1.Unmarried Parents: Custody, Parenting Time, Support Forms and Instructions
Packet Number 5 Instructions1 Unmarried Parents: Custody, Parenting Time, Support Forms and Instructions Packet Number 5 Instructions I. General Information:A.Use black ink or type.B. Always file the original forms with the clerk. You should always make
yourself an extra copy before you file any form with the clerk.
C.Keep the court informed of your current address. It is your responsibility
to keep the court informed of your current address.
D.You are the petitioner . Since you are starting this divorce case, you are the
petitioner and your spouse is the respondent. Make sure you fill in the petitioner and
respondent blanks at the top of the forms using your full names (first, middle or middle
initial, last). Write the names the same way on all of the forms.
E.Case number . The clerk will give you a case number when you file your
papers. Don’t worry about filling out this part of the case heading until that time. Make
sure you put this number on all your copies and papers you file with the court, and the
papers you serve on your spouse.
F. Signing the forms. Some of the forms in this packet have to be notarized,
or signed in the presence of a court clerk. Either way, you should wait to sign your papers
in front of a notary or court clerk, and should bring picture ID with you. Many local
banks provide notary services.
Also, many of the forms say on the bottom, “I certify that this is a true copy”, and
provide a place for you to sign below. Don’t sign this line on the original form or on
your own copy. You only need to sign this line on the copies that are served on your
spouse. This is what these instructions are referring to when you see the phrase “certified
true copy”. This step is required so your spouse knows the copy is the same as the
original you filed with the court.Optional Forms. (Available upon request)Waiver of Personal Service form. This form allows you to waive your right topersonal service. After your decree is final, you have the right to be personally served
with a contempt charge if the other party believes you haven’t followed the provisions of
the final judgment. If you want to keep your residential address confidential, this form
allows you to list a mailing address, business address or a specified agent, and waive your
1.Unmarried Parents: Custody, Parenting Time, Support Forms and Instructions
Packet Number 5 Instructions2right to be personally served (to have the papers actually delivered to you in person).
Should you choose to use this form, you are responsible for making sure that all papers
delivered to the specified address are actually delivered to you.Motion, Affidavit and Order for Nondisclosure. If the court orders supportpayments, you will be required to list your residence, mailing or contact address, Social
Security number, telephone number, driver license number and information about your
employment on the final judgment. If disclosure of this information would unreasonably
put you or your child at risk, you may use this form to ask that you not be required to
provide the information to the other party. If the court grants the request, you won’t be
required to put that information in the final judgment. The order doesn’t affect your
obligation to provide that information to the state (Department of Justice Division of
Child Support, District Attorney’s Office).II. Step 1.To complete step one, your must: (1) fill out the forms, (2) file the forms with the clerk,
and (3) serve the forms on the other party.A. Fill out the following forms.* Petition for custody and parenting time.* Summons.* Petitioner’s certificate of mailing (if applicable).If your child is receiving assistance from the Department of Human Resources and yourpetition asks for child support, you must mail or personally deliver a true copy of the
Petition for Custody, Visitation and Support to the Department of Justice, Division of
Child Support, 1495 Edgewater NW, Salem, OR 97304). The certificate of mailing
should be filed with the clerk to show the petition was mailed.B. File the forms with the clerk.When you have finished filling out your forms, file the following forms with the clerk:
(1) petition for custody and visitation (and support), and (2) Petitioner’s certificate of
mailing (if applicable). Remember you need to keep a copy of all of the documents you
file for your own records. You also will need to make a copy of the forms you will serve
on the other party, and sign each copy if the form says “I certify that this is a true copy”.When you file your petition, you must pay a fee of $264.00. You may ask the court to
waive or defer payment of this fee, by filing out a “Motion for Deferral of Fees and
Costs” and an “Affidavit for Deferral of Fees and Costs”. You may obtain these forms
through Dissolution Resource Services or through the information window on the first
floor of the courthouse. Fill out these forms and file them with the clerk. Check back in
about a week to find out whether the judge has signed the papers. If you need to start the
1.Unmarried Parents: Custody, Parenting Time, Support Forms and Instructions
Packet Number 5 Instructions3action right away, ask at the information window whether there is a judge available to
sign your papers. You will not be allowed to file your petition until you either pay the
fee, or get the judge to sign the deferral forms. (If the judge “defers” your fee rather than
“waiving” your fee, you will be required to pay all deferred fees back to the court at a
later date.)C. Sign up for the Children Cope with Divorce class.If minor children (under age 18) are involved, you are required to go through this class.
To register, fill out the form the clerk gave you when you filed your petition and send it
to the YWCA together with the $45 fee. After you have completed the COPE class, file
your certificate of completion with the court.D. Serve the other party.The other party must be served with certified true copies of: (1) petition for custody andvisitation, (2) notices in groups of two given to you by the clerk when you file your
papers, and (3) summons.1. How to serve the other party.Three different ways to serve the other party are listed below.a. Service by sheriff. The Marion County Sheriff’s office is located in thebasement of the Courthouse. They usually charge $25.00 to serve the other
party. If the other party lives outside of Marion County, you need to
contact the sheriff’s office in the county where the other party lives.b. Service by process server or disinterested party. You may also pay aprocess server to serve the papers for you. Names of process servers can
be found in the yellow pages of the phone book. If you don’t want to pay
someone to serve the papers, a competent person 18 years of age or older
who is not a party or attorney in your case may complete service. If you
don’t have the sheriff or a professional process server serve the papers for
you, make sure the person who completes service fills out the original
“Affidavit of Service” form, and signs it in front of a notary or court clerk.
You must file the original affidavit of service form with the court clerk.c. Acceptance of service. You can avoid the service requirements if theother party is willing to sign this form, saying that he or she has received
the papers that you are required to serve. The other party must sign this
form in front of a notary or court clerk, and you must make sure the
original is filed with the court.Regardless of which process you use to serve the other party, it is your responsibility to
make sure the original summons and a proof of service is filed with the clerk. The
1.Unmarried Parents: Custody, Parenting Time, Support Forms and Instructions
Packet Number 5 Instructions4affidavit of service or acceptance of service forms may be used as proof of service if one
of them is applicable to your situation.If you aren’t able to serve the other party through the methods listed above, you will need
to get permission from a judge before you are allowed to use another service method.III. Step 2. If: (1) you have filed the forms listed under step 1, (2) you have served those forms on
the other party, or the other party has voluntarily accepted service, (3) 31 days have
passed from the date the other party was actually served or accepted service, and (4) no
response or appearance has been filed by the other party, then you may skip step 3 and go
to step 4.If (1) you filed the forms listed above, (2) completed service and (3) the other party has
filed a response, go to step 3.IV. Step 3.If a response is filed by the other party, you should contact an attorney immediately.
Many important decisions are made for you during this type of case, and people are
usually better off if they are represented by an attorney. If you aren’t able to hire an
attorney, an explanation of the process you will go through is described below.A. Custody and parenting time issues. If you and the other party disagree on
child custody or parenting time (visitation) issues, the court will refer your case to
mediation. A mediator is a neutral party who will help you and the other party talk
about the issues, and agree on a way to resolve the disagreement. You usually
don’t have to pay for the mediator’s services. There is only a resolution in
mediation if you and the other party agree. You must attend COPE beforeyou attend mediation.B. Support issues. If you and the other party can’t agree on child support, a judge
will determine whether either party should pay support, and the amount of support
that should be paid.C. Status conferences. You and the other party (or his or her attorney) may be
required to meet with the judge assigned to your case periodically. The reason the
judge has these conferences is to make sure the case is proceeding through the
system smoothly, and to make decisions on how the case should be handled along
the way.D. Final judgment A final judgment is a document that finalizes your case and
contains all of the issues decided in mediation and trial. This document is usually
prepared by one or both of the parties (or their attorneys) for the judge to sign. If
you are asked to prepare this document, you may use the document labeled
1.Unmarried Parents: Custody, Parenting Time, Support Forms and Instructions
Packet Number 5 Instructions5“Judgment of Custody and Parenting Time and Support; or Order re: Jurisdiction”
for this purpose. The section of the judgment beginning on page eight labeled
“Required Information About the Parties” refers to information that Oregon law
may require the parties to provide. Oregon law requires the parties to provide
the following information regarding each party if the judgment contains a
provision regarding child support: residence, mailing or contact address, social
security number, telephone number, driver license number and the address and
telephone number of all employers of each party. ORS 25.020. In addition,
Oregon law requires that the following information be provided in all money
judgments: (1) the name and address of each judgment creditor (the person who
is owed money) and his or her attorney, and (2) the following information about
the judgment debtor (the person who owes money): address, date of birth, Social
Security number, driver license number and state of issuance, name of attorney,
and (3) the name of any person or public body known by the judgment creditor,
other than the judgment creditor’s attorney, who is entitled to any portion of a
payment made on the judgment. ORCP 70.Please note that it is the responsibility of the parties to fill out the judgment completely
(with the exception of the judge’s signature line) unless the judge has directed otherwise.
Before you submit the original, you should make three copies: one is for you, one is for
the other party and the third you will submit to the court with the original (the court will
forward this one to the Department of Justice, Division of Child Support). Make sure the
other party is given or sent a copy of the document, fill out the certificate of mailing form
and file it along with the original judgment. The judge won’t sign the judgment untilyou have filed your COPE certificate of completion with the court. Once the judgment is signed, your court case is finished.V. Step 4.A.If the other party didn’t file a response, follow the directions below:1. Fill out the following forms.*Petitioner’s ex parte motion for order of default*Petitioner’s affidavit in support of motion for order of default*Petitioner’s motion for order allowing entry of judgment; and
order*Petitioner’s affidavit supporting judgment*Judgment of custody and parenting time and support; or order re:
jurisdiction (please refer to the instructions regarding the judgment in Step 3).*Support order abstract (if you asked for support in your petition)2. File the forms listed above with the clerk along with your COPE (parent
1.Unmarried Parents: Custody, Parenting Time, Support Forms and Instructions
Packet Number 5 Instructions6education) certificate of completion after 31 days have expired from the
date the other party was served with the papers listed in step one.3. Check to see if the judge signed the forms. Call the clerks office after a
week has passed to see if the judge signed your forms.VI. Step 5.If there were no existing child support orders when this case was filed you are finished. Ifthere was an existing child support order, and the final judgment in this case says that the
other order is now “satisfied” or “superseded” (see page 5 of the judgment), the parties to
this case are responsible for providing a certified copy of the judgment in this case to the
court or agency that issued the first child support order.
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26 2728 Petition for Custody and Parenting Time under ORS 109..103 and Child Support7 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF __________________ In the Matter of: )________________________________, )Case No. ___________Petitioner, )) PETITION FOR CUSTODY ANDand PARENTING TIME under ORS
109.103 and CHILD SUPPORT________________________________, ) Respondent. )DOMESTIC RELATIONS CASE) SUBJECT TO FEE UNDER ORS
21.111 I. ____________________________ is the mother and _______________________is the father of _______________________________________born ________________(names of children)_______________________________________________________________________. II. Paternity of the child/ren has been established:
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26 2728 Petition for Custody and Parenting Time under ORS 109..103 and Child Support8
_ by filing with the State Registrar of Vital Statistics a voluntary acknowledgment
of paternity:_____________________________________________________________.(names of children involved)
_ by administrative order docketed with the ____________________ County
Circuit Court:___________________________________________________________.(name of children involved)
_ by judicial order entered by the ____________________ County Circuit Court in
Case No. __________________: _______________________________________________________.(names of children involved)
_ by: __________________________________________________________________:
__________________________________________________________________.(names of children involved) III. The minor child/ren reside(s) in _________________________ County, State of _________________. The petitioner resides in __________________________ County,
State of _________________. The respondent resides in ________________________
County, State of _________________. IV. (Check all boxes that apply)
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26 2728 Petition for Custody and Parenting Time under ORS 109..103 and Child Support9____The child/ren have lived in Oregon continuously for the last six months._____The child/ren have lived in Oregon continuously for six months sometime during
the last twelve months and the child/ren are not now in Oregon but one parent lives in
this state.____ The child/ren have lived in another state continuously for six months but a court
in that state has declined to exercise jurisdiction on the ground that this state is the more
appropriate forum, and____ The child/ren and _________________________ have significant connections to(name of parent or caretaker)Oregon and substantial evidence about them is available here.____The child/ren are physically present in Oregon, and____The child/ren have been abandoned, or___ An emergency exists because the child, or a sibling or parent of the child, is
subject to or threatened with mistreatment or abuse.The current residence or mailing address of the minor child/ren is:___________________________________________________________________________________________
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26 2728 Petition for Custody and Parenting Time under ORS 109..103 and Child Support10 VI. The places where the minor child/ren have lived in the last five years and the
names of the person with whom these child/ren have resided are:Dates County/State With Whom Which ChildrenFrom: _____To: _____ ____________ _______________ __________________From: _____ To: _____ ____________ _______________ __________________From: _____ To: _____ ____________ _______________ __________________From: _____ To: _____ ____________ _______________ __________________ VII. The current addresses of the persons listed in paragraph 6 are:Name Address________________________________________________________________________________________________________________________________________________________________________________________________________________________
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26 2728 Petition for Custody and Parenting Time under ORS 109..103 and Child Support11________________________________________________________________________ VIII.
_ I have not participated in any litigation concerning the custody, visitation,
parenting time or placement of the children in this or any other state._ I have participated in the following litigation regarding the child/ren’s
custody, visitation, parenting time or placement:
Name of Court State Case No. Date Result________________________________________________________________________ IX. I do not know of any other domestic violence, custody, visitation, parenting time
or placement proceeding involving the child/ren pending in this or any other state except
for:________________________________________________________________________(Identify court, case number and the nature of the proceeding)________________________________________________________________________
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26 2728 Petition for Custody and Parenting Time under ORS 109..103 and Child Support12 X. I do not know any person (other than the respondent) who has physical custody of the child/ren or who claims to have custody, visitation or parenting time rights except for: ________________________________________________________________________ (List name and address)________________________________________________________________________ PARENTING PLAN XI. ____ _______________________________ is/are a fit and proper person(s) to be
awarded custody of the parties’ minor children. Custody of the child/ren should be
awarded as follows:___ Mother should be awarded custody of the following child/ren: ___________________________________________________________________________ Father should be awarded custody of the following child/ren: ________________________________________________________________________ __________________________________________ should have parenting
time in accordance with __________ County ____________.____ Specific parenting time should be as follows:
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26 2728 Petition for Custody and Parenting Time under ORS 109..103 and Child Support13____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Additional page(s) attached; see “Exhibit A.”____Mother and father 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.____ __________________________ should not be granted parenting time
because this would endanger the health or safety of the child/ren.____ Petitioner should be allowed to move more than 60 miles distant from the
other parent without advance written notice because good cause exists. CHILD SUPPORT
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26 2728 Petition for Custody and Parenting Time under ORS 109..103 and Child Support14 XII. ____There are no existing child support orders, administrative or judicial, currently in
effect in the State of Oregon or any other state.____ The following child support order(s) is/are currently in effect: ________________________________________________________________________________________________________________________________________________(List name of court or agency, case number, date of order and amount of arrearage (if
any))A certified copy of this order(s) is attached to this petition. XIII. ____No child support should be ordered in this case because:____ Child support in the amount of $ __________ monthly has already been orderedand docketed with the _________________________ County Circuit Court ___ Other
reason: ________________________________________________________________________________________________________________________________________________
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26 2728 Petition for Custody and Parenting Time under ORS 109..103 and Child Support15____Child support should be paid by _______________________ to
_______________________ beginning on the first day of the month following the date of
the judgment and continuing on the first (1st) day of each month thereafter. The support
for each child should be paid until that child reaches eighteen (18) years of age, or is
otherwise emancipated. The support should continue until the child reaches the age of
twenty-one (21) so long as the child is a student attending school as defined by Oregon
law. The total payment of child support per month should be $ __________________ for________ children.The support amount was calculated pursuant to the support guidelines set out in
Oregon’s Administrative Rules. The support amount:____ does not deviate from the amount presumed correct under the guidelines____does deviate from the amount presumed correct under these guidelines
because ________________________________________________________________________________________________________________________________________________ XIV. Oregon law requires that child support on all new or modified orders be
collected by income withholding. Exceptions may be granted under the provisions of
ORS 25.317.
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26 2728 Petition for Custody and Parenting Time under ORS 109..103 and Child Support16All payments of child support should be made to the Oregon Department of
Justice, Child Support Accounting Unit, P. O. Box 14506, Salem, Oregon, 97309.
Petitioner requests that collection, accounting, disbursement, and enforcement services be
provided by the State of Oregon’s Department of Justice. In addition, support for a child
attending school (between 18 and 21 years of age) as defined in ORS107.108, should be
distributed by the Oregon Department of Justice, Child Support Accounting Unit directly
to the child subject to ORS 107.108. LIFE INSURANCE COVERAGE FOR CHILD/REN XV. ________________________________ 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 an amount sufficient to provide continued support,
in the event of the paying parent’s death, at least at the level of and for the duration of the
support obligation. MEDICAL INSURANCE COVERAGE FOR CHILD/REN XVI. Throughout the period of the support obligation, _________________________
should name the child/ren as beneficiaries of any health, accident, dental, orthodontic,
and optical insurance plan, available through that parent’s employment, group, or union,
at a cost not to exceed the amount of child support awarded in the final judgment. If that
parent fails to maintain insurance under these circumstances for the child/ren, that parent
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26 2728 Petition for Custody and Parenting Time under ORS 109..103 and Child Support17should be liable for any of those expenses incurred after the date of the court order
requiring the coverage. If that parent maintains this insurance but the insurance does not
provide complete coverage, that parent should pay ___ one-half ___ all of the uninsured
costs. If the insurance coverage for the child/ren is provided through the parent’s
employment, group, or union, and if this employment, or group of union membership is
then terminated, that parent shall notify the other parent of this fact prior to or
immediately upon termination. If health insurance is not available to this parent when the
final judgment is entered, that parent should provide health insurance in the future when
it becomes available to him/her.Whenever _____________________________ does not have health, accident,
dental, orthodontic, or optical insurance available through employment, group of union
membership, that parent should pay ____ one-half ____ all uninsured costs incurred by
the child/ren throughout that period, including costs for prescriptions. COURT COSTS AND FEES XVII. Deferred Costs and Fees:___Father ___ Mother should be liable for all the court costs that were
deferred.
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26 2728 Petition for Custody and Parenting Time under ORS 109..103 and Child Support18___Father and Mother should each be liable for one-half the court costs that
were deferred.___The State of Oregon should have judgment against ___ Father ___
Mother for ___ one-half ___ all the court costs. Court Costs and Fees Paid by the Parties ____ Father ____ Mother should be liable for ____ one-half _____ all the court
costs and service fees that have been paid in this suit.____ Father ____ Mother should have a judgment against ____ Father ____
Mother for ____ one-half _ all of these costs.WHEREFORE, petitioner prays for a Judgment granting the relief petitioned for
above.STATE OF ______________________ )) County of ________________________ )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.
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26 2728 Petition for Custody and Parenting Time under ORS 109..103 and Child Support19______________________________________________Petitioner, Pro Se (signature)______________________________________________Print name______________________________________________Address______________________________________________City, State, Zip Code______________________________________________TelephoneSUBSCRIBED AND SWORN to before me this ___________ day of
______________, ______, by _______________________________________________._______________________________________________Notary Public for ____________/Court ClerkMy Commission Expires: __________________________ Certificate of Document Preparation I certify that: (check all that apply)____ I selected this document for myself.
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26 2728 Petition for Custody and Parenting Time under ORS 109..103 and Child Support20____ 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.__________________________________________Petitioner’s SignatureI certify that this is a true copy._____________________________________Petitioner (Signature)
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26 2728 Summons21 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF _______________ In the Matter of: ))_____________________________, ) Case No. ____________ Petitioner, ))SUMMONSand ))_____________________________, )Respondent. ))TO: _______________________________________, Respondent.Home Address Work Address________________________________________________________________________
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26 2728 Summons22________________________________________________________________________________________________________________________________________________ ________________________________________________________________________A petition involving your child/ren has been filed with the Court. 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.” This
paper must be given to the Court 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.”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.______________________________________Petitioner, Pro Se (signature)______________________________________Print name______________________________________Address
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26 2728 Summons23______________________________________City, State, Zip Code______________________________________Telephone Certificate of Document Preparation I certify that: (check all 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.____________________________________________Petitioner’s signatureI certify that this is a true copy.____________________________________Petitioner’s signature
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26 2728 Petitioner’s / Respondent’s Certificate of Mailing24 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 CERTIFICATE OF MAILING and ) , )Respondent. ))I certify that on _____________________________, _______, I mailed a true copy of _______________________________________________________________ (List of documents) previously filed in this case: ____ to the other party directly, at the following address, because s/he has no
attorney _____________________________________________________________.
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26 2728 Petitioner’s / Respondent’s Certificate of Mailing25____ to the other party’s attorney ___________________________________ at (Name of the other party’s attorney) the following address:____________________________________________________________________________________________________________________________.Mailing was done by ____ first class mail and by ____ certified or ____
registered mail, return receipt requested, or ____ express mail.DATED this ______ day of ______________________, ______.________________________________________ Petitioner __ Respondent, Pro Se, Signature______________________________________Print name______________________________________Address______________________________________City, State, Zip Code______________________________________Telephone
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26 2728 Petitioner’s / Respondent’s Certificate of Mailing26 Certificate of Document Preparation I certify that: (check all 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
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26 2728 Petitioner’s Ex Parte Motion for Order of Default; and Order27 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 EX PARTE
MOTION FOR ORDER OF DEFAULT; and and )ORDER)________________________________, )Respondent. )) Motion Based on the attached Affidavit, petitioner requests that this Court grant an Order
entering the default of respondent for the reason that respondent was served with the
Summons, Petition, and Certificate of Residency in _________________________
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26 2728 Petitioner’s Ex Parte Motion for Order of Default; and Order28County, State of ________________, on ______________________, _____ and has not made an appearance within the time ________________________________(insert date)prescribed by law. Statement of Points and Authorities ORCP 69 requires 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.DATED this _______ day of ____________________, _____.______________________________________Petitioner, Pro Se (signature)______________________________________Print name______________________________________Address______________________________________City, State, Zip Code_____________________________________ Telephone
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26 2728 Petitioner’s Ex Parte Motion for Order of Default; and Order29 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 ORDER ____Allowed.____Denied.DATED this _______ day of ____________________, ________.______________________________________Circuit Court Judge
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26 2728 Petitioner’s Affidavit in Support of Motion for Order of Default30 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF _______________ In the Matter of : )) , )Case No. _________Petitioner, ))PETITIONER’S AFFIDAVIT IN SUPPORT OF MOTION FOR and ) ORDER OF DEFAULT , )Respondent. )STATE OF _ )) ss.County of )I, ____________________________________, being first duly sworn, say: I am
the petitioner in this proceeding.
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26 2728 Petitioner’s Affidavit in Support of Motion for Order of Default31____ The respondent is not now, and was not at the time of service of the
Summons and Petition, in the active military service of the United States, an
unemancipated minor, or incapacitated.____The respondent is now, or was at the time of service of the Summons and
Petition, in the active military service of the United State, but the respondent has waived
his or her rights under the Soldiers and Sailors Civil Relief Act, as shown by the attached
affidavit, labeled as Exhibit 1. The respondent is not now and was not at the time of
service of the Summons and Petition, an unemancipated minor or incapacitated.Dated this ________ day of ____________________, ______.______________________________________Signature______________________________________Print name______________________________________Address______________________________________City, State, Zip Code______________________________________Telephone
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26 2728 Petitioner’s Affidavit in Support of Motion for Order of Default32SUBSCRIBED AND SWORN to before me this ___________ day of
______________, _____, by ________________________________________________.___________________________________Notary Public for ____________/Court ClerkMy Commission Expires: ______________ Certificate of Document Preparation I certify that: (check all 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
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26 2728 Petitioner’s Ex Parte Motion for Order Allowing Entry of Judgment on Affidavit in
Lieu of Hearing; And Order.33 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF _________________ In the Matter of: )) , )Case No. ___________Petitioner, ))PETITIONER’S EX PARTE
MOTION FOR ORDER ALLOWING ENTRYand ) OF JUDGMENT ON AFFIDAVIT IN LIEU OF HEARING; and ORDER ) , )Respondent. )) Motion Based on ORS 109.103 and 107.095(4) and the Order of Default on record in this
matter, petitioner requests that the Court grant an Order allowing entry of judgment based
on the attached Affidavit of petitioner, in lieu of a hearing.
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26 2728 Petitioner’s Ex Parte Motion for Order Allowing Entry of Judgment on Affidavit in
Lieu of Hearing; And Order.34 Statement of Points and Authorities In a suit for dissolution of marriage where the respondent is found by the Court to
be in default, ORS 107.095(4) authorizes the Court to enter a judgment of dissolution
upon the affidavit of petitioner without a hearing.ORS 109.103 extends the provisions of ORS 107.095 to suits involving the
children of unmarried parents.DATED this ______ day of ________________________, _____.______________________________________Petitioner, Pro Se (signature)______________________________________Print name______________________________________Address______________________________________City, State, Zip Code______________________________________Telephone
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26 2728 Petitioner’s Ex Parte Motion for Order Allowing Entry of Judgment on Affidavit in
Lieu of Hearing; And Order.35 Certificate of Document Preparation I certify that: (check all 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 ORDER ___Allowed.___Denied.DATED this _____ day of _____________________, _____.____________________________________Circuit Court Judge
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26 2728 Petitioner’s Affidavit Supporting Judgment of Dissolution36 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 AFFIDAVITand )SUPPORTING JUDGMENT OF DISSOLUTION ________________________________, )Respondent. )STATE OF ________________________ ))County of _________________________ )I, ____________________________________, being first duly sworn, say: I am the petitioner in this proceeding. Respondent and I were married on ________________, in the County of __________________________, (Date)State of ___________________________. Irreconcilable differences between us have
caused the irremediable breakdown of our marriage. ____ Petitioner ____ Respondent
was an Oregon resident continuously for more than six months immediately prior to
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26 2728 Petitioner’s Affidavit Supporting Judgment of Dissolution37commencement of this suit. ____ No domestic relations suits involving this marriage of
Petitioner and Husband are pending in any other court.____There are ________ child/ren of the marriage. ____ The wife is pregnant
with husband’s child. The wife was cohabiting with the husband when the child was
conceived. The expected date of the child’s birth is ________________________.____The wife is not now pregnant.____ Child(ren) named _______________________________ were born to wife
on the following dates _________________________________, during this marriage.
The husband is not the father of the child/ren. The wife was not cohabiting with the
husband when the child/ren were conceived.____The wife is pregnant at this time and the husband is not the father of this
child. The wife was not cohabiting with the husband when this child was conceived. The
expected date of the child’s birth is _____________________________.Respondent has not appeared in this matter and an Order of Default has been
entered. This case is now ready for a hearing on the merits. I make this affidavit in
support of a Judgment and Decree of Dissolution of Marriage without a hearing. The
allegations in my Petition are true and it is just and reasonable that I be granted the relief
I request.____ Child custody or child support is involved in this case and at the time of
filing:____ The child/ren had continuously resided in Oregon for six months.
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26 2728 Petitioner’s Affidavit Supporting Judgment of Dissolution38____ The child/ren had lived in Oregon continuously for six months sometime
during the twelve months prior to filing, and the child/ren are not now in Oregon but one
parent lives in this state.____ The child/ren had lived in another state continuously for six months prior to
filing, but a court in that state had declined to exercise jurisdiction on the ground that this
state is the more appropriate forum, and____ The child/ren and ____________________ have significant connections to (name of parent or caretaker)Oregon and substantial evidence about them is available here.____ The child/ren were physically present in Oregon at the time of filing and:____ The child/ren have been abandoned, or____ An emergency exists because the child, or a sibling or parent of the child, issubject to or threatened with mistreatment or abuse. That emergency is:________________________________________________________________________________________________________________________________________________The current residence of the minor child/ren is:Name of Child Resides With For How Long________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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26 2728 Petitioner’s Affidavit Supporting Judgment of Dissolution39____ Parenting time should not be ordered because my child/ren’s health or safety
would be endangered because: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ I have good reason for the court to allow me to move more than 60 miles
distant from the other parent without giving written advance notice to the other parent.
My good cause is:_____________________________________________________________________________________________________________________________________________________________________________________________________________ Child support or spousal support is involved: I believe that respondent’s
gross monthly income is approximately $____________. My gross monthly income is
approximately $ _________. 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 $ ___________ because:
________________________________________________________________________ ________________________________________________________________________ ____________________________________________________________________________ There is an existing child support order, a certified copy of which is on file
in this case. As of today’s date, the back child support owed is _________________. The (Total amount not paid to date)
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26 2728 Petitioner’s Affidavit Supporting Judgment of Dissolution40next payment of ______________ is due on _____________________. (Monthly payment) (Date due)__________________________________________Petitioner, Pro Se (Signature)__________________________________________Print Name__________________________________________Address__________________________________________City, State, Zip Code__________________________________________TelephoneSUBSCRIBED AND SWORN to before me this ___________ day of
______________, ______, by _______________________________________________.__________________________________________Notary Public for ____________/Court ClerkMy Commission Expires: ____________________ 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.
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26 2728 Petitioner’s Affidavit Supporting Judgment of Dissolution41____ I completed this document without paid assistance.____I paid or will pay money to _____________________________ for assistance in
preparing this document.__________________________________________Signature
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26 2728 Judgment of Custody and Parenting Time / Support Order re Jurisdiction42 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF ________________ In the Matter of: )________________________________, ) Case No. ________Petitioner, )JUDGMENT OF CUSTODYand ) AND PARENTING TIME AND SUPPORT ________________________________, ) __ ORDER RE: JURISDICTIONRespondent. )This matter came before the Court:____ On the motion and affidavit of petitioner, the default of respondent having
been found.____ On the stipulations of the parties, as shown by their signatures below.____At a hearing held ___________________, _____, at which the following (Date) persons were present:____ Petitioner ____ Petitioner’s attorney _______________________________
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26 2728 Judgment of Custody and Parenting Time / Support Order re Jurisdiction43____ Respondent ____ Respondent’s attorney ___________________________The Court considered the:____Affidavit____Affidavit and stipulations____Evidence presentedand found that: (check the appropriate boxes in a or check b)a. ____Oregon has jurisdiction under the Uniform Child Custody
Jurisdiction and Enforcement Act to hear the ____ custody ____ parenting time issue
because:____ Oregon is the child/ren’s home state (lived here continuously for the last
six months).____ The child/ren had lived in Oregon continuously for six months sometime
during the twelve months prior to filing, and the child/ren are not now in Oregon but one
parent lives in this state.
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26 2728 Judgment of Custody and Parenting Time / Support Order re Jurisdiction44____The child/ren had lived in another state continuously for six months but a
court in that state declined to exercise jurisdiction on the ground that this state is the more
appropriate forum, and____ The child/ren and _______________________ have significant connections
(name of parent or caretaker)to Oregon and substantial evidence about them is available here.____ The child/ren were physically present in Oregon at the time of filing and:____ The child/ren have been abandoned, or____ An emergency exists because the child, or a sibling or parent of the child, issubject to or threatened with mistreatment or abuse.b. ____ Oregon does not have jurisdiction under the Uniform Child Custody
Jurisdiction Act because: ___________________________________________________________________________________________________________________________________________________________________________________________________IT IS THEREFORE ORDERED that: PARENTING PLAN Custody of the child/ren is awarded as follows:
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26 2728 Judgment of Custody and Parenting Time / Support Order re Jurisdiction45____ Mother is awarded custody of the following child/ren:____________________________________________________________________________ Father is awarded custody of the following child/ren:____________________________________________________________________________ ____________________________________________ shall have the right
to parenting time with the child/ren in accordance with Marion County SLR 8.075. A
copy of this rule is attached, labeled, “Exhibit A", and incorporated herein by reference.____ Specific parenting time shall be as follows:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ The terms on the attached additional sheets, labeled “Exhibit A”, shall be
incorporated herein by reference.
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26 2728 Judgment of Custody and Parenting Time / Support Order re Jurisdiction46____ Both parties shall provide contact addresses and contact telephone number
to each other and notifiy 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 shown.____ _____________________________ shall not have the right to parenting
time with the child/ren because access would endanger the health or safety of the
child/ren because:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________ If emergency jurisdiction was exercised, the child custody and parenting time provisions of this judgment shall expire on ______________________________.(Insert date)
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26 2728 Judgment of Custody and Parenting Time / Support Order re Jurisdiction47 NOTICE ABOUT PARENTING TIME AND CHILD SUPPORT The terms of child support and parenting time (visitation) are
designed for the child’s benefit and not the parents’ benefit. You must pay
support even if you are not receiving parenting time. You must comply with
parenting time orders even if you are not receiving child support.Violation of child support orders and parenting time orders is
punishable by fine, imprisonment or other penalties.Publicly funded help is available to establish, enforce, and modify
child support orders.Paternity establishment services are also available. Contact your local
district attorney, the domestic relations court clerk, or the Child Support
Program at 1-800-850-0228 or 503- 378-5567 for information.Publicly funded help may be available to establish, enforce and
modify visitation orders. Forms are available to enforce visitation orders.
Contact the domestic relations court clerk or civil court clerk for
information. CHILD SUPPORT ____ No child support should be ordered at this time because:____ Child support in the amount of $______ monthly has already been ordered
and docketed with the ________________ County Circuit Court.____ Other reason: __________________________________________________
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26 2728 Judgment of Custody and Parenting Time / Support Order re Jurisdiction48____________________________________________________________________________ Child support should be paid by ________________________________ to
______________ __________________ beginning on the first day of the month
following the date of the judgment and continuing on the 1st 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. The support shall continue until the child
reaches the age of twenty-one (21) so long as the child is a student attending school as
defined by Oregon law. Until further order, the total payment per month shall be
$___________, for ________ children. CALCULATION _____ The child support worksheet on which the support amount was calculated
is labeled “Exhibit 2" and attached to and incorporated in this judgment.____The support award does not deviate from the amount presumed correct under the guidelines set out in Oregon Administrative Rules.____The support amount presumed correct under the guidelines set out in
Oregon Administrative Rules is $__________. The support award deviates from this amount because this Court finds that application of the formula would be
unjust or inappropriate in this case because:___________________________
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26 2728 Judgment of Custody and Parenting Time / Support Order re Jurisdiction49________________________________________________________________________________________________________________________________________________ BACK CHILD SUPPORT ____The following child support order(s) is hereby superseded by the terms of this judgment effective: ______________________: ___________________________ (Date) (For previous child support order, ________________________________________________________________________list name of court or agency, case number and date of order)____The Department of Justice, Division of Child Support, is directed to update,
correct and bring its records into conformance with this judgment.____ ____________________________ is awarded judgment against _________(Petitioner/Respondent)________________________ in the amount of $ _________________________ for back (Petitioner/Respondent) child support for the period from ____________________ to
(Date)______________________.(Date)____ The previous support order(s) listed above shall be considered satisfied. PAYMENT All payments of child support shall be made:
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26 2728 Judgment of Custody and Parenting Time / Support Order re Jurisdiction50____To the Child Support Accounting Unit, Department of Justice, P.O. Box
14506, Salem, Oregon, 97309. By petitioner’s request, collection, accounting,
disbursement and enforcement services of this obligation shall be through the Department
of Justice. Pursuant to ORS 25.311(1), an income withholding order shall be issued
to enforce this obligation unless an exception is indicated below.____ Directly to ______________________’s checking or savings account. A
receipt of deposit shall be kept by the parent paying support as proof of payment. The
person receiving support shall provide the paying parent 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
25,311to 25.318, 25.351 to 25.367 and 25.722. Withholding shall occur
immediately, whenever there is an arrearage at least equal to the support
payment for one month, whenever the obligated parent requests such
withholding, or whenever the obligee requests withholding for good cause.
The District Attorney or, as appropriate, the Division of Child Support of the
Department of Justice will assist in securing such withholding. Exceptions
may apply in some circumstances.
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26 2728 Judgment of Custody and Parenting Time / Support Order re Jurisdiction51____ Exceptions to withholding. Income withholding is not ordered at this
time because any support arrearage has been paid in full, the paying parent has not
previously been granted an exemption from withholding, and:____The parent, 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
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________NOTICE ABOUT MODIFICATION OF CHILD SUPPORT
ORDERSThe support agency handling your case will also review your support
order for compliance with the guidelines whenever a substantial change in
circumstance has occurred. You can request this “change in circumstance”
modification from the support agency. But any support order (not just orders
handled by the District Attorney or the Department of Justice) can be
modified because of a change in circumstance, so a private attorney is able to
assist you with this, too. You may also represent yourself.
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26 2728 Judgment of Custody and Parenting Time / Support Order re Jurisdiction52 NOTICE ABOUT PERIODIC REVIEW OF CHILD SUPPORT
ORDERS If your child support case is handled by the District Attorney or the
Department of Justice Division of Child Support, this agency will review
your child support order if at least two years have passed since the order was
entered, modified, or last reviewed. This review will take place only if a parent
requests.The purpose of the review is to see if the amount ordered is still within
the guidelines for child support set out in Oregon law. The review could
result in an increase or decrease in the support amount, depending on the
parents’ financial circumstances and the needs of the child.This “periodic review” service is provided at no cost to parents, but is
available only for cases handled by the District Attorney or the Department
of Justice. LIFE INSURANCE COVERAGE FOR CHILD/REN ____ _________________________________ shall obtain and maintain life
insurance for the benefit of the parties’ child/ren throughout the period of the support
obligation. This parent shall maintain coverage in an amount sufficient to provide, in the
event of this parent’s death, continued support at least at the level of and for the duration
of the support obligation.
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26 2728 Judgment of Custody and Parenting Time / Support Order re Jurisdiction53 MEDICAL INSURANCE COVERAGE FOR CHILD/REN Throughout the period of the support obligation, _________________________
shall name the child/ren as beneficiaries of any health, accident, dental, orthodontic, and
optical insurance plan, available through this parent’s employment, group, or union, at a
cost not to exceed the amount of child support award on page 4. If this parent fails to
maintain insurance under these circumstances for the child/ren, this parent shall be liable
for any of those expenses incurred after the date of the court order requiring the coverage.
If this parent maintains the required insurance but the insurance does not provide
complete coverage, this parent shall pay ____ one-half ____ all of the uninsured costs. If
this parent provides insurance that is available through his or her employment, group, or
union membership, and this employment or membership then terminates, this parent shall
notify the other parent of this fact prior to or immediately upon termination. If health
insurance is not currently available, this parent shall provide health insurance for the
child/ren when it becomes available.____ Whenever ________________________ does not have health, accident,
dental, orthodontic, or optical insurance available through employment, group, or union
membership, this parent shall pay ____ one-half ____ all of the uninsured medical,
dental, orthodontic, optical and prescription medicine costs incurred for the child/ren
throughout that period.
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