Fill and Sign the General Judgment of Custody Parenting Timesupport Order Oregon Form

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: ) ________________________________, ) Case No. ______________________ Petitioner, ) JUDGMENT OF CUSTODY and ) AND PARENTING TIME AND SUPPORT ________________________________, ) ___ _ ORDER RE: JURISDICTION Respondent. ) This matter came before the Court: ____ O n 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 _______________________________ ____ Respondent ____ Respondent’s attorney ___________________________ The Court considered the: ____ Affidavit ____ Affidavit and stipulations ____ Evidence presented Judgment of Custody and Parenting Time / Support Order re Jurisdiction 1 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 and 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. ____ 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, is subject 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: Judgment of Custody and Parenting Time / Support Order re Jurisdiction 2 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 PARENTING PLAN Custody of the child/ren is awarded as follows: ____ 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. ____ 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. Judgment of Custody and Parenting Time / Support Order re Jurisdiction 3 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 ____ 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) 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. Judgment of Custody and Parenting Time / Support Order re Jurisdiction 4 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 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: __________________________________________________ ________________________________________________________________________ ____ 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 Judgment of Custody and Parenting Time / Support Order re Jurisdiction 5 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 Court finds that application of the formula would be unjust or inappropriate in this case because: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 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: ____ 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. Judgment of Custody and Parenting Time / Support Order re Jurisdiction 6 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 ____ 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. ____ 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 ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Judgment of Custody and Parenting Time / Support Order re Jurisdiction 7 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 NOTICE ABOUT MODIFICATION OF CHILD SUPPORT ORDERS The 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. 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. Judgment of Custody and Parenting Time / Support Order re Jurisdiction 8 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 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. 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. Judgment of Custody and Parenting Time / Support Order re Jurisdiction 9 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 COURT COSTS AND FEES Deferred Costs and Fees (i.e., filing, hearing, trial, COPE fees) ____ Mother ____ Father shall be liable for all the court costs that were deferred. ____ Mother and Father shall each be liable for one half the deferred court costs. ____ The State of Oregon shall have judgment against __ _ Mother __ _ Father for ___ _ o ne-half ____ all the court costs. Paid Costs and Fees (i.e., filing, hearing, trial, COPE fees) ____ Mother ____ Father shall be liable for ____ one-half ____ all the court costs and service fees that have been paid in this suit. ____ Mother ____ Father shall have a judgment against ____ Mother ____ Father for ____ one-half ____ all of these costs. REQUIRED INFORMATION ABOUT THE PARTIES ____ Based on a finding that the health, safety, or liberty of _____________________________ or a child ___________________________ would (Name of person at risk) (Name of child at risk) unreasonably be put at risk by disclosure of the following information in this section, ____________________________ has been allowed not to disclose this information. Mother Father ________________________________ ___________________________________ Residence, mailing or contact address Residence, mailing or contact address __________________________________ ______________________________________ Social security number Telephone number Social security number Telephone number _______________________________ ___________________________________ Date of Birth Date of Birth _______________________________ ___________________________________ Driver license number and State of Issuance Driver license number and State of Issuance __________________________________ ______________________________________ Employer Name Employer Name Judgment of Custody and Parenting Time / Support Order re Jurisdiction 10 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 __________________________________ ______________________________________ Employer Address Employer Address __________________________________ ______________________________________ Employer Telephone Number Employer Telephone Number (Attach additional sheet if more than one employer) ___________________________________ _______________________________________ Attorney, Name, Address, Phone Attorney, Name, Address, Phone ___________________________________ _______________________________________ Name of any person entitled to portion of payment on judgment, if judgment creditor Both parties shall inform the court (P.O. Box 12869, Salem, OR 97309) and the Division of Child Support (P.O. Box 14506, Salem, OR 97309) in writing of any change in the information required because child support is involved within ten (10) days of such change, unless a finding of unreasonable risk has been made in this case. If the court has ordered that a party be allowed not to disclosure information by means of this judgment, the Department of Justice shall not disclose this information to the other parent. MONEY JUDGMENT SUMMARY (Child Support Obligation _ included _ not included) A. CHILD SUPPORT 1. Judgment Creditor _______________________________________________ 2. Judgment Debtor ________________________________________________ Judgment of Custody and Parenting Time / Support Order re Jurisdiction 11 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 3. Amount of Judgment __________, representing back child support. ________________ per month, starting the first day of the month following the date of the judgment. 4. Interest a. Interest accrues at 9% per annum, simple interest. b. Interest accrues on the judgment on each unpaid installment as it becomes dues on the first day of each month. B. COURT COSTS (i.e., filing, hearing, trial, COPE fees) 1. Judgment Creditor ____________________________________________ 2. Judgment Debtor _____________________________________________ 3. Amount of Judgment__________________________________________ 4. Interest a. Interest accrues at 9% per annum, simple interest. b. Interest accrues on the judgment on each unpaid installment as it becomes dues on the first day of each month. C. SERVICE FEES 1. Judgment Creditor __________________________________________________ 2. Judgment Debtor ___________________________________________________ 3. Amount of Judgment ________________________________________________ 4. Interest a. Interest accrues at 9% per annum, simple interest. b. Interest accrues on the judgment on each unpaid installment as it becomes dues on the first day of each month. Judgment of Custody and Parenting Time / Support Order re Jurisdiction 12 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 DATED this _____ day of ____________________________, ______. __________________________________________ CIRCUIT COURT JUDGE ____ Both parties have agreed to the terms of this judgment: (sign only your name) ______________________________ ____________________________________ Petitioner, Pro Se Respondent, Pro Se ______________________________ ____________________________________ Date Date Submitted by: ______________________________________ Signature ______________________________________ Print name ______________________________________ Address or Contact Address ______________________________________ City, State, Zip Code ______________________________________ Telephone or Contact Telephone 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. Judgment of Custody and Parenting Time / Support Order re Jurisdiction 13 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 ____ 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 Judgment of Custody and Parenting Time / Support Order re Jurisdiction 14