Fill and Sign the Date of Marriagedomestic Partnership Form

CO -PETITION FOR DISSO LUTION OF MARRIAGE/DOMESTIC PARTNERSHIP WITH CHILDREN – PAGE 1 OF 10 , Co -Petitioners 9A : Petition9AVer08 .doc (1/08 ) IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF In the Matter of □ the Marriage of ) ) ) ________________________________, ) Case No. Co -Petitioner, ) CO -PETITION FOR DISSOLUTION OF ) MARRIAGE /DOMESTIC PARTNERSHIP ) [With Children] and ) ) DOMESTIC RELATIONS CASE SUBJECT ) TO FEE UNDER ORS 21.111 ________________________________, ) Co -Petitioner, ) ) and ) ) □ _____________________________ ___, ) Child who is at least 18 and under 21 years ) of age , unmarried and unemancipated. ) (ORS 107.108) ) 1. Date of marriage/domestic p artnership : . Place of marriage/domestic partnership : (County, State ) 2. Irreconcilable differ ences between the parties have caused the irremediable breakdown of their marriage/domestic p artnership . 3. Certificate of Residency: Marriage Only : I certify that one or both of the parties to this case currently live in the county in which this petition is being filed. Domestic Partnership Only : I certify that one or both of the parties to this case currently live in the county in which this petition is being filed, or □ neither party currently resides in Oregon but I certify that this petition is filed in the county where □ Petitioner or □ Respondent last resided. 4. □ One, ( enter name): or □ Both Co -Petitioner s is/are (an ) Oregon resident /s and has /have continuously resided in Oregon for the past six months. 5. By filing this co -petition, we acknowledge that we are bound by the terms of the statutory restraining order prohibiting either party from disposing of marital assets, a copy of which we each have received and read, and understand that this restraining order is effective immediately upon filing of this co -petition. CO -PETITION FOR DISSO LUTION OF MARRIAGE/DOMESTIC PARTNERSHIP WITH CHILDREN – PAGE 2 OF 10 , Co -Petitioners 9A : Petition9AVer08 .doc (1/08 ) 6. Children Born or Adopted to Both Parties. Name Date of Birth Social Security No. Address Do not list. Provide by UTCR 2.100 Affidavit Do not list. Provide by UTCR 2.100 Affidavit Do not list. Provide by UTCR 2.100 Affidavit □ Additional page attached; see section labeled “paragraph 6 continued.” □ Co -Petitioner, (write name) , is pregnant. □ Co -Petitioner (write name) □ is □ is not the parent of this child . Th e expected date of the child ’s birth is . □ Neith er party is now pregnant. 7. Child/ren Born During Marriage/Domestic Partnership . List any child/ren born during the marriage/domestic partnership that either party is not the parent of, and that were not conceived when the parties were living together: (nam e/s) and date/s ) of birth ) 8. UCCJEA Information. □ The child/ren listed above in Paragraph 6 has/have continuously resided in Oregon for the six months preceding the filing of this case. List the places where the minor child/ren of the parties have lived in the last five years and the names of the peopl e they lived with at that time. Dates From/To County, State Parent(s)/Caretaker Current Address/ Contact Address of Parent/Caretaker Which Children □ Additional page attached; see section labeled “Paragraph 8 continued.” We □ have □ have not participated in any litigation concerning the custody, visitation, parenting time or placement of the child/ren in this or any other state. We have participated in the following litigation: Name of Court State Case No. Date Result We 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 □ except for: (identify court, case number and the kind of proceeding ) /// CO -PETITION FOR DISSO LUTION OF MARRIAGE/DOMESTIC PARTNERSHIP WITH CHILDREN – PAGE 3 OF 10 , Co -Petitioners 9A : Petition9AVer08 .doc (1/08 ) We do not know any person other than each other who has physical custody of the child/ren or who claims to have custody, visitation or parenting time rights □ ex cept for: (list name and address ) 9. Parenting Plan (Custody and Parenting Time). Custody of the child/ren should be awarded as follows: □ Co -Petitioner , (write name) should be awarded sole custody of the following child/ren (list nam es) : □ Co -Petitioner , (write name) should be awarded sole custody of the following child/ren (list names) : □ The parties have agreed to joint custody of the following child/ren (list names) : □ Co -Petitioner , (write name ) should have parenting time with the child/ren □ as set forth in the attached Parenting Plan, labeled Exhibit or □ Other: □ Co -Petitioner , (write name) should not be granted paren ting time because this would endanger the health and safety of the child/ren. State supporting facts: □ Parenting time should be supervised by □ Any cost of the supervision shall be paid by □ Co -Petitioner , (write name ) □ Other: □ Co -Petitioners 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. □ Co -Petitioner , (write name ) should be allowed to move more than 60 miles further distant from the other parent without advance notice because good cause exists. 10. Child Support, including Health Care Coverage and Cash Medical Support. A. Other Pending Child Support Cases. (Check one.) □ No other agency or court child support proceeding is currently pending (include any child support matter being heard as part of a dissolution, separation, annulment, paternity, support or modification case) . □ There is/are other child support proceedin g(s) currently pending in either an agency or court case as set forth in the CERTIFICATE RE: PENDING CHILD SUPPORT PROCEEDING and/or EXISTING CHILD SUPPORT ORDER attached to this co -petition. B. Other Child Support Orders. (Check one.) □ No other child support orders, from an agency or court, are currently in effect in the State of Oregon or any other state. □ There is/are other child support orders from an agency or court as set forth in the CERTIFICATE RE: PENDING CHILD SUPPORT PROCEEDING and/or EXI STING CHILD SUPPORT ORDERS/JUDGMENTS attached to this petition. C. Currently Effective Child Support Order. (Check any that apply. ) □ The following child support order(s) is/are currently in effect: (List state, court/agency, ca se number, date of order. ) CO -PETITION FOR DISSO LUTION OF MARRIAGE/DOMESTIC PARTNERSHIP WITH CHILDREN – PAGE 4 OF 10 , Co -Petitioners 9A : Petition9AVer08 .doc (1/08 ) □ This order should remain in place , □ and includes provisions for health care coverage for the child/ren, 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: D. Child Support in this Case. □ No child support should be o rdered in this case because: □ Child support has already been ordered as described in “C” above and this order should remain in place. □ Other reason: □ Child support should be paid by □ Co -Petitioner , (write name ) to □ Co -Petitioner , (write name ) beginning on the first day of the month following the date of the judgment and continuing on the first (1 st) day of each month thereafter. Under the Support Guidelines set out in Oregon’s Administrative Rules, the total payme nt of child support per month should be: □ $ for children, □ as reflected in the attached 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. □ deviates from the am ount presumed correct under the guidelines because application of the formula would be unjust or inappropriate in this case because of (check one or more that apply) : □ Recurring medical expenses (describe) : □ Other: □ 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 costs in the amount of $ (Check if applicable ) □ Co -Petitioner , (write name) □ both Co -Petitioners 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, Oregon, 97309 □ by electronic payment withdrawal (EPW) or electronic funds transfer (EFT) . 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.) Co -Petitioners request an exception to the income withholding requirement of ORS 25.378 allowing payment to be made directly to □ Co -Petitioner’s, ( write name ) checking or savings account. A receipt of deposit should be kept by the parent paying support as proof of payment. The parent receiving support should provide the paying parent with current deposit slips and/or bank n ame, account name, and account number. CO -PETITION FOR DISSO LUTION OF MARRIAGE/DOMESTIC PARTNERSHIP WITH CHILDREN – PAGE 5 OF 10 , Co -Petitioners 9A : Petition9AVer08 .doc (1/08 ) E. Health care coverage. (DO NOT FILL THIS SECTION OUT if you have marked the box es in Parag raph 10(C) above , stating that you have a currently effective child support order that includes health care coverage and you are requesting that order remain in place. ) 1.) PRIVATE INSURANCE IS AVAILABLE A.) THROUGH ONE PARENT □ Co –Petitioner , (write name ) has appropriate private health care coverage available for the parties’ child/ren either through an employer, union, or other source, or through a domestic partner, spouse or other family member residing with them (descri be type of coverage) : We request that □ Co -Petitioner, ( write name ) 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 Co -Petitioner s have appropriate private health care coverage availabl e for the parties’ child/ren. We select the following health care coverage to be maintained throughout the period of the support obligation: □ Co -Petitioner, ( write name ) 's □ Both Co - Petitioner’s (describe type/s of coverage) : 2.) NO PRIVATE INSURANCE IS AVAILABLE NOW □ Neithe r Co -Petitioner has appropriate private health care coverage available for the parties’ child/ren A.) □ Co -Petitioner , (write name ) □ Both Co -Petitioner s should be ordered to apply for and enroll the child/ren in public health care coverage. B.) □ Co -Petitioner , (write name ) has already applied to enroll the child/ren in public health care coverage. This cov erage should be maintained if the child/ren are accepted for enrollment. C.) □ The child/ren is/ are currently enrolled in public health care coverage. This coverage should be maintained. D.) □ Both Co -Petitioners should be ordered to provide appropr iate private health care coverage when such coverage becomes available to them through any source. 3.) RESPONSIBILITY FOR UNINSURED HEALTH EXPENSES □ Co -Petitioner , (write name ) should pay % □ and Co - Petitioner, ( write name ) 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 10(D) as part of the child support award. F. (Check one.) □ Co -Petitioner shall be entitled to claim the foll owing child(ren) as dependent/s for tax purposes beginning the year this judgment is entered (list names) : OR □ Other (specify) : G. The support payments for each child should con tinue 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. CO -PETITION FOR DISSO LUTION OF MARRIAGE/DOMESTIC PARTNERSHIP WITH CHILDREN – PAGE 6 OF 10 , Co -Petitioners 9A : Petition9AVer08 .doc (1/08 ) 11. Life Insurance Coverage for Child/ren. □ Co -Petitioner ( write name ) should obtain and maintain life insurance for the benefit of the parties’ child/ren throughout the period of the support obligation. The coverage should be in the amount of $ 12. Additional Provisions. □ Additional page attached; labeled “Paragraph 12 Continued - Additional Provisions.” 13. Spousal Support and Life Insurance . □ No spousal support or life insurance claims are made in this case (skip the rest of paragraph 13). A. Spousal Support. Support should be paid by □ (write name ) to □ (write name ) □ In the amount of $ per month for the following period of time: OR □ In the amount of $ by (date) List reason(s) support should be paid: The support shall be called ( check one or more ): □ transitional □ compensatory □ maintenance based on consideration of the following factors (list): Spousal support payments are taxable to the obligee spouse /domestic partner and deductible to the obligor spouse /domestic partner . All payments terminate upon the death of either party. Payments. Payments should be made on the first day of each month beginning the month following the date the judgment is signed by a judge. All payments of spousal support should be made: ( check (a) or (b) ): (a) □ To the Department of Justice, Child Support Accounting Unit, P.O. Box 14506, Salem, Oregon, 97309. Co -Petitioner s request that collection, accounting, dis bursement, and enforcement services be provided through the Department of Justice. (Required if child support is paid through the state.) (b) □ Directly into ’s checking or savings account. A receipt of deposit should be kept by the paying spouse /domestic partner as proof of payment. The spouse /domestic partner receiving support should provide the paying spouse /domestic partner with current deposit slips and/or bank name, account name, and account number. □ The terms for Life Insurance and Medic al Coverage indicated below shall be in effect: Withholding. □ If child support is also ordered in this case and if enforcement services are provided through the State of Oregon’s Department of Justice, the spousal support order should be enforceable by income withholding under ORS 25.378. /// CO -PETITION FOR DISSO LUTION OF MARRIAGE/DOMESTIC PARTNERSHIP WITH CHILDREN – PAGE 7 OF 10 , Co -Petitioners 9A : Petition9AVer08 .doc (1/08 ) B. Life Insurance. □ Co -Petitioner , (write name ) should buy and maintain life insurance for the benefit of □ Co -Petitioner , (write name ) throughout the period of the spousal support obligation, in the amount of $ 14. Real Property. □ Co -Petitioners do not have any interest in any real property located in this or any other state. □ Co -Petitioner □ Co -Petitioners (write name /s) □ has/have an interest in real property located at the addres s of: □ This property should be distributed as follows: □ Additional page labeled “Paragraph 14 - Real Property continued” attached. □ The legal description of the real prop erty is attached as Exhibit and incorpora ted in this petition. □ Distribution of this property is not within the jurisdiction of this court. 15. Personal Property (including motor vehicles). □ Co -Petitioners have divided between them all personal effects, household goods, and other personal proper ty they own separately or together, and neither should claim those items now in possession of the other. □ Co -Petitioner, ( write name ) should be awarded the following personal property: □ Additional page labeled “Para graph 15 - (write name ) 's Personal Property Distribution continued” attached. □ Co -Petitioner, ( write name ) should be awarded his/ her retirement benefits, pension plan, profit -sharing plan, deferred -compensation plan, and /or stock option plan held by spouse/domestic partner’s employer, free of any int erest in the spouse/domestic partner . □ Co -Petitioner, ( write name ) should be awarded the following personal property: □ Additional p age l abeled “Paragraph 15 - (write name ) 's Personal Property Distribution continued” attached. □ Co -Petitioner, ( write name ) should be awarded his /her retirement benefits, pension plan, profit -sharing plan, deferred -compensation plan, and/or st ock option plan held by spouse/domestic partner’s employer, free of any interest in the spouse/domestic partner . /// /// /// /// /// /// /// /// /// CO -PETITION FOR DISSO LUTION OF MARRIAGE/DOMESTIC PARTNERSHIP WITH CHILDREN – PAGE 8 OF 10 , Co -Petitioners 9A : Petition9AVer08 .doc (1/08 ) 16. Distribution of Debts. □ There are no outstanding debts of this marriage/domestic p artnership . □ The debts s hould be paid as follows: Name of Creditor (who debt is owed to ) What debt is for Amount Who should pay (write names ) □ Additional page attached, labeled, “paragraph 16 continued”. Each spouse /domestic partner should be responsible for the payment of all debts incurred by him/her individually since the date of their separation; all debts which are distributed to him/her by the court; and all debts which are secured by property distributed to that spouse /domestic partner . Also, if any creditor asks the spouse /domestic partner not responsible for a debt to pay all or a portion of it, and s/ he does so, the spouse /domestic partner responsible for that debt should reimburse the other spouse /domestic partner for any monies s/ he paid to the creditor after the date of the judgment. 17. Transfer of Debts and Property. Within 30 days of the date of judgment, each party should execute, acknowledge, and deliver whatever documents are necessary to accomplish the distribution of debts an d property ordered by the court. The judgment should operate to covey title to the spouse /domestic partner awarded the property if the other spouse /domestic partner fails to comply with this requirement. 18. Former Name. □ ’s former nam e of should be restored. 19. 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 □ Co -Petitioner ( write name ) □ or a child for the following reasons: □ Otherwise: (Fill out the information in the table below) Co -Petitioner, ( write name ): Co -Petitioner, ( write name ): Full Name Former Legal Name(s) Age Address or Contact Address Telephone Number CO -PETITION FOR DISSO LUTION OF MARRIAGE/DOMESTIC PARTNERSHIP WITH CHILDREN – PAGE 9 OF 10 , Co -Petitioners 9A : Petition9AVer08 .doc (1/08 ) Co -Petitioner, ( write name ): Co -Petitioner, ( write name ): Social Security Number Do not list. Provide by UTCR 2.100 Affidavit. Do not list. Provide by UTCR 2.100 Affidavit. Drivers License Number Employer Name Employer Address Employer Telephone □ Additional page labeled “Paragraph 19 continued” attached. 20. Court Co sts and Fees. A. Deferred Costs and Fees Any court costs and service fees (if service completed by the Sheriff) that are deferred (required to be paid at a later date) by the court should be paid by: □ Co -Petitioner ( write name ) □ Both part ies equally □ Other: B. Costs and Fees Paid by the Parties □ Each party should b e responsible for paying his/ her own court costs and service fees for this case. □ To be paid by both parties equally □ Co -Petitioner, ( write name ) should reimb urse the other party for his/ her court costs and service fees for this case. □ Other: Judgment should be entered according to the cost and fee allocation listed above. Certificate of Document Preparation . You are required to tr uthfully complete this certificate regarding the document you are filing with the court. Check all boxes and complete all blanks that apply: □ We selected this document for ourselves and completed it without paid assistance. □ We paid or will pay money t o for assistance in preparing this form. /// /// /// /// /// /// /// /// /// /// CO -PETITION FOR DISSO LUTION OF MARRIAGE/DOMESTIC PARTNERSHIP WITH CHILDREN – PAGE 10 OF 10 , Co -Petitioners 9A : Petition9AVer08 .doc (1/08 ) WHEREFORE, Co -Petitioners request a Judgment granting the relief asked for above, and other equitable relief that the Court thinks is just. STATE OF ) ) ss. County of ) I, , bei ng duly sworn, say that I am a Co -Petitioner in this matter and that the foregoing petition is true and correct to the best of my knowledge. Co -Petitioner (signature) Print Name Address or Contact Address City, State, Zip Code Telephone or Contact Telephone SIGNED AND SWO RN to before me this day of , 20 by Notary Public for /Court Clerk My Commission Expires: I, , being duly sworn, say that I am the Co -Petitioner in this matter and that the foregoing petition is true and correct to the best of my knowledge. Co -Petitioner (signature) Print Name Address or Contact Address City, State, Zip Code Telephone or Contact Telephone SIGNED AND SWO RN to before me this day of , 20 by Notary Public for /Court Clerk My Com mission Expires: I certify that this is a true copy. Co -Petitioner (signature)