
and/or their regular routine or interfere with the other parent’s usual contact with the
child(ren).
        You may use the Motion for Evidentiary Hearing, Packet 4, to ask the court for orders
other than status quo, such as temporary child support or temporary custody.
          The court has Family Abuse Prevention Act Restraining Order forms for cases
involving domestic violence. Contact the court clerk’s office for further information.

                            STEP 2: WAITING FOR A RESPONSE

        Oregon law allows the respondent 30 days to respond to the petition. The time
starts running from the date of service. The response must be written and must be filed
with the required filing fee. The respondent may ask the court to waive or defer the fee.
         The respondent should mail or deliver a copy of the response to you when it is filed
with the court. If you have not received a copy of a response after 30 days from the date of
service you may check with the court clerk to see if one has been filed.

A.) No Response Filed
          If the respondent does not file a response within 30 days of the date of service you
may request a default order. A default means that you may ask the court to enter a
judgment granting you the conditions you asked for in your petition with no input from the
other party.
        To ask the court to enter a default, you must complete and file an Ex Parte Motion for
Order of Default; and Order and an Affidavit in Support of Motion for Order of Default.
        Make a copy of the completed forms for your records. You can file the originals with
the court anytime after 30 days have expired from the date of service. Check back with the
court clerk in seven to ten days to see if your request was granted.
        If proof that service was made on the other party is not complete enough for the
judge to be certain that service was adequate your request may be denied. If your request
is granted you may move to Step 4 – Finalizing Your Case.

B.) Response Filed
        If the respondent files a response agreeing with everything you asked for in your
petition you may be able to move to Step 4. The respondent may wish to complete and file
a Waiver of Further Appearance and Consent to Entry of Judgment
(www.courts.oregon.gov/OJD) Packet 6J.

INSTRUCTIONS FOR PACKET 1A - PAGE 5 OF 7                                              (01/29/10)
        If the respondent files a response disagreeing with one or more conditions in your
petition and/or he/she files a counterclaim(s) your case will be set for trial. At any time
during the pendency of your case you and the respondent may agree to settle the case.
Please review the section below titled Working Toward Agreement for some resources to
assist you in settling your case.
         If the respondent files a response then decides what you requested in the petition is
acceptable he/she can file a Waiver of Further Appearance and Consent to Entry of
Judgment (www.courts.oregon.gov/OJD) Packet 6J and you may be able to move to Step 4.

                        STEP 3: WORKING TOWARDS AGREEMENT

        The court wants to assist you in resolving issues. You may discuss these issues with
the other party directly if it is safe for you to do so and if no court order prohibits this
contact. If you cannot resolve the issues on your own the court provides some options to
help you, including mediation of custody and parenting time.
        Mediation: A mediator is a person trained to help people resolve disagreements.
You will be required to meet with a court mediator if you don’t agree on a parenting plan
(who has custody and parenting time [visitation] with the child(ren) and how decisions
about the child(ren) will be made). There is no fee for custody and parenting time
mediation. If mediation has not been ordered you may request it by filing a Request for
Mediation available in Optional Forms; at the court mediation office; the clerk’s office; or the
family law facilitator. You may ask, and the court will consider, that mediation be waived if
you have good reason (i.e. domestic violence) by filing a Motion and Affidavit for Waiver of
Mediation available in Optional Forms.

                              STEP 4: FINALIZING YOUR CASE

Preparing and Filing a Judgment
        The judgment contains all of the issues decided in mediation; at hearing/trial;
through your agreement; or by the respondent’s default.
                If a trial is held in your case, the judge will instruct one of you to prepare and
                submit a judgment reflecting the court’s ruling.
                If both parties stipulate (agree) on all issues the judgment may be prepared
                by either party as long as it is reviewed and signed by both parties.
                If the respondent did not file a response you are to fill out the final judgment
                stating the same things you asked for in your petition.
         Review the documents listed in Step 4 of the Steps and Forms table on page 3.
Depending on whether a trial was held in your case; you and the respondent are stipulating
to the judgment; or the respondent was found in default you will need to complete and file
some or all of the listed documents. Additionally, you must address the following regardless
of how the conditions in your judgment were reached.
            Parenting Plan: The parenting plan may be completely contained within the
            body of the final judgment or it may be attached as an exhibit to the final
            judgment.
            Child Support Worksheet: Child Support Worksheets must be completed and
            attached as an exhibit to the final judgment.
            Certificate of Completion of Parent Education Class: Must be on file before
            judgment will be entered.
            If you are responsible for filling out the judgment prepare the original and make
sufficient copies for your needs. If your case involves child support submit an additional
copy of the judgment and the UTCR 2.100 Segregated Information Sheet. You may leave
additional copy(ies) of the judgment which will be conformed after the original is signed by
a judge. After you receive notice the judgment has been signed you may return to pick up
your conformed copies unless you provided a self-addressed, stamped envelope to the court
for mailing.

       Your case is final the date the judgment is signed by a judge.

                                     ADDITIONAL RESOURCES

INSTRUCTIONS FOR PACKET 1A - PAGE 6 OF 7                                                (01/29/10)
Oregon Judicial Department                    Oregon State Legislature
Jackson County Courts                         Oregon Revised Statutes
Family Law Forms and Resources                www.leg.state.or.us/ors
www.courts.oregon.gov/Jackson
                                              Oregon State Bar
Oregon Judicial Department                    www.osbar.org
Family Law Forms and Resources                Lawyer Referral 1-800-452-7636
www.courts.oregon.gov/OJD                     Modest Means (low income)
                                              Tel-law 1-800-452-4776
Family Mediation and Parent Education
776-7171, ext 240                             Jackson County Law Library
www.courts.oregon.gov/Jackson/mediation       Justice Building
                                              100 S Oakdale
Center for NonProfit Legal Services           Medford OR 97501
“Legal Services”                              774-6437
www.cnpls.org
225 W Main                                    Department of Human Services -
Medford OR 97501                              Child Welfare
779-7291                                      909 Royal Ct
                                              Medford OR 97501
Oregon Department of Justice                  776-6120
Division of Child Support                     www.oregon.gov/dhs
www.dcs.state.or.us
310 E 6th St, Suite 300                       Community Works
Medford OR 97501                              Dunn House 779-4357
776-6043                                      Court Advocate 774-4986

Jackson County District Attorney’s Office     National Domestic Violence Hotline
Family Support Division                       1-800-799-SAFE
715 W 10th St
Medford OR 97501                              Oregon Law Help
774-8186                                      (Free legal info for low income Oregonians)
                                              www.oregonlawhelp.org




   INSTRUCTIONS FOR PACKET 1A - PAGE 7 OF 7                                        (01/29/10)
                                               DOCUMENT 1A - 1




IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR JACKSON COUNTY

In the Matter of:
                                                                    CASE NUMBER:

Petitioner,                                                         PETITION FOR CUSTODY AND PARENTING
                                                                    TIME under ORS 109.103
vs.
                                                                    □ and CHILD SUPPORT
                                                                    DOMESTIC RELATIONS CASE SUBJECT TO
Respondent                                                          FEE UNDER ORS 21.111

And


Child(ren) who is/are at least 18 and under
21 years of age, unmarried and
unemancipated.(ORS 107.108.)


1. Petitioner is the □ mother □ father and Respondent is the □ mother □ father of:
______________________________________________________________________
______________________________________________________________________
               list name(s); date(s) of birth of the child(ren) separately provided under UTCR 2.130

2. Paternity has been established:
    □ By filing with the State Registrar of Vital Statistics a voluntary acknowledgment of
    paternity (e.g. birth certificate) concerning the following child(ren):_________________
 _______________________________________________________________
               list name(s); date(s) of birth of the child(ren) separately provided under UTCR 2.130

      □ By administrative order docketed with the following court: _____________________
      located in ____________________ County, as case number ______________________
      concerning the following child(ren):__________________________________________
      ______________________________________________________________________
                 list name(s); date(s) of birth of the child(ren) separately provided under UTCR 2.130



      □ By judicial order docketed with the following court: ___________________________
      located in ____________________ County, as case number ______________________
      concerning the following child(ren):__________________________________________
      ______________________________________________________________________
                 list name(s); date(s) of birth of the child(ren) separately provided under UTCR 2.130

      □ By another method:_____________________________________________________
      concerning the following child(ren):__________________________________________
      ______________________________________________________________________
               list name(s); date(s) of birth of the child(ren) separately provided under UTCR 2.130




1A-1 Petition for Custody and Parenting Time    pg. 1 of 7                                        OJIN Code PT__
                                                                                                          01/11/2010
3.The minor child(ren) reside(s) in _______________ County, State of _______________
The Petitioner resides in __________________ County, State of ___________________
The Respondent resides in ________________ County, State of ___________________

4.UCCJEA Information
      □ The child(ren) listed above has/have continuously resided in Oregon for the past six
      months preceding the filing of this case. List the place(s) the minor child(ren) of the
      parties have lived for the past five years and the name(s) of the person/people they
      lived with at that time.
     Dates        County, State       Parent(s)/      Current/Contact address         Which
                                     Caretaker(s)     of Parent(s)/Caretaker(s      Child(ren)




□ Additional Sheet Attached
        □ I have not participated in any litigation concerning the custody; visitation; parenting
        time; or placement of the child(ren) in this or any other state,
        OR
        □ I have participated in the litigation listed below.
        Date            State             Case No.            Name of Court             Result




   □ Additional Sheet Attached
        □ I do not know of any other domestic violence; custody; visitation; parenting time; or
        placement proceeding involving the child(ren), or of any other court case which could
        affect this case, pending in this or any other state.
        OR
        □ I do know of the litigation listed below.
        Date             State            Case No.            Name of Court          Result




□ Additional Sheet Attached
        □ I do not know of any other person other than the other party who has physical
        custody of the child(ren) or who claims to have custody; visitation; or parenting time
        rights.
                                            OR
        □ I do know of the person(s) listed below.
                           Name                                           Address




1A-1 Petition for Custody and Parenting Time   pg. 2 of 7                         OJIN Code PT__
                                                                                          01/11/2010
5. Parenting Plan (Custody and Parenting Time)
   Custody of the child(ren) should be awarded as follows:

    □ Petitioner should be awarded sole custody of the following child(ren): ____________
    ______________________________________________________________________

    □ Respondent should be awarded sole custody of the following child(ren): ___________
    ______________________________________________________________________

    □ The parties should be awarded joint custody of the following child(ren): ___________
    ______________________________________________________________________

    □ The parties have agreed to joint custody of the following child(ren): ______________
    ______________________________________________________________________

    □ Petitioner □ Respondent should have parenting time with the child(ren)
     □ As set forth in the attached Parenting Plan labeled Exhibit _____
    □ Other ____________________________________________________________
      ___________________________________________________________________
      ___________________________________________________________________

    □ Parenting time should be supervised by: ____________________________________
    ______________________________________________________________________
    □ Any cost of the supervision shall be paid by □ Petitioner □ Respondent □ Other: _____

    □ Petitioner □ Respondent should not be granted parenting time with the child(ren)
    because this would endanger the health and safety of the child(ren.)
     State supporting facts _________________________________________________
     ___________________________________________________________________
    □ Petitioner and Respondent should each provide contact addresses and contact telephone
    numbers to the other and notify each other of any emergency circumstances or substantial
    changes in the child(ren)’s health.

    □ Petitioner should be allowed to move more than 60 miles further distant from the
    Respondent without advance notice because good cause exists.

6. Child Support Including Health Care Coverage And Cash Medical Support
     A. Currently Effective Child Support Order(s) (From any agency or court.)
    (Check any that apply.)

□ The following child support order(s) is/are in effect.
      Date             State           Case No.                Name of Agency/Court




□ This/these order(s) should remain in place,
OR
□ This order is from an Oregon court or agency, one of the parents or the child(ren) receiving
support still resides in Oregon and the order should be changed because circumstances have
changed since the last order was entered. State facts showing how circumstances have
changed: _______________________________________________________________
______________________________________________________________________




1A-1 Petition for Custody and Parenting Time   pg. 3 of 7                       OJIN Code PT__
                                                                                        01/11/2010
A copy of the existing child support order is attached to the Certificate Re: Pending Child
Support Proceedings And/Or Existing Child Support Orders/Judgments filed with this petition.


B. Pending Child Support Case(s) (Check one)
□ There is not an agency or court child support proceeding currently pending.
OR
□ There is an agency or court child support proceeding currently pending as set forth in the
Certificate Re: Pending Child Support Proceedings And/Or Existing Child Support
Orders/Judgments filed with this petition.

C. Child Support in This Case
□ No child support should be ordered in this case because:
□ Child support has already been ordered as described in “A” above and this order
 should remain in place,
 OR
 □ Other reason: ______________________________________________________________
 ___________________________________________________________________________

□ Child support should be paid by □ Petitioner to Respondent OR □ Respondent to Petitioner
    beginning on the first day of the month following the date of the judgment and continuing
    on the first day of each month thereafter. Under the Support Guidelines set out in
    Oregon’s Administrative Rules, the total payment of child support per month should be:
 $__________ for __________ child(ren), □ as reflected in the attached Child Support
    Computation Worksheets,
OR
□ Determined prior to judgment.

If a specific amount is indicated above, that amount:
□ Does not deviate from the amount presumed correct under the guidelines,
OR
□ Does deviate from the amount presumed correct under the guidelines because application of
  the formula would be unjust or inappropriate in this case because:
(check one or more that apply)
□ Recurring medical expenses (describe): __________________________________________
____________________________________________________________________________
□ Other (describe): ____________________________________________________________
____________________________________________________________________________
□ Includes Cash Medical Support
□ For out-of-Pocket medical expenses exceeding $250 per year per child in the
 amount of $__________
AND/OR
□ To reimburse for public health care coverage costs in the amount of $__________
(Check if applicable)
□ Petitioner □ Respondent and/or □ Child(ren) are eligible for public medical assistance and
     should not be ordered to pay cash medical support.
□ All payments of child support should be made to the Department of Justice, Child Support
     Accounting Unit, P.O. Box 14506, Salem, OR, 97309 by □ electronic payment withdrawal
     (EPW) or electronic funds transfer (EFT). Petitioner requests that collection; accounting;
     disbursement; and enforcement services be provided by the Department of Justice. In
     addition, support for a child attending school (between the ages of 18 and 21) as defined
     by Oregon law, shall be distributed by the Department of Justice directly to the child
     subject to ORS 107.108.
□ Applies only if support enforcement services are not being provided.
     Petitioner requests an exception to the income withholding requirement of ORS 25.378
     allowing payment to be made directly to □ Petitioner’s □ Respondent’s checking or savings
     account. A receipt of deposit should be kept by the party paying support as proof of
     payment. The party receiving support should provide the paying party with current
     deposit slips and/or bank name; account name; and account number.

1A-1 Petition for Custody and Parenting Time   pg. 4 of 7                       OJIN Code PT__
                                                                                        01/11/2010
D. Health Care Coverage (Check any that apply.)

1.) Private Insurance is Available
       a.) Through One Parent
         □ Petitioner □ Respondent has appropriate private health care coverage available for
       the parties child(ren) through an employer; union; through a domestic partner, spouse
       or other family member residing with them; or other source (describe type of
       coverage): __________________________________________________________
       ___________________________________________________________________
       I request that □ Petitioner □ Respondent be ordered to maintain this coverage
       throughout the period of the support obligation for the benefit of the parties’
       child(ren).

        b.) Through Both Parents
        □ Both Petitioner and Respondent have appropriate private health care coverage
        available for the parties’ child(ren). I select the following health care coverage to be
        maintained throughout the period of the support obligation: □ Petitioner’s □
        Respondent’s □ both Petitioner’s and Respondent’s (describe type(s) of
        coverage):_____________________________________________________________
        _________________________________________________________________

 2.) No Private Insurance is Available Now
   □ Neither Petitioner nor Respondent have appropriate private health care coverage available
       for the parties’ child(ren).
       a.) □ Petitioner □ Respondent □ both Petitioner and Respondent should be ordered to
       apply for and enroll in public heath care coverage.
       b.) □ Petitioner □ Respondent has already applied to enroll the child(ren) in public
       health care coverage. This coverage should be maintained if the child(ren) is/are
       accepted for enrollment.
       c.) □ The child(ren) is/are currently enrolled in public health care coverage. This
       coverage should be maintained.
       d.) □ Both Petitioner and Respondent should be ordered to provide appropriate private
       health care coverage when such coverage becomes available to them through any
       source.

3.) Responsibility for Uninsured Health Expenses
       □ Petitioner should pay __________% and □ Respondent should pay __________% of
       the uninsured health; accident; dental; orthodontic; and optical health costs incurred
       by the child(ren). This obligation is in addition to any cash medical support requested
       in Paragraph 6C as part of the child support award.

E. Tax Dependent(s)
 □ Petitioner □ Respondent shall be entitled to claim the following child(ren) as dependent(s)
     for tax purposes beginning the year this judgment is entered.
                            Name                                               DOB
                                                              Separately provided under UTCR 2.130
                                                              Separately provided under UTCR 2.130
                                                              Separately provided under UTCR 2.130
OR
□ Other: ______________________________________________________________
______________________________________________________________________

F. The support payments for each child should continue until the child reaches 18 years of age
    or is otherwise emancipated, or until the child reaches age 21, so long as the child is a
    student attending school, as defined by Oregon law.

7. Life Insurance For The Benefit Of The Child(ren)
    □ Petitioner □ Respondent should obtain and maintain life insurance for the benefit of the
    parties’ child(ren) in the event of the parent’s death. The coverage should be in the
    amount of $____________________

1A-1 Petition for Custody and Parenting Time   pg. 5 of 7                          OJIN Code PT__
                                                                                           01/11/2010
8. Additional Provisions
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________
    ________________________________________________________________________

9. Information Required By ORS 25.020 And ORS 107.085
     □ Disclosure of the following information would unreasonably put to risk the health;
     safety; or liberty of □ Petitioner □ Respondent □ Child(ren) for the following reason(s):
     ________________________________________________________________________
     ________________________________________________________________________
     ________________________________________________________________________

□ Otherwise, complete the following
                                               Petitioner                            Respondent

    Full Name

    Former Legal Name(s)

    Age

    Address/Contact
                                  Separately provided under UTCR 2.130   Separately provided under UTCR 2.130
    Telephone
                                  Separately provided under UTCR 2.130   Separately provided under UTCR 2.130
    Driver’s License
                                  Separately provided under UTCR 2.130   Separately provided under UTCR 2.130
    Employer Name
                                  Separately provided under UTCR 2.130   Separately provided under UTCR 2.130
    Employer Address
                                  Separately provided under UTCR 2.130   Separately provided under UTCR 2.130
    Employer Telephone




1A-1 Petition for Custody and Parenting Time   pg. 6 of 7                                    OJIN Code PT__
                                                                                                     01/11/2010
10. Court Costs And Fees
    A. Deferred Costs and Fees
    Any court costs and/or service fees (if service completed by the Jackson County Sheriff)
    that are deferred by the court should be paid by □ Petitioner □ Respondent □ Both Parties
    Equally

     B. Costs and Fees Paid by the Parties
     □ Each party should be responsible for paying his/her own court costs and/or service fees
     for this case.
     □ The parties should be equally responsible for paying the court costs and/or service fees
     for this case.
     □ Petitioner □ Respondent should reimburse the other party for his/her court costs and/or
     service fees for this case.

     Judgment should be entered according to the cost and fee allocation listed above.

WHEREFORE, the petitioner requests a judgment granting the relief asked for above and
Other equitable relief that the court thinks is just.

STATE OF OREGON )
           ) ss.
County of Jackson )

I, ______________________________, being duly sworn, say that I am the petitioner in
this matter and that the foregoing petition is true and correct to the best of my knowledge.

Dated:_________________________                    Signed:_________________________________
                                                   Name:__________________________________
                                                            (Please Print)
                                                   Address:________________________________
                                                          _________________________________
                                                   Phone:__________________________________

Subscribed and sworn to before me ____________________________________, 20______.
                                    _________________________________________
                                    Clerk of the Court/Notary Public




1A-1 Petition for Custody and Parenting Time   pg. 7 of 7                        OJIN Code PT__
                                                                                         01/11/2010
                                      DOCUMENT 1A - 2




IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR JACKSON COUNTY
In the Matter of:
                                                        CASE NUMBER:

Petitioner,                                             SUMMONS
                                                        DOMESTIC RELATIONS SUIT
vs.


Respondent




  TO: __________________________________________________________, Respondent.

       Home Address                                 Work Address
____________________________________________________________________________
___________________________________________________________________________
       A petition involving your children has been filed with the court. If you do not file the
appropriate legal paper with the court in the time required (see below), the petitioner may ask
the court for a judgment against you that orders the relief requested.

                NOTICE TO RESPONDENT: READ THESE PAPERS CAREFULLY!



        You must appear in this case or the other side will win automatically. To
appear, you must file with the Court a legal paper called a Response or Motion.
Response forms are available on the Jackson County Circuit Court website at
www.ojd.state.or.us/jac or at the court located at 100 S Oakdale, Medford, OR
97501. This response must be filed with the court clerk or administrator within thirty
(30) days along with the required filing fee. It must be in proper form and you must
show that the petitioner’s attorney (or the petitioner if he or she does not have an
attorney) was served with a copy of the Response or Motion. The location to file your
response is at the court whose address is indicated above.
        If you have questions, you should see an attorney immediately. If you need help
finding an attorney, you may call the Oregon State Bar’s Lawyer Referral Service at
(503) 684-3763 or toll free in Oregon at (800) 452-7636.
         If special accommodation under the Americans with Disabilities Act is needed please
contact your local court at the address above; telephone number 776-7171.

Signed:_________________________________                  I certify that this is a true copy.
Name:__________________________________
        (Please Print)
Address:________________________________                  _____________________________
    _________________________________                     Petitioner’s signature
Phone:__________________________________



1A -2 Summons                              pg. 1 of 1                                  01/11/2010
                                             DOCUMENT 1A - 3




IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR JACKSON COUNTY
In the Matter of:
                                                                   CASE NUMBER:

Petitioner,                                                         CERTIFICATE RE: PENDING CHILD
                                                                    SUPPORT PROCEEDINGS AND/OR
vs.                                                                 EXISTING CHILD SUPPORT
                                                                    ORDERS/JUDGMENTS (UTCR 8.090)

Respondent.




I hereby certify that:


1.      PENDING CHILD SUPPORT PROCEEDINGS (include any child support matter being
heard by either a court or agency as part of a dissolution, separation, annulment, paternity,
juvenile court, support or modification case):
        □ There is no pending child support proceeding in this or any other state involving the
        parties’ child(ren).
         □ There is a pending child support proceeding □ in Oregon □ in another state which
        involves the parties’ child(ren) as follows:
        Name/County of Court or Agency where pending ____________________________
        ___________________________________________________________________
        Agency Case No.______________________________________________________
        Court Case No.________________________________________________________


2.      EXISTING CHILD SUPPORT ORDERS OR JUDGMENTS (include any order/judgment
whether made by an agency or a court in this or any other state, and whether or not currently
effective):
         □ There are no other child support orders/judgments in this or any other state
        involving the parties’ child(ren).
         □ There is/are other child support orders/judgments involving the parties’ child(en), as
        follows:


Document 1A -3 Certificate Re: Pending Child Support Proceedings                OJIN CODE CECS ___
and/or Existing Child Support Orders/Judgments               pg. 1 of 2         01/11/2010
 Children’s Names (Last, First, Middle)                          Date of Birth         Social Security No.




Please attach an additional sheet if there are more than five children involved in the proceeding.

I hereby declare that the above statements are true to the best of my knowledge and belief, and
that I understand they are made for use as evidence in court and are subject to penalty for perjury.

Date:___________________________ Signature:__________________________________________

                                           Type or Print Name:__________________________________


  REQUEST TO PREVENT DISCLOSURE TO OPPOSING PARTY AND THEIR ATTORNEY, IF ANY
   Fill out only if requesting the CIF form be withheld from the opposing party or their attorney.


 To the Court: I request that this Confidential Information Form (CIF) be segregated from
 information otherwise available to the opposing party/attorney, and that I not be required to
 mail or deliver it to the opposing party/attorney, based on the following:
     A Finding of Risk and Order for Nondisclosure of Information has been made by the Administrator of
    the Oregon Child Support Program under OAR 137-055-1160,
     A restraining order or protective order is in effect protecting    the petitioner  the respondent
     the children, and/or
     The health, safety, or liberty of a party or child would be jeopardized or unreasonably put at risk by
     disclosure of information because:




For Court Use Only:
ORDER:
  The request to prevent disclosure is GRANTED.
  The request to prevent disclosure is DENIED because

   Other:


DATED this _______ day of ______________, 20______.



                                                   Circuit Court Judge

NOTE TO COURT STAFF: Where this ORDER has been granted and signed by a judge, the
CONFIDENTIAL INFORMATION FORM is NOT AVAILABLE to the PUBLIC or to the OPPOSING
PARTY OR HIS/HER ATTORNEY, except for the STATE.


Page 2 – Form 2.130.1 – FAMILY LAW CONFIDENTIAL INFORMATION FORM – UTCR 2.130
(8-1-09)

                                           UTCR App. Page 10
                       IN THE CIRCUIT COURT OF THE STATE OF OREGON
                              FOR ___________________ COUNTY


                                                 )    Case No.: ____________________
                                                 )
                                               , )    FAMILY LAW CONFIDENTIAL INFORMATION
                       Petitioner,
                                                 )    FORM (CIF)
                                                 )      Amended
        vs.                                      )      and Request to Prevent Disclosure
                                                 )
                                                 )
                                                        This document is not accessible to the public.
                                                 )
                       Respondent.                      However, it is accessible to the opposing
                                                 )
                                                        party (and his/her attorney) unless the order
                                                 )
                                                        on page 2 has been signed by a judge.
                                                 )


ATTENTION COURT STAFF: THIS IS A RESTRICTED ACCESS DOCUMENT.

The information below is for:    Petitioner     Respondent     Other:

Name (Last, First, Middle):


The names of the parties and the children are not confidential. The other information you provide
in the boxes below is not accessible by the public. If you do not want the opposing party to know
your residence or mailing address, you may provide a contact address below instead of a
residence or mailing address.

 Former Married Name(s) (if applicable):

 Date of Birth:

 Social Security Number/Tax Identification Number:

 Driver License (Number and State):

 Telephone or Telephone Contact Number:

 Residence, Mailing, or Contact Address in the same state as your home:


 Electronic Mail Address or Contact Email Address:

 Name, Address, and Telephone Number of Employer:




Page 1 – Form 2.130.1 – FAMILY LAW CONFIDENTIAL INFORMATION FORM – UTCR 2.130
(8-1-09)


                                           UTCR App. Page 9
 Children’s Names (Last, First, Middle)                          Date of Birth         Social Security No.




Please attach an additional sheet if there are more than five children involved in the proceeding.

I hereby declare that the above statements are true to the best of my knowledge and belief, and
that I understand they are made for use as evidence in court and are subject to penalty for perjury.

Date:___________________________ Signature:__________________________________________

                                           Type or Print Name:__________________________________


  REQUEST TO PREVENT DISCLOSURE TO OPPOSING PARTY AND THEIR ATTORNEY, IF ANY
   Fill out only if requesting the CIF form be withheld from the opposing party or their attorney.


 To the Court: I request that this Confidential Information Form (CIF) be segregated from
 information otherwise available to the opposing party/attorney, and that I not be required to
 mail or deliver it to the opposing party/attorney, based on the following:
     A Finding of Risk and Order for Nondisclosure of Information has been made by the Administrator of
    the Oregon Child Support Program under OAR 137-055-1160,
     A restraining order or protective order is in effect protecting    the petitioner  the respondent
     the children, and/or
     The health, safety, or liberty of a party or child would be jeopardized or unreasonably put at risk by
     disclosure of information because:




For Court Use Only:
ORDER:
  The request to prevent disclosure is GRANTED.
  The request to prevent disclosure is DENIED because

   Other:


DATED this _______ day of ______________, 20______.



                                                   Circuit Court Judge

NOTE TO COURT STAFF: Where this ORDER has been granted and signed by a judge, the
CONFIDENTIAL INFORMATION FORM is NOT AVAILABLE to the PUBLIC or to the OPPOSING
PARTY OR HIS/HER ATTORNEY, except for the STATE.


Page 2 – Form 2.130.1 – FAMILY LAW CONFIDENTIAL INFORMATION FORM – UTCR 2.130
(8-1-09)

                                           UTCR App. Page 10
                       IN THE CIRCUIT COURT OF THE STATE OF OREGON
                              FOR ___________________ COUNTY


STATE OF OREGON                                   )      Child Support No.:
                                                  )      Case No.:
                                                  )
                                                  )      FAMILY LAW CONFIDENTIAL INFORMATION
        vs.
                                                  )      FORM (CIF)
                                                  )        Amended
                                                  )        Finding of Risk/Order for Nondisclosure
                                                  )
                  Obligee       Petitioner,       )
                                                          This document is not accessible to the public.
                                                  )
                                                          However, it is accessible to the opposing
                                                  )
                                                          party (and his/her attorney) unless a finding of
                                                  )
                  Obligor       Petitioner.               risk and order for nondisclosure has been
                                                  )
                                                          marked on page 2 of this form.
                                                  )


ATTENTION COURT STAFF: THIS IS A RESTRICTED ACCESS DOCUMENT.

The information below is for:     Obligee      Obligor    Petitioner    Respondent
  Other:

Name (Last, First, Middle):


The names of the parties and the children are not confidential. The other information you provide
in the boxes below is not accessible by the public. If you do not want the opposing party to know
your residence or mailing address, you may provide a contact address below instead of a
residence or mailing address.

 Former Married Name(s) (if applicable):

 Date of Birth:

 Social Security Number/Tax Identification Number:

 Driver License (Number and State):

 Telephone or Telephone Contact Number:

 Residence, Mailing, or Contact Address in the same state as your home:


 Electronic Mail Address or Contact Email Address (optional):

 Name, Address, and Telephone Number of Employer:




Page 1 – Form 2.130.2 – FAMILY LAW CONFIDENTIAL INFORMATION FORM – UTCR 2.130
(8-1-09)


                                           UTCR App. Page 11
 Children’s Names (Last, First, Middle)                        Date of Birth         Social Security No.




Please attach an additional sheet if there are more than five children involved in the proceeding.



                                  (For STATE Use Only)
            FINDING OF RISK and ORDER FOR NONDISCLOSURE OF INFORMATION:

       A FINDING OF RISK AND ORDER FOR NONDISCLOSURE OF INFORMATION was entered
   on                           , 20     , based on OAR 137-055-1160 by the Administrator as
   defined in ORS 25.010 and disclosure of the information in this form would unreasonably put
   at risk the health, safety, or liberty of the   Obligee   Obligor    Petitioner   Respondent
      Other:                                                                                 .




Date:___________________________ Signature:__________________________________________
                                 Authorized Representative, Oregon Child Support Program

                                          Type or Print Name:__________________________________


 NOTE TO COURT STAFF: Where the box “Notice and Finding (or Order) of Nondisclosure”
 above has been checked, the CONFIDENTIAL INFORMATION FORM is NOT AVAILABLE TO
 THE PUBLIC or to the OPPOSING PARTY OR HIS/HER ATTORNEY, except for the STATE.




Page 2 – Form 2.130.2 – FAMILY LAW CONFIDENTIAL INFORMATION FORM – UTCR 2.130
(8-1-09)


                                          UTCR App. Page 12
                                            DOCUMENT 1A - 6




IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR JACKSON COUNTY

In the Matter of:
                                                                  CASE NUMBER:

Petitioner,                                                       CERTIFICATEOF DOCUMENT PREPARATION

vs.


Respondent.




        You are required to truthfully complete this certificate regarding the document(s) you
        are filing with the court.

        Check the boxes and complete the blanks that apply.

        □ I selected these documents for myself and I completed them without paid
        assistance.

        □ I paid, or will pay, money to _________________________ for assistance in
        preparing this document.


Dated:_________________________                      Signed:_________________________________
                                                     Name:__________________________________
                                                                   (Please Print)
                                                     Address:________________________________
                                                            _________________________________
                                                     Phone:__________________________________




Document 1A -6 Certificate of Document Preparation   pg. 1 of 1                     OJIN CODE: CFDP __
                                                                                            01/11/2010
                                       DOCUMENT 1A - 7




IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR JACKSON COUNTY

In the Matter of:
                                                            CASE NUMBER:

Petitioner,                                                 AFFIDAVIT OF SERVICE

vs.


Respondent.




STATE OF ________________________            )
                                             ) ss.
County of _________________________          )


I, the undersigned, declare: I am a resident of the County of _________________________,
State of ____________________. I am a competent person, 18 years of age or older and not
a party to nor an attorney in this proceeding. I certify that the person served is the identical
one named in this action.

On the _____ day of____________________, 20_____, at _____ a.m./p.m.,
I served the
□ Petition, Summons and other information provided by the court clerk
□ Motion, Affidavit and Notice of Evidentiary Hearing
□ Other:____________________________________________________________________

by delivering to
□ The Petitioner □ The Petitioner’s Attorney______________________________________
□ The Respondent □ The Respondent’s Attorney____________________________________

in person true copies of the originals at the following address: _________________________
___________________________________________________________________________
                                      (Include county and state)



I hereby declare that the above statement is true to the best of my knowledge and
belief, and that I understand it is made for use as evidence in court and is subject to
penalty for perjury.


Dated:_________________________              Signed:_________________________________
                                             Name:__________________________________
                                                               (Please Print)
                                             Address:________________________________
                                                    _________________________________
                                             Phone:__________________________________

1A -7 Affidavit of Service                   pg. 1 of 1                         OJIN CODE: RSSU OR AFSR __
                                                                                                 01/11/2010
                                     DOCUMENT 1A - 8




IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR JACKSON COUNTY

In the Matter of:
                                                        CASE NUMBER:

Petitioner,                                             ACCEPTANCE OF SERVICE

vs.


Respondent.




STATE OF ________________________          )
                                           ) ss.
County of _________________________        )

I, ____________________________________, being first duly sworn, say: I am the
respondent in this matter and on ________________________ I received a true copy of the
Petition, Summons and other information provided by the court clerk in the
County of ___________________ State of____________________.

Certificate of Document Preparation. You are required to truthfully complete this
certificate regarding the document you are filing with the court. Check all boxes and complete
all blanks that apply:
           I selected this document for myself and I completed it without paid assistance.
           I paid or will pay money to _________________________ for assistance in preparing
         this form.

Dated:_________________________            Signed:_________________________________
                                           Name:__________________________________
                                                         (Please Print)
                                           Address:________________________________
                                                  _________________________________
                                           Phone:__________________________________

Subscribed and Sworn to before me ____________________________________, 20______.

                                           _______________________________________
                                           Clerk of the Court/Notary Public




1A-8 Acceptance of Service                 pg. 1 of 1                       OJIN CODE: RSSU __
                                                                               01/11/2010
                                       DOCUMENT 1A - 9




IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR JACKSON COUNTY

In the Matter of:
                                                         CASE NUMBER:

Petitioner,                                              CERTIFICATE OF MAILING

vs.


Respondent.




        I, the undersigned, certify that on ________________________________, 20_____,
I did cause to be deposited a true and correct copy of the:
□ Petition        □ Response
□ Motion, Affidavit and Notice of Evidentiary Hearing
□ Request for Mediation and Order
□ Other:___________________________________________________________________

at: ______________________________________________________________________,
                                     (City, State)
postage paid thereon, in a sealed envelope addressed to:
□ The Petitioner □ The Petitioner’s Attorney______________________________________
□ The Respondent □ The Respondent’s Attorney____________________________________
□ Oregon Department of Justice, Child Support, 310 E 6th St, Ste 300 Medford, OR 97501
□ Oregon Department of Human Services, Child Welfare, 909 Royal Ct, Medford, OR 97504
□ Other:___________________________________________________________________

Address:___________________________________________________________________

Mailing was done by:
□ First Class Mail
 or
□ First Class Mail and by □ Certified □ Registered (return receipt requested) or □ Express Mail.

Mailing was done following:
□ Substitute Service
 or
□ Office Service

Dated:_________________________             Signed:_________________________________
                                            Name:__________________________________
                                                           (Please Print)
                                            Address:________________________________
                                                   _________________________________
                                            Phone:__________________________________




1A-9 Certificate of Mailing             pg. 1 of 1                          OJIN CODE: CECM ____
                                                                            01/11/2010
                                           DOCUMENT 1A - 10




IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR JACKSON COUNTY

In the Matter of:
                                                            CASE NUMBER:
□ the Marriage of                               )
□ the Domestic Partnership of
                                                            PROOF OF SERVICE BY
                                                            CERTIFIED/REGISTERED/EXPRESS MAIL
Petitioner,

vs.


Respondent.




         I, the undersigned, certify that on ________________________________, 20_____,

I did serve the:

         □ Petition, Summons (with attached Notice of Statutory Restraining Order Preventing
         Dissipation of Assets) and other information provided by the court clerk

         □ Motion, Affidavit and Notice of Evidentiary Hearing

         □ Other:_____________________________________________________________

by certified, registered or express mail. The return receipt card or other proof provided by the

Post Office, electric or otherwise, showing the signature of the □ Petitioner □ Respondent and

the date signed is attached below.



Dated:_________________________             Signed:_________________________________
                                              Name:__________________________________
                                                              (Please Print)
                                              Address:________________________________
                                                    _________________________________
                                              Phone:__________________________________




1A-10 Proof of Service by Certified Mail    pg. 1 of 1                           01/11/2010
                                              DOCUMENT 1A - 11




IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR JACKSON COUNTY

In the Matter of:
                                                                 CASE NUMBER:

                                                                 PETITIONER’S EX PARTE MOTION FOR
Petitioner,
                                                                 ORDER OF DEFAULT AND ORDER
vs.


Respondent.




                                                  MOTION

       Based on the attached Affidavit, petitioner request that this Court grant an Order
entering the default of respondent for the reason that respondent was served with the
Summons, Petition for Dissolution, and other documents required by law in
_________________________ County, State of _________________________,
on ____________________, 20_____, and has not made an appearance within the time
prescribed by law.

                                    STATEMENT OF POINTS AND AUTHORITIES

        ORCP 69 requires that the Court or Clerk to enter an order of default on a showing by
affidavit or otherwise that a party against whom a judgment is sought has been served with
Summons or is otherwise subject to the jurisdiction of the Court and has failed to plead or
otherwise defend within the time set by law.
_________________________________________________________________________

                                                   ORDER

        The motion is:

         □ Allowed          □ Denied

        DATED this _______ day of ____________________, 20_______.

                                                                    ____________________________
                                                                    Circuit Court Judge

Dated:_________________________                    Signed:_________________________________
                                                   Name:__________________________________
                                                                    (Please Print)
                                                   Address:________________________________
                                                          _________________________________
                                                   Phone:__________________________________




1A-11 Petitioner’s Ex Parte Motion For Order Of            pg. 1 of 1                OJIN CODE: MODF/ORDF_
Default And Order                                                                    01/11/2010
                                               DOCUMENT 1A - 12




IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR JACKSON COUNTY

In the Matter of:
                                                                   CASE NUMBER:
□ the Marriage of                                       )
□ the Domestic Partnership of
                                                                   PETITIONER’S AFFIDAVIT IN SUPPORT OF
                                                                   MOTION FOR ORDER OF DEFAULT
Petitioner,

vs.


Respondent.




         I, _______________________________, am the petitioner in this proceeding.

1.       Check one of the following:
         a.     □ The respondent is not now, and was not at the time of the service of the
                Summons and Petition, in the active military service of the United States.
         b.     □ The respondent is now, or was at the time of the service of the Summons and
                Petition, in the active military service of the United States.
                         □ (check if applicable) The respondent has waived his or her rights
                        under the Service Members’ Civil Relief Act, as shown by the attached
                        affidavit, labeled as Exhibit _____.
         c.      □ After diligent efforts, I am unable to determine whether or not the
                respondent is now, or was at the time of the service of the Summons and
                Petition, in the active military service of the United States.
                         □ (check if applicable) I have requested, but have not yet received, a
                        determination from the Department of Defense regarding respondent’s
                        military status.

2.       REQUIRED: The following facts support my declaration regarding respondent’s military
         status:_______________________________________________________
         ______________________________________________________________________
         _______________________________________________________________.

3.       Respondent is not now and was not at the time of the service of the Summons and
         Petition a minor, incapacitated, a financially incapable person, a protected person, or a
         respondent in a fiduciary protective proceeding, as defined by Oregon law.

I HEREBY DECLARE THAT THE ABOVE STATEMENT IS TRUE TO THE BEST OF MY KNOWLEDGE
AND BELIEF, AND THAT I UNDERSTAND IT IS MADE FOR USE AS EVIDENCE IN COURT AND IS
SUBJECT TO PENALTY FOR PERJURY.

Dated:_________________________                         Signed:_________________________________
                                                        Name:__________________________________
                                                                      (Please Print)
                                                        Address:________________________________
                                                               _________________________________
                                                        Phone:__________________________________

1A-12 Petitioner’s Affidavit in Support of Motion for        pg. 1 of 1                OJIN CODE: AFSM__
Order of Default                                                                              01/11/2010
                                             DOCUMENT 1A - 13




IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR JACKSON COUNTY
In the Matter of:
                                                             CASE NUMBER:
□ the Marriage of                                 )
□ the Domestic Partnership of
                                                             MOTION FOR ENTRY OF JUDGMENT ON
                                                             AFFIDAVIT IN LIEU OF HEARING
Petitioner,

vs.


Respondent.




                                                  MOTION
        Based on □ the Order of Default on record (or) □ Respondent appeared, but has waived
the right to further appearance (or) □ the parties have stipulated to the entry of a general
judgment, □ Petitioner □ Respondent requests that this Court grant an Order allowing entry of
judgment based on the attached Affidavit in lieu of a hearing.


Dated:_________________________                   Signed:_________________________________
                                                  Name:__________________________________
                                                                (Please Print)
                                                  Address:________________________________
                                                         _________________________________
                                                  Phone:__________________________________




1A-13 Motion for Entry of Judgment on Affidavit        pg. 1 of 1                OJIN CODE: MODH
in Lieu of Hearing                                                                01/11/2010
                                                 DOCUMENT 1A - 14




IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR JACKSON COUNTY

In the Matter of:
                                                                     CASE NUMBER:
□ the Marriage of                                     )
□ the Domestic Partnership of
                                                                     PETITIONER’S AFFIDAVIT IN LIEU OF
                                                                     HEARING IN SUPPORT OF ENTRY OF
Petitioner,                                                          JUDGMENT OF CUSTODY AND PARENTING
                                                                     TIME
vs.


Respondent.


STATE OF ________________________                     )
                                                      ) ss.
County of _________________________                   )

I, ______________________________, being first duly sworn, say: I am the petitioner
in this proceeding. Respondent and I are the parents of the following minor child(ren):
_________________________________________________________________________
list name(s); date(s) of birth of the child(ren) separately provided under UTCR 2.130

□ Respondent has not appeared in this matter and an Order of Default was entered on
_________________________

□ Respondent filed a response and later □ signed and filed a Waiver of Further Appearance and
Consent to Entry of Judgment, (or) □ has waived further hearing by stipulating to the terms of
the Judgment.

This case is now ready for a hearing on the merits. I make this affidavit in support of a
Judgment regarding custody and parenting time without a hearing. The allegations in my
petition are true and it is just and reasonable to grant the relief requested in the proposed
judgment.

□ Child custody or child support is involved in this case and at the time of filing.

□ The child(ren) have/had continuously resided in Oregon for six months before this case was
filed.
□ List any other basis for child custody jurisdiction: ________________________________
_________________________________________________________________________

The current residence of the minor child(ren) is:
   Name of Child           Resides With (Name, Address or Contact address)                 For how long




□ Additional Sheet Attached
1A-14 Petitioner’s Affidavit in Lieu Petitioner, of            pg. 1 of 2               OJIN CODE: AF__
Hearing in Support of Entry of Judgment                                                      01/11/2010
Parenting time should not be ordered because my child(ren)’s health or safety would be
endangered. State supporting facts: ___________________________________________
_________________________________________________________________________

□ I have good reason for the court to allow me to move more than 60 miles further distant
from the other parent without giving written advance notice to the other parent. My good
cause is: __________________________________________________________________
_________________________________________________________________________

□ Child support is involved. Petitioner’s average gross monthly income is approximately
$_________. Respondent’s average gross monthly income is approximately $__________.
Work or school related daycare is $__________ per month and is paid by
□ Petitioner □ Respondent. Health insurance for child(ren) costs $__________ per month out
of pocket and is paid by □ Petitioner □ Respondent.

The child support amount I have requested □ does not deviate from the amount presumed
correct under Oregon Administrative Rules, or □ does deviate from the presumed amount of
$__________ per month because:______________________________________________
__________________________________________________________________

□ Child support is involved and Respondent does not live in Oregon.
(If you checked the box above, check any of the following boxes that are true)
              □ Respondent was personally served with the petition in Oregon.
              □ Respondent lived in Oregon with the child.
              □ Respondent lived in Oregon and paid expenses for the birth or support of the
              child.
              □ The child was possibly conceived in Oregon.
              □ The child lives in Oregon because of the wishes of Respondent.
              □ Respondent and I both lived in Oregon at the same time (either together or
              separately) for a period of six months, beginning _________________and
              ending__________________ and less than one year has passed since
              respondent moved to a new residence out of state.
              □ Other basis for jurisdiction: _____________________________________.

□ A child support order currently exists and I requested that this court issue a new order
because the existing order was issued by an Oregon court or agency, one of the parents or
the child(ren) receiving support under the order still resides in Oregon, and circumstances
have changed since the first order was entered. The changed circumstances are (explain what
has changed since the last order) __________________________________________

□ I request that personal information, such as telephone number, address and employment
information, not be disclosed in the court’s judgment as otherwise required by ORS 25.020
and ORS 107.085 because my health, safety or liberty, or that of my child(ren) ______ would
unreasonably be put at risk by such disclosure. State supporting facts: __________
_________________________________________________________________________
Dated:_________________________               Signed:__________________________________
                                              Name: ___________________________________
                                                               (Please Print)
                                        Address: _________________________________
                                                 _________________________________
                                        Phone: __________________________________
Subscribed and Sworn to before me ____________________________________, 20______.
                                        _________________________________________
                                        Clerk of the Court/Notary Public




1A-14 Petitioner’s Affidavit in Lieu Petitioner, of   pg. 2 of 2                OJIN CODE: AF__
Hearing in Support of Entry of Judgment                                              01/11/2010
                                          DOCUMENT 1A - 15



IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR JACKSON COUNTY

In the Matter of:
                                                            CASE NUMBER:
□ the Marriage of                                 )
□ the Domestic Partnership of
                                                            GENERAL JUDGMENT OF CUSTODY AND
                                                            PARENTING TIME
Petitioner,
                                                             AND CHILD SUPPORT
vs.


Respondent.

And


Child(ren) who is/are at least 18 and under
21 years of age, unmarried and
unemancipated.(ORS 107.108.)




1. This matter came before the court:
        □ On the motion and affidavit of Petitioner, the default of Respondent having been
found.
□ On the motion of Petitioner, the default of Respondent having been found and Respondent
being represented by a guardian ad litem or another person described in ORCP 27.
□ On the motion and affidavit of Petitioner, Respondent having filed a Waiver of Further
Appearance.
         □ On the stipulations of the parties as shown by the signatures below.
                                                    □ At a trial/hearing held _____________,
at which the following persons were present:
    □ Petitioner □ Petitioner’s attorney: ____________________________________
   □ Respondent □ Respondent’s attorney: __________________________________

2. Findings:
The court considered the: □ Affidavit □ Affidavit and stipulations □ Evidence presented and
found that:

A. Child(ren) of the Parties
                         Name                                        DOB                    Address
                                                              Separately provided      Separately provided
                                                              under UTCR 2.130         under UTCR 2.130
                                                              Separately provided      Separately provided
                                                              under UTCR 2.130         under UTCR 2.130
                                                              Separately provided      Separately provided
                                                              under UTCR 2.130         under UTCR 2.130
  □ Additional Sheet Attached




1A-15 General Judgment Of Custody And Parenting       pg. 1 of 10                   OJIN CODE: JGGM__
 Time And Child Support                                                                   01/11/2010
B. Child Custody Jurisdiction
1. □ Oregon has jurisdiction under the Uniform Child Custody Jurisdiction and Enforcement Act
     to hear the □ Custody □ Parenting time issue(s) because:
     □ Oregon is the child(ren)’s home state (i.e. the child(ren) has/have lived in
     Oregon continuously for the six month period immediately before this case was filed).
     □ Other: _________________________________________________________
      _________________________________________________________________
   2. □ Oregon does not have jurisdiction under the Uniform Child Custody Jurisdiction
   and Enforcement Act because: __________________________________________
   ___________________________________________________________________

           C. Child(ren) Who Are At Least 18 And Under 21 Years Of Age
                       Name                                 DOB                            Age
                                                    Separately provided under UTCR 2.130
                                                    Separately provided under UTCR 2.130
                                                    Separately provided under UTCR 2.130
     The child(ren) listed above is/are unmarried and unemancipated and has/have:
                       □ Waived further appearance in this proceeding.
        □ Signed and stipulated to the terms of the judgment as evidenced by the
                                   signature(s) on page 9.
     □ Fully participated in the proceedings and the judgment effectively binds him/her
                                         to the terms.

NOW, THEREFORE IT IS HEREBY ORDERED AND ADJUDGED:

     The terms of this judgment are effective immediately.

1.                   Parenting Plan (Custody and Parenting Time)
                      Custody of the child(ren) is awarded as follows:

□ Petitioner is awarded sole custody of the following child(ren):___________________
______________________________________________________________________
□ Respondent is awarded sole custody of the following child(ren): _________________
______________________________________________________________________
□ The parties are awarded joint custody of the following child(ren): ________________
______________________________________________________________________
□ The parties have agreed to joint custody of the following child(ren): ______________
______________________________________________________________________
□ Petitioner □ Respondent shall have parenting time with the child(ren)
 □ As set forth in the attached Parenting Plan labeled Exhibit ________________________
 □ Other __________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________

 □ Parenting time shall be supervised by: ____________________________________
______________________________________________________________________
□ Any cost of the supervision shall be paid by □ Petitioner □ Respondent □ Other: _____
______________________________________________________________________

□ Petitioner □ Respondent shall not be granted parenting time with the child(ren) because this
would endanger the health and safety of the child(ren.)
□ Petitioner and Respondent shall each provide contact addresses and contact telephone
numbers to the other and notify each other of any emergency circumstances or substantial
changes in the child(ren)’s health.
□ Neither parent shall move to a residence more than 60 miles further distant from the other
parent without giving the other parent reasonable notice of the change of residence and
providing a copy of such notice to the court.
OR
□ The requirement of ORS 107.159 regarding notice of move is suspended for good cause

1A-15 General Judgment Of Custody And Parenting     pg. 2 of 10              OJIN CODE: JGGM__
 Time And Child Support                                                            01/11/2010
found.

2. Child Support including Cash Medical Support
Check A or B
□ A. No child support shall be ordered at this time because:
□ Child support in the amount of $______ monthly has already been ordered                  and
docketed in the __________ County Circuit Court, Case No ______________
□ Other ___________________________________________________________
_________________________________________________________________
□ B. Child support shall be paid by □ Petitioner to Respondent □ Respondent to Petitioner
beginning on the □ first, or □ _____ day of the month following the date of the judgment or □
beginning (date) ___________________________ and continuing on the same day of each
month thereafter. The support for each child shall continue until the child reaches eighteen
(18) years of age, or is otherwise emancipated, unless the child is a student attending school
as defined by Oregon law, in which case support shall continue until the child reaches 21 years
of age. Until further order, the total payment per month shall be $__________ for _____
child(ren.)

Cash Medical Support
Of the amount ordered above in paragraph 2B, $__________ is cash medical. The cash
medical support amount ordered is in addition to any percentage of uninsured costs either of
the parties is ordered to pay in paragraph 4(3) below.
Check if applicable
□ Neither Petitioner nor Respondent have appropriate private or public health care coverage
available for the parties’ child(ren) (see paragraph 4(3) below. Cash medical support □ is □ is
not ordered and the court’s findings in this regard are: ____________
______________________________________________________________________

□ Petitioner □ Respondent and/or □ Child(ren) is/are eligible for public medical assistance and
cannot be ordered to pay cash medical support.

Check if applicable
□ This order shall modify and replace the following existing order __________________
______________________________________________________________________
because the court finds that the existing order was issued by an Oregon court or agency; one
of the parents or the child(ren) receiving support under the order still resides in Oregon; and
circumstances have changed since this order was entered.

3. Child Support Calculation
□ The child support worksheet on which the support amount was calculated is labeled
“Exhibit __________” and is attached to, and incorporated in, this judgment.
□ The support amount presumed correct under the guidelines set out in the Oregon
Administrative Rules is $__________.
□ The support award does not deviate from the amount presumed correct under the
guidelines set out in the Oregon Administrative Rules.
□ The support award does deviate from the amount presumed correct under the guidelines
set out in the Oregon Administrative Rules because this court finds that application of the
formula would be unjust or inappropriate in this case because of:
□ Recurring medical expenses of _________________________________________
□ Other _____________________________________________________________
___________________________________________________________________
4. Health Care Coverage
A. □ Private Insurance is Available
□ Petitioner □ Respondent shall name the child(ren) as beneficiaries of the following
private health care coverage for the duration of the support obligation (describe
type(s) of coverage): __________________________________________________
___________________________________________________________________

B. □ No Private Insurance is Available
Neither Petitioner nor Respondent has appropriate private health care coverage
1A-15 General Judgment Of Custody And Parenting     pg. 3 of 10            OJIN CODE: JGGM__
 Time And Child Support                                                          01/11/2010
Available for the parties’ child(ren).
I. □ Petitioner □ Respondent is ordered to apply to enroll the child(ren) in public
health care coverage. If the child(ren) is/are accepted for enrollment this coverage shall be
maintained.
II. □ Petitioner □ Respondent has already applied to enroll the child(ren) in public
 health care coverage. If the child(ren) is/are accepted for enrollment this
overage shall be maintained.
III.□ The child(ren) is/are currently enrolled in public health care coverage. This
 coverage shall be maintained.
IV. □ Petitioner □ Respondent □ Both Petitioner and Respondent are ordered to
 provide appropriate private health care coverage when such coverage becomes
 available to them through any source.
C. Responsibility for Uninsured Health Expenses
        □ Petitioner shall pay _____% and □ Respondent shall pay _____% of           uninsured
        health; accidental; dental; orthodontic; and optical costs incurred by the child(ren)
        including costs for prescriptions. This obligation is in addition to any cash medical
        support ordered above in paragraph 2 as part of the child support award.

                                 NOTICE ABOUT PERIODIC REVIEWS
 If you are receiving child support services through the Department of Justice pursuant to option
 A above, either party may request that the Department of Justice/Division of Child Support
 review the amount of support ordered after three (3) years from the date the order took effect
 or at any time upon a substantial change of circumstances.


5. Payment of Child Support
    Pursuant to ORS 25.378(1), an income withholding order shall be issued to enforce the
    child support obligation unless an exception is indicated below.
    □ Exceptions to withholding: Income withholding is not ordered at this time because there
    is no support arrearage; the paying party has not previously been granted an exemption
    from withholding; and:
       □ The parties, and the State if support rights are assigned, have agreed in writing to
       an alternative arrangement; or
       □ Good cause not to require withholding is found because there is proof of timely
       payment of previously ordered support and income withholding would not be in the
       best interests of the child(ren.)

                       All payments of child support shall be made
     Check A or B
□ A. To the Oregon Department of Justice, Child Support Accounting Unit, P.O. Box 14506,
     Salem, OR 97309, or □ by electronic payment withdrawal (EPW) or electronic funds
     transfer (EFT.) By petitioner’s request collection; accounting; disbursement; and
     enforcement services of this obligation shall be through the State of Oregon’s Department
     of Justice.
□ B. Pursuant to the above exception, directly to the □ Petitioner’s □ Respondent’s checking or
     savings account. A receipt of deposit shall be kept by the party paying support as proof of
     payment. A cancelled check is also prima facie evidence that payment has been made.
     The party receiving support shall provide the paying party with current deposit slips
     and/or bank name; account name; and account number.

                                NOTICE OF INCOME WITHHOLDING
 This support order is enforceable by income withholding under ORS 25.378 to 25.390, 25.414,
 25.372 and 25.375. Withholding shall occur immediately whenever there is an arrearage at least
 equal to the support payment for one month; whenever the obligated party requests such
 withholding; or whenever the oblige requests withholding for good cause. The District Attorney,
 or as appropriate, the Department of Justice/Division of Child Support will assist in securing such
 withholding. Exceptions may apply in some circumstances.


     6. Dependant(s) for Tax Purposes
1A-15 General Judgment Of Custody And Parenting     pg. 4 of 10             OJIN CODE: JGGM__
 Time And Child Support                                                           01/11/2010
   □ Petitioner □ Respondent shall be entitled to claim the following child(ren) as dependent(s)
     for tax purposes beginning the year this judgment is entered.
                             Name                                               DOB
                                                                   Separately provided under UTCR 2.130
                                                                   Separately provided under UTCR 2.130
                                                                   Separately provided under UTCR 2.130
  OR
   □ Other: _______________________________________________________________
  _______________________________________________________________

7. Support Obligation
    The support obligation(s) ordered in paragraphs two (2) through six (6) above shall
    continue until the child reaches 18 years of age or is otherwise emancipated, or until the
    child reaches age 21 so long as the child is a student attending school as defined by
    Oregon Law.

8. Life Insurance for the Benefit of the Child(ren)
     □ Petitioner □ Respondent shall obtain and maintain life insurance for the benefit of the
     child(ren) in the event of the party’s death. The coverage shall be in the amount of
     $_______________.

                      NOTICE ABOUT PARENTING TIME AND CHILD SUPPORT
  The terms of child support and parenting time (visitation) are designed for the child(ren)’s
  benefit and not the parents’ benefit. You must pay child support even if you are not receiving
  parenting time. You must comply with parenting time even if you are not receiving child
  support.

  Violation of child support and parenting time orders and judgments is punishable by fine;
  imprisonment; or other penalties.

  Publicly funded assistance is available to establish; enforce; and modify child support orders
  and judgments. Paternity establishment services are also available. Contact the local district
  attorney’s office or the Department of Justice at 1-800-850-0228.

  Publicly funded assistance may be available to establish; enforce; and modify parenting time
  orders and judgments. Contact the local circuit court or the Oregon Judicial Department
  website to obtain forms.


9. Additional Provisions
____________________________________________________________________________
    ________________________________________________________________________
    ______________________________________________________________

10. Information Required by ORS 25.020 and ORS 107.085
□ Disclosure of the following information would unreasonably put to risk the health; safety; or
     liberty of □ Petitioner, □ Respondent, □ Child(ren) for the following reason(s):
     ________________________________________________________________________
     ____________________________________________________________________
______________________________________________________________________

                             □ Otherwise, complete the following
                                           Petitioner                          Respondent

    Full Name

    Former Legal Name(s)

    Age
1A-15 General Judgment Of Custody And Parenting      pg. 5 of 10                OJIN CODE: JGGM__
 Time And Child Support                                                               01/11/2010
    Address/Contact
                               Separately provided under UTCR 2.130   Separately provided under UTCR 2.130
    Telephone
                               Separately provided under UTCR 2.130   Separately provided under UTCR 2.130
    Driver’s License
                               Separately provided under UTCR 2.130   Separately provided under UTCR 2.130
    Employer Name
                               Separately provided under UTCR 2.130   Separately provided under UTCR 2.130
    Employer Address
                               Separately provided under UTCR 2.130   Separately provided under UTCR 2.130
    Employer Telephone

Both parties shall inform the court and the Department of Justice (P.O Box 14506, Salem OR
97309) in writing of any change in the above information required by ORS 25.020 within ten
(10) days of such change unless a finding of unreasonable risk has been made in this case. If
the court has ordered that a party be allowed not to disclose information by means of this
judgment in Paragraph 10 above, the Department of Justice or the District Attorney shall not
disclose the information in the preceding section to the other party.

11. Court Costs and Fees
                                A. Deferred Costs and Fees
     Any court costs and/or service fees (if service completed by the Jackson County
                   Sheriff) that are deferred by the court shall be paid by
   □ Petitioner, □ Respondent, □ Both Parties Equally, □ Other ____________________

                          B. Costs and Fees Paid by the Parties
□ Each party shall be responsible for paying his/her own court costs and/or service fees for
    this case.
□ The parties shall be equally responsible for paying the court costs and/or service fees for
    this case.
□ Petitioner, □ Respondent shall reimburse the other party for his/her court costs and/or
    service fees for this case.
□ Other _______________________________________________________________
                                                    Judgment should be entered according to
    the cost and fee allocation listed above.
12. Money Award Child Support Obligation □ Included, □ Not Included

    Additional information     Judgment Creditor                            Judgment Debtor
    required by ORS         (Party receiving payment                    (Party required to pay the
    18.042                 from the Judgment Debtor)                       Judgment Creditor)
                            □ Petitioner □ Respondent                   □ Petitioner □ Respondent

    Full Name
    Address/
    Contact Address
    Attorney’s Name;
    Telephone Number;
    Address (if applicable)

    Date of Birth
    Driver’s License Number
    and State of Issuance
    The following information is to be provided by any party entitle to receive a money award
    (a “judgment creditor”) as listed in this judgment.




1A-15 General Judgment Of Custody And Parenting         pg. 6 of 10                OJIN CODE: JGGM__
 Time And Child Support                                                                  01/11/2010
    Others Entitled to           The following person(s) or public body(ies) are known by
    Portions of Judgment         Petitioner to be entitled to a portion of a payment made on the
    Payable to Petitioner        judgment (other than Petitioner’s attorney):



                                 □ None
    Others Entitled to           The following person(s) or public body(ies) are known by
    Portions of Judgment         Respondent to be entitled to a portion of a payment made on the
    Payable to Respondent        judgment (other than Respondents attorney):



                                 □ None
    Type of Judgment                                             Amount of Judgment
    Child Support Award        WHO PAYS           $_________ □ per month or □ other __________,
                               □ Petitioner       starting on the □ first day or □ __________ of the
                              □ Respondent        month following the date of the judgment.

                             WHO RECEIVES □ Of this Child Support Award
                               □ Petitioner $__________ constitutes Cash Medical Support.
                              □ Respondent
    Prejudgment                WHO PAYS
    Interest                   □ Petitioner
    (Note: ORS                □ Respondent
    21.607(1) disallows                     $_________
    interest on fees that    WHO RECEIVES
    have been                  □ Petitioner
    deferred.)                □ Respondent
    Prejudgment                WHO PAYS           Nine percent (%) per annum simple interest on the
    Interest                   □ Petitioner       total judgment amount(s) of $____________.
    (Note: ORS                □ Respondent        Interest begins accruing the date the judgment is
    21.607(1) disallows                           entered until fully paid.
    interest on fees that    WHO RECEIVES
    have been                  □ Petitioner
    deferred.)                □ Respondent
    Accrued Arrears            WHO PAYS     $_________ □ per month or □ other __________,
    (if any, on                □ Petitioner starting on the □ first day or □ __________ of the
    judgments to be           □ Respondent month following the date of the judgment, until the
    paid on a periodic                      total amount of $__________ is paid in full.
    basis.
                             WHO RECEIVES OR
                               □ Petitioner
                              □ Respondent A lump sum payment of $___________________
                                            to be paid by _______________________(date.)

    Costs and Service          WHO PAYS
    Expenses                   □ Petitioner
    (e.g. filing fees,        □ Respondent        $____________________
    hearing fees, trial
                             WHO RECEIVES
    fees, process fees)
                               □ Petitioner
                              □ Respondent
    Attorneys’ Fees             WHO Pays
     (if applicable)           □ Petitioner
                              □ Respondent $____________________




1A-15 General Judgment Of Custody And Parenting          pg. 7 of 10            OJIN CODE: JGGM__
 Time And Child Support                                                               01/11/2010
                             WHO RECEIVES
                               □ Petitioner
                              □ Respondent




DATED this __________ day of ___________________, 20_____.


                                                   _________________________________
                                                   Circuit Court Judge

APPLICATION FOR CHILD SUPPORT PROGRAM SERVICES:
By signing below I apply for child support services from the Child Support Program (CSP.) (If
you never received TANF or AFDC in any state, an annual $25. Fee will apply if over $500. Is
collected and distributed to the family each year.)

_____________________________________              _________________________________
Petitioner Signature                               Date

_____________________________________             __________________________________
Respondent Signature                               Date

□ All parties have stipulated (agreed) to the terms of this judgment.

_____________________________________                _________________________________
Petitioner Signature                               Date

State of Oregon   )
County of Jackson )

This instrument was acknowledged before me on _________________________, 20_____,
by _______________________________________________________, (name of person.)


                                                   Court Clerk/Notary Public

                                                  My Commission Expires: ______________
___________________________________                _______________________________
Respondent Signature                              Date

State of Oregon   )
County of Jackson )

This instrument was acknowledged before me on _________________________, 20_____,
by _______________________________________________________, (name of person.)


                                                   Court Clerk/Notary Public

                                                   My Commission Expires: ______________



If applicable, child(ren) who is/are at least 18 and under 21 years of age, has/have
stipulated (agreed) to the terms of this judgment (sign only your name.)

 ___________________________________               _________________________________
Child Signature                                    Date
1A-15 General Judgment Of Custody And Parenting    pg. 8 of 10            OJIN CODE: JGGM__
 Time And Child Support                                                         01/11/2010
State of Oregon   )
County of Jackson )

This instrument was acknowledged before me on _________________________, 20_____,
by _______________________________________________________, (name of person.)


                                         Court Clerk/Notary Public
                                         My Commission Expires: ______________
____________________________________________________________________
Child Signature                          Date

State of Oregon   )
County of Jackson )

This instrument was acknowledged before me on _________________________, 20_____,
by _______________________________________________________, (name of person.)


                                                  Court Clerk/Notary Public

                                                  My Commission Expires: ______________


____________________________________________________________________
Child Signature                          Date

State of Oregon   )
County of Jackson )

This instrument was acknowledged before me on _________________________, 20_____,
by _______________________________________________________, (name of person.)


                                                  Court Clerk/Notary Public
                                                  My Commission Expires: ______________

Certificate of Document Preparation. You are to truthfully complete this certificate
regarding the document you are filing with the court. Check all boxes and complete all blanks
that apply:
  □ I selected this document for myself and I completed it without paid assistance.
  □ I paid, or will pay, money to ________________________ for assistance in preparing
  this document.

Submitted by:

____________________________________________________________________
□ Petitioner □ Respondent Signature              Print Name
_________________________________________________________________________
Address/Contact Address         City, State, ZIP   Telephone/Contact Telephone


Certificate of Mailing. I certify that I mailed a copy of this judgment and attachment thereto
by U.S. Mail with postage paid, to the other party at the following address:
________________________________________________________________________,
on _________________________, 20_____,

____________________________________              _____________________________
□ Petitioner □ Respondent Signature               Print Name
1A-15 General Judgment Of Custody And Parenting   pg. 9 of 10            OJIN CODE: JGGM__
 Time And Child Support                                                        01/11/2010

								
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