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INSTRUCTIONS for the UTCR 2.100 FORMS - PAGE 1 OF 3
Co -Petitioners -9A B: Instructions -UTCR2.10 0Ver01.doc (3/08 )
Instructions for the UTCR 2.100 Forms
These instructions contain basic information about the UTCR 2.100 forms. These forms appear in many
of the packets on the Optional Statewide Family Law Forms website ( www.ojd.state.or.us/familylaw).
W HAT UTCR 2.100 FORM TO USE
Oregon law requires that Social Security numbers be given but kept confidential from the public in
dissolution, separation and annulment proceedings filed after January 1, 2004 (ORS 107.840).
SHORT VERSION : The “short version” of the UTCR 2.100 forms are the way in which you comply
with this requirement if you do not want to keep other information about yourself confidential (see “Long
Version” below).
LONG VERSION : The long version of the UTCR 2.100 forms allows you to protect personal
identifying information from disclosure in addition to your social security number. For example, you can
protect credit card numbers, bank or other financial account numbers and location s, driver license numbers,
maiden names, birth dates, and birthplace. You cannot protect “contact information” such as telephone
numbers, personal or business addresses, e -mail addresses, or employer identification and addresses by
using this form . IF YO U FEAR FOR YOUR OR YOUR CHILDREN’S SAFETY, you may use a
“contact address” or you may be eligible for an order of nondisclosure (see Packet #8).
FILLING OUT THE “S HORT FORM ” VERSION OF THE UTCR 2.100 FORM
Page 1 -Affidavit
• On page 1 of the Short F orm, in the box under “ A. Protected Personal Information ” check those boxes for
the social security numbers you are protecting. Your social security number, and that of the other party’s, if you
know it, and of your child/ren should be protected if you kn ow them.
• Check the appropriate box that applies to you under the “ Certificate of Document Preparation .”
• Date, sign and print your name on the bottom of page 1. The “OSB #” will be provided by your attorney if
you have one.
Page 2 -Segregated In formation Sheet
• You are the “requestor.” Fill out the lines for your name, address, and telephone number. Mark the box for
whether you are the “petitioner”or “respondent”. If you are not called the “petitioner” or “respondent” in your
other court p apers, put what you are called on the “other” line.
• Provide names and social security numbers on the appropriate lines.
FILLING OUT THE “L ONG FORM ” VERSION OF THE UTCR 2.100 FORM
• Page 1 - Affidavit : In the column marked “A”, describe the TYPE of personal information you want
protected BUT DO NOT WRITE THE ACTUAL INFORMATION. For example, if you want to protect your
driver’s license number, write “my driver’s license number” but do not write the actual number itself.
INSTRUCTIONS for the UTCR 2.100 FORMS - PAGE 2 OF 3
Co -Petitioners -9A B: Instructions -UTCR2.10 0Ver01.doc (3/08 )
• Page 1 - Affidavit : In the column marked “B”, put the applicable law that permits you to keep this
information confidential, if you know it.
NOTE: In most cases, you may simply write “ Oregon Public Records Law .” The Oregon
Public Records Law provides that “[i]nformation of a personal nature such as but not limited to
that kept in a personal, medical or similar file....” may be exempt from disclosure if showing this
information to the public would be “an unreasonable invasion of privacy.” ORS 109.502(2)
• Page 2 - Af fidavit : Write your initials for each of Paragraphs 1 through 6 as follows:
1. Required - Initial #1 and make sure you fill out and give the court clerk the form called “UTCR 2.100
(LONG FORM) SEGREGATED INFORMATION SHEET.”
2. Required - Initial #2 because you will be filing other documents with the court clerk where you or the
form itself has the words “Provided by UTCR 2.100 Affidavit” (or something similar to that) in it.
3. Not required - If you want the court clerk to send you a postcard informing you of the court’s response to
your request to keep information about yourself confidential, you should initial #3 ( not required) AND
PROVIDE THE COURT WITH POSTCARD ADDRESSED TO YOURSELF AND STAMPED. You do not
have to initial #3 if you do not have or wan t a postcard sent to you.
4. Required - Initial #4 showing that you understand that, even though you have requested certain
information about yourself be kept confidential, it may still be provided to certain persons and government
agencies as required by o ther Oregon laws, in particular UTCR 2.100(7).
5. May not be required - Initial #5 (may not be required) if you or someone who is not an attorney prepared
the UTCR 2.100 Long Form AND ATTACH A “CERTIFICATE OF DOCUMENT PREPARATION.” You
can download and pri nt such a form from Packet #6M on the OJD Optional Statewide Family Law Forms
website ( www.ojd.state.or.us/familylaw).
NOTE: If you have an attorney, s/he will fill out this form and put “n/a” on the line. You do not need to initial
or write anything if you have an attorney who completes the UTCR 2.100 Long Form.
6. Required - Initial #6 and mail or deliver a copy of ONLY the “UTCR 2.100 AFFIDAVIT (LONG
FORM) REQUEST TO SEGREGATE PROTECTED PERSONAL INFORMATI ON FROM
CONCURRENTLY FILED DOCUMENT” to the other party in your case. ***** HOWEVER, DO NOT
PROVIDE THE OTHER PARTY WITH A COPY OF THE FORM CALLED “UTCR 2.100 (LONG
FORM) SEGREGATED INFORMATION SHEET ” *****.
• Page 2 - Affidavit : Date, sign and pr int your name in the middle of page 2. The “OSB #” will be provided by
your attorney if you have one. DO NOT FILL OUT THE BOTTOM PART OF PAGE 2. It is reserved for court
use.
• Page 3 - Segregated Information Sheet : You are the “requestor.” In Para graph #1, fill out the lines for your
name, address, and telephone number, and on the line called “Relationship to case”, write whether you are the
INSTRUCTIONS for the UTCR 2.100 FORMS - PAGE 3 OF 3
Co -Petitioners -9A B: Instructions -UTCR2.10 0Ver01.doc (3/08 )
“petitioner”or “respondent.” If you are a party who is not called the “petitioner” or “respondent” in the c ourt
papers, write down what you are called. If you are not a party to the case, indicate why you are involved in the
case on this line.
• Page 4 - Segregated Information Sheet : In Paragraph #2, in the table provided, write the following:
1. In t he column called “ Row number used to identify on affidavit ” - Go back to page 1 to the box under
the column called “A.” For each row marked with a number that you have filled out, put the same number in
this column on page 4.
2. In the column called “ Gener al - Description of the protected personal information ” - Go back to
page 1 to the box under the column called “A.” Write the same description for the same row number on page 4.
3. In the column called “ Related to (Person’s Name) ” - Write the name of the p erson whose information it
is.
4. In the column that begins with “The following is the specific Protected Personal Information to be
segregated.... ” - Write down the actual information, such as the actual social security number, the actual bank
account numb er, the actual birthdate, the actual driver’s license number.
• Page 4 - Segregated Information Sheet : In Paragraph #3, put an “X” if there are additional sheets attached
beyond page 4 to your UTCR 2.100 Long Form.
SUBMITTING THE UTCR 2.100 FORM TO THE COURT
Submit either the UTCR 2.100 SHORT FORM or LONG FORM to the court clerk together with your
other court documents.
IMPORTANT: In your court papers, where a social security number or other item of
personal information that should be protected appears, write in the phrase :
“Provided by UTCR 2.100 Affidavit .”
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