Fill and Sign the Chapter 109 Oregon State Legislature Form

IN THE CIRCUIT COURT OF THE STATE OF OREGONFOR THE COUNTY OF ___________________ In the Matter of G the Marriage of: ) ) Case No. ______________________ , ) Petitioner, ) CERTIFICATE RE: PENDING CHILD and ) SUPPORT PROCEEDINGS and/or EXISTING ) CHILD SUPPORT ORDERS/JUDGMENTS , ) Respondent. ) (UTCR 8.090) 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) : G There is no pending child support proceeding in this or any other state involving the parties ’ child[ren]. G There is a pending child support proceeding G in Oregon G in another state which involves the parties ’ child[ren] as follows: Name/County of Court or Agency where pending: Agency Case Number: Court Case Number: 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) : G There are no other child support orders/judgments in this or any other state involving the parties ’ child[ren]. G There is/are other child support orders/judgments involving the parties ’ child[ren], as follows: Page 1 - Form 8.090 — CERTIFICATE RE: PENDING CHILD SUPPORT PROCEEDINGS and/or EXISTING CHILD SUPPO RT ORDERS – UTCR 8.090 (Revised 8-1-09) ORDER/JUDGMENT #1 (Attach a copy of the signed order) Name/County of Court or Agency where issued: Case Number: Date of Order: ORDER/JUDGMENT #2 (Attach a copy of the signed order) Name/County of Court or Agency where issued: Case Number: Date of Order: ORDER/JUDGMENT #3 (Attach a copy of the signed order) Name/County of Court or Agency where issued: Case Number: Date of Order: ORDER/JUDGMENT #4 (Attach a copy of the signed order) Name/County of Court or Agency where issued: Case Number: Date of Order: Attach additional sheets if necessary, labeled “Attachment 1 to Certificate Re: Child Support Proceedings and Orders ”. 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: GI selected this document for myself and I completed it without paid assistance. G I paid or will pay money to for assistance in preparing this form. DATED this day of , 20 . G Petitioner G Respondent, Signature Print name Address or Contact Address City, State, Zip Code Telephone or Contact Telephone Page 2 - Form 8.090 — CERTIFICATE RE: PENDING CHILD SUPPORT PROCEEDINGS and/or EXISTING CHILD SUPPO RT ORDERS – UTCR 8.090 (Revised 8-1-09)