Fill and Sign the Judgment Dissolution Marriage 497323926 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 the Marriage of: ) ) Case No. ____________________ ________________________________, ) Petitioner, ) JUDGMENT OF DISSOLUTION OF MARRIAGE ) and ) ) ________________________________, ) Respondent. ) This matter came before the Court: ____ On the motion and affidavit of _______________________________, the default of _________________________________ having been found. ____ On the stipulations of the parties, as shown by the signatures below. ____ At a hearing held on the _____ day of _____________, _____, at which the following persons were present: ____ Petitioner ____ Petitioner’s attorney _______________________________ ____ Respondent ____ Respondent’s attorney ____________________________ Judgment of Dissolution of Marriage 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 The Court considered the: ____ Affidavit ____ Affidavit and stipulations ____ Evidence presented and found that irreconcilable differences have caused the irremediable breakdown of this marriage. THE COURT FOUND FURTHER THAT: ____ Husband ____ Wife has/have been a resident of and domiciled in the state of Oregon continuously for six months immediately prior to the filing of the Petition for Dissolution of Marriage. CHILDREN OF THE MARRIAGE The following children were born to or adopted by the parties before or during this marriage: ________________________________________________________________________ ________________________________________________________________________ ____ Husband is not the father, or paternity has not been established, of wife’s child/ren named_________________________________________________ born during the marriage on the following date(s): ____________________________________. ____Wife is not now pregnant. ____Wife is now pregnant. Husband ____ is ____ is not the father of the wife’s child due _____________________. (Insert date) CHILD CUSTODY JURISDICTION (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). Judgment of Dissolution of Marriage 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 ____ 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 for six months prior to filing 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: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ NOW, THEREFORE, IT IS HEREBY ORDERED: The terms of this judgment are effective immediately. The marital status of the parties shall terminate on the date this judgment is signed by the judge, or if an appeal is taken, upon determination of the appeal. PARENTING PLAN Custody of the child/ren is awarded as follows: Judgment of Dissolution of Marriage 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 _____ Wife is awarded legal custody of the following child/ren: _______________________________________________________________________. _____ Husband is awarded legal custody of the following child/ren: _______________________________________________________________________. _____ ____________________________________ shall have the right to parenting time with the child/ren, in accordance with the current version of Marion County SLR 8.075, a copy of which is attached, labeled “Exhibit A", and incorporated herein by reference. ____ Specific parenting time rights shall be as follows: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ____ The terms on the attached additional sheets, labeled “Exhibit A”, shall also be incorporated herein by reference. ____ 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 found. ____ ___________________________ shall not have the right to parenting time (Name of parent) with the child/ren because access would endanger the health or safety of the child/ren because: ________________________________________________________________ ________________________________________________________________________ Judgment of Dissolution of Marriage 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 ________________________________________________________________________ ________________________________________________________________________ ____ Wife and Husband shall each provide contact addresses and contact telephone numbers to the other and notify each other of any emergency circumstances or substantial changes in the children’s health. 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 and visitation orders even if you are not receiving child support. Violation of child support orders and visitation or 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 Department of Justice at 1-800-850-0228 or 503-378-5567 for information. Publicly funded help may be available to establish, enforce, and modify parenting time or visitation orders. Forms are available to enforce parenting time or visitation orders. Contact the domestic relations or civil court clerk for information . CHILD SUPPORT Check either (a) or (b) below: (a) ____ No child support shall be ordered at this time because: Judgment of Dissolution of Marriage 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 ____ Child support in the amount of $________ monthly has already been ordered and docketed with the _______________________ County Circuit Court, case number _____________. ____ Other reason:__________________________________________________ ________________________________________________________________________ (b) ____ Child support shall be paid by ________________________________ to ____________________ beginning on the first day of the month following the date of the decree 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 ____" 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 the 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 ____________________________________________ ________________________________________________________________________ Judgment of Dissolution of Marriage 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 BACK CHILD SUPPORT ____The following child support order(s) are hereby superseded by the terms of this judgment effective ___________:_________________________________________ (Date) ________________________________________________________________________ (For previous child support order, list name of court or agency case number, date of order). ____ The Oregon Department of Justice, Division of Child Support, is directed to update, correct and bring its records into conformance with this judgment of dissolution. ____ (Petitioner/respondent)___ is awarded a judgment against (Petitioner/respondent) in the amount of $_____________ for back child support for the period from ____________ to ______________. ____ The previous support order(s) listed above shall be considered satisfied. PAYMENT Pursuant to ORS 25.311(1), an income withholding order shall be issued to enforce the child support obligation unless an exception is indicated below. ____ Exceptions to withholding. Income withholding is not ordered at this time because there is no support arrearage, the paying parent has not previously been granted an exemption from withholding, and: ____ The parents, 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 Dissolution of Marriage 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 All payments of child support shall be made: (Check either (a) or (b)below) (a) ____ To the Oregon Department of Justice, Child Support Accounting Unit, P.O. Box 14506, Salem, Oregon, 97309. By petitioner’s request, collection, accounting disbursement, and enforcement services of this obligation shall be through the State of Oregon’s Department of Justice. (b) ____Pursuant to the above exception, directly to _____________________’s checking or savings account. A receipt of deposit shall be kept by the parent paying support as proof of payment. A canceled check is also prima facie evidence that payment has been made. 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 state law. 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.NOTICE ABOUT PERIODIC REVIEW AND Judgment of Dissolution of Marriage 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 MODIFICATION 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. 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 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. 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 if he/she is insurable. This parent shall maintain coverage in an amount sufficient to provide, in Judgment of Dissolution of Marriage 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 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) ____ ___________________________________ shall name the child/ren as beneficiaries of any health, accident, dental, orthodontic and optical insurance plan, throughout the period of the support obligation, whenever such insurance is available through this parent’s employment, group, or union, at a cost not to exceed the amount of child support award on page ___. 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 or ____ all of the uninsured costs. If this parent provides insurance that is available through his or her employment, or 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 insurance is not available to this parent when the final judgment is entered, this parent shall provide 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, or union membership, this parent shall pay: (check one) ____ one-half ____ all of the reasonably incurred uninsured medical, dental, orthodontic, optical and prescription medicine costs incurred for the child/ren throughout that period. SPOUSAL SUPPORT, LIFE INSURANCE, AND MEDICAL COVERAGE Check either a or b: Judgment of Dissolution of Marriage 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 (a) ____ No spousal support, spousal life insurance, or spousal medical coverage is ordered in this case. (b) ____ The terms indicated on the inserted pages 8a and 8b shall be in effect. REAL PROPERTY DISTRIBUTION Check either a or b: (a) ____ Neither wife nor husband has any interest in any real property located in this or in any other state. (b) ____ ___________________________ has/have an interest in real property located at the address of ___________________________________________________. ____ This property shall be distributed as follows: ________________________________________________________________________ ________________________________________________________________________ ____ The legal description of the property is attached as “Exhibit ____” and incorporated into this Judgment. ___________________________ shall be responsible for the preparation, signing and recording of a deed, transferring the real property as required by this judgment. ____ Distribution of this property is not within the jurisdiction of this court. PERSONAL PROPERTY DISTRIBUTION ____ The wife and husband have divided between them all personal effects, household goods and other personal property they own separately or together, and each shall be awarded those items now in their possession. ____ The wife is awarded the following personal property: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Judgment of Dissolution of Marriage 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 ________________________________________________________________________ ____ The wife is awarded her retirement benefits, pension plan, profit-sharing plan, deferred compensation plan, and/or stock option plan held by wife’s employer, free of any interest in the husband. ____ The husband is awarded his retirement benefits, pension plan, profit-sharing plan, deferred compensation plan, and/or stock option plan held by husband’s employer, free of any interest in the wife. ____ The husband is awarded the following personal property: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ DISTRIBUTION OF DEBTS (a) Husband’s Responsibility ____ Husband shall pay the debts listed below. Name of Creditor What debt is for Amount ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ____ Wife is granted a judgment against husband in the amount of $ _________ to be satisfied to the extent husband pays these debts. (b) Wife’s Responsibility Judgment of Dissolution of Marriage 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 ____ Wife shall pay the debts listed below. Name of Creditor What debt is for Amount ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ____ Husband is granted a judgment against wife in the amount of $ _________ to be satisfied to the extent wife pays these debts. FORMER NAME ____ ____________________’s former name of _____________________ is restored. COURT COSTS AND FEES (a) If Court Costs and Fees were Deferred: (please check the boxes below that apply) ____ Husband (or) ____ Wife shall be liable for all the court costs (including arbitration and COPE fees) that were deferred. ____ Husband and Wife shall each be liable for one half the court costs (including arbitration and COPE fees) that were deferred. ____The State of Oregon shall have judgment against __ _ Husband __ _ Wife for ___ _ one-half ___ all the filing fees, arbitration fees and COPE fees. (b) If Court Costs and Fees were Paid by the Parties: (please check the boxes below that apply) ____ Husband ____ Wife shall be liable for ____ one-half ____ all the court costs (including arbitration fees and COPE fees) and service fees that have been paid in this suit, and judgment shall be entered accordingly. Judgment of Dissolution of Marriage 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 INFORMATION REQUIRED BY ORCP 70, ORS 25.020 AND ORS 107.085 _____ Based on a finding that the health, safety, or liberty of ____________________ or (Name of parent at risk) a child _____________________________ would unreasonably be put at risk by disclosure (Name of child at risk) of the following information in this section, ___________________________ has been allowed not to disclose this information. Wife Husband _______________________________ ___________________________________ 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 _______________________________ ___________________________________ 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 and the Department of Justice (P.O. Box 14506, Salem, Oregon 97309) in writing of any change in the information required because child Judgment of Dissolution of Marriage 14 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 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 disclose information by means of this Judgment, the Department of Justice shall not disclose the information in the preceding section to the other parent. ADDITIONAL INFORMATION REQUIRED BY ORS 107.085 Wife Husband Date of birth: _______ Age:____ Date of birth: ______ Age: _____ All former legal names of the wife are: ________________________________________ All former legal names of the husband are: _____________________________________ Date of marriage: _________ Place of marriage: ________________________________ There are _____ children born to or adopted by the parties, whose names, ages and dates of birth are: Name Age Expected/Date of Birth ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ MONEY JUDGMENT SUMMARY (Child Support Obligation _ included _ not included) A. CHILD SUPPORT Judgment of Dissolution of Marriage 15 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. Judgment Creditor ____________________________________________ II. Judgment Debtor _____________________________________________ III. Amount of Judgment: _____________ representing back child support. _______________ per month, starting the first day of the month following the date of the judgment. IV. Interest a. Interest accrues at 9% per annum, simple interest. b. Interest accrues on the judgment on each unpaid installment as it becomes due on the first day of each month. B. SPOUSAL SUPPORT I. Judgment Creditor ____________________________________________ II. Judgment Debtor _____________________________________________ III. Amount of Judgment: _______________ per month, starting the first day of the month following the date of the decree, and terminating after the payment due on ___________. IV. Interest a. Interest accrues at 9% per annum, simple interest. b. Interest accrues on the judgment on each unpaid installment as it becomes due on the first day of each month. C. PROPERTY AND DEBT DIVISION (Judgments against Husband) I. Judgment Creditor ____________________________________________ II. Judgment Debtor _____________________________________________ III. Amount of Judgment __________________________________________ IV. Interest Judgment of Dissolution of Marriage 16 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 a. Interest accrues at 9% per annum, simple interest. b. Date from which interest runs: date judgment is entered. D. PROPERTY AND DEBT DIVISION (Judgments against Wife) I. Judgment Creditor ____________________________________________ II. Judgment Debtor _____________________________________________ III. Amount of Judgment __________________________________________ IV. Interest a. Interest accrues at 9% per annum, simple interest. b. Date from which interest runs: date judgment is entered. E. COURT COSTS (i.e., filing fees, hearing fees, trial fees, arbitration fees, COPE fees) I. Judgment Creditor ____________________________________________ II. Judgment Debtor _____________________________________________ III. Amount of Judgment __________________________________________ IV. Interest a. Interest accrues at 9% per annum, simple interest. b. Date from which interest runs: date judgment is entered. F. SERVICE FEES I. Judgment Creditor ____________________________________________ II. Judgment Debtor _____________________________________________ III. Amount of Judgment __________________________________________ IV. Interest a. Interest accrues at 9% per annum, simple interest. b. Date from which interest runs: date judgment is entered. Judgment of Dissolution of Marriage 17 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 (stipulated) to the terms of this judgment: (sign only your name) _____________________________ ____________________________________ Petitioner, Pro Se (signature) Respondent, Pro Se (signature) Submitted by: _______________________________________ Petitioner/Respondent, Pro Se (print name) _______________________________________ Petitioner/Respondent, Pro Se (signature) _______________________________________ Address _______________________________________ City, State, Zip Code _______________________________________ Telephone Certificate of Document Preparation You are required to truthfully complete this certificate regarding the document you are filing with the court. 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 Judgment of Dissolution of Marriage 18