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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF ________________ In the Matter of the Marriage of: ) ) Case No. _________________________ __________________________________ ) Petitioner, ) ) PETITIONER’S RESPONDENT’S EX PARTE MOTION, AFFIDAVIT AND vs. ) ORDER FOR NONDISCLOSURE OF INFORMATION REQUIRED BY ORS __________________________________ ) 25.020 Respondent. ) MOTION On the basis of ORS 25.020 and the following affidavit, (___ Petitioner) (___ Respondent) requests that the Court issue an Order allowing nondisclosure of my address, Social Security number, telephone number, driver license number and information about my employer to the other party. I understand I will still be required to submit this information to the Department of Justice and/or the District Attorney’s Office. Petitioner’s / Respondent’s Ex Parte Motion, Affidavit & Order for Non-Disclosure of Information Required by ORS 25.0201 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Statement of Points and Authorities ORS 25.020 requires a Court entering an order with a provision concerning paternity or support to order that personal information otherwise required by statute not be contained in a document provided to the other party when the court finds that the health, safety, or liberty of a party or child would unreasonably be put at risk by disclosure of the information. This finding may be made ex part e. Affidavit State of Oregon ) ) County of _________ ) I, ______________________________________, swear/affirm that I am the ( ___ Petitioner) (__ _ Respondent) in this matter. The disclosure of the information listed above would put the health, safety, or liberty of _________________________________ (list name of party or child) at risk because of the following reasons: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ _______________________________________________ Signature _______________________________________________ Print name Petitioner’s / Respondent’s Ex Parte Motion, Affidavit & Order for Non-Disclosure of Information Required by ORS 25.0202 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 SUBSCRIBED AND SWORN TO before me this ______ day of ________________, _____. ________________________________________________ NOTARY PUBLIC FOR OREGON/COURT CLERK My Commission Expires: ________________________ Order ____ Motion granted. ____ Motion denied. IT IS SO ORDERED this ________ day of ___________________, ______. _______________________________________ CIRCUIT COURT JUDGE. 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. ____ I was provided this document by an attorney. ____ I completed this document without paid assistance. ____ I paid or will pay money to _____________________________ for assistance in preparing this document. _______________________________________________ Signature Submitted by: _______________________________________ ___ Petitioner ___ Respondent (Print name) Petitioner’s / Respondent’s Ex Parte Motion, Affidavit & Order for Non-Disclosure of Information Required by ORS 25.0203 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 _______________________________________ (Signature) _______________________________________ Address or Contact Address _______________________________________ City, State, Zip Code _______________________________________ Telephone Petitioner’s / Respondent’s Ex Parte Motion, Affidavit & Order for Non-Disclosure of Information Required by ORS 25.0204