Fill and Sign the Motion and Affidavit for Waiver of Mediation 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 the Marriage of: ) ) , ) Case No. Petitioner, ) ) MOTION AND AFFIDAVIT FOR WAIVER OF MEDIATION ) and ) ) , ) Respondent. ) ) I. (Check one box)  Petitioner  Respondent moves the court for an order waiving mediation. This motion is based on the provisions of SLR 12.025(2). II. Mediation is not appropriate and should be waived for the following reasons: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ (Attach an additional page labeled “Paragraph 2, continued” if necessary) Motion and Affidavit for Waiver of Mediation 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 III. Is there a Family Abuse Prevention Act restraining order currently in effect?  No  Yes If so, attach a copy to this motion. Information about me: Information about the other party: ___________________________________ ___________________________________ Name Name ___________________________________ ___________________________________ Mailing Address Mailing Address ____________________________________ ___________________________________ ____________________________________ ___________________________________ Daytime or contact telephone number Daytime or contact telephone number NOTICE TO BOTH PARTIES This motion and affidavit must be signed before a notary public or court clerk and then filed with the court. You must serve the other party with a copy of this document. If the initial pleading for this case has already been personally served, you may complete service by mailing a copy of this document to the other party’s attorney (or the other party if he or she isn’t represented) and completing the certificate of mailing below. Otherwise, you are required to personally serve a copy of this document on the other party. Motion and Affidavit for Waiver of Mediation 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 Certificate of Mailing I certify that I mailed a true copy of this Motion and Affidavit for Waiver of Mediation to the other party by placing a copy in a stamped envelope in the US Mail on ________________ (insert date of mailing) addressed to: ________________________________________________ _______________________________________________________________________. (Insert name and address of other party). If the party served with this motion objects to the motion and believes that mediation should be ordered, a written response must be filed with the court within 10 days of the mailing of this motion. Dated this ______day of ________________, _____ ______________________________________ (Signature) ______________________________________ Print Name ______________________________________ Address ______________________________________ City, State, Zip Code ______________________________________ Telephone Motion and Affidavit for Waiver of Mediation 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 SUBSCRIBED AND SWORN to before me this _______day of ________________,_____. _____________________________________ Notary Public for ___________/Court Clerk My Commission expires: _________________ Motion and Affidavit for Waiver of Mediation 4