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28 IN THE CIRCUIT COURT OF THE STATE OF OREGON
FOR THE COUNTY OF _______________
)
__________________________________ ) PETITIONER’S RESPONDENT’S
MOTION, AFFIDAVIT AND ORDER TO
SHOW CAUSE FOR MODIFYING
Petitioner, ) RESTRAINING ORDER
)
vs. )
)
__________________________________ ) NO. _
___________________________
Respondent. )
MOTION
On the basis of ORS 107.730 and the following affidavit, (check one):
(__Petitioner) (__ Respondent) moves the court to issue an Order to Show Cause why the
Restraining Order entered in this matter should not be modified as follows as to custody and/or
parenting time in the manner indicated below.
I. Custody .
_____ A. (__ Petitioner) (__Respondent) should be awarded custody of the following
children of the parties, subject to the parenting time terms set forth below.
Petitioner’s / Respondent’s Motion, Affidavit, Order to Show Cause For Modifying
Restraining Order1
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28 Name: ________________________________________ Age: _________
Name: ________________________________________ Age: _________
Name: ________________________________________ Age: _________
Name: ________________________________________ Age: _________
____ B. A peace officer of the county or city in which the children are located should be
ordered to assist in recovering the custody of the children of the above parties to the party
awarded custody. The peace officer should be authorized to use any reasonable force necessary
to that end.
II. Parenting Time.
____ A. NO PARENTING TIME due to _________________________________
________________________________________________________________________
________________________________________________________________________
____ B. SUPERVISED PARENTING TIME: Three hours per week, Supervised by:
________________________________ As follows (day of week, location,
time):________________________________________________________________
_____________________________________________________________________
____ C. Once per week on _________________ (day) from ___________ a.m./p.m. to
______________ a.m./p.m.
Petitioner’s / Respondent’s Motion, Affidavit, Order to Show Cause For Modifying
Restraining Order2
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28 ____ D. On the FIRST and THIRD weekends of each month from 7:00 p.m. Saturday to
7:00 p.m. Sunday. The first weekend is the one in which both Saturday and Sunday are in the
new month.
____ E. On the FIRST and THIRD weekends of each month from 7:00 p.m. Friday to
7:00 p.m. Sunday. The first weekend is the one on which both Saturday and Sunday are in the
new month.
____ F. OTHER PARENTING TIME AS FOLLOWS: ____________________
_______________________________________________________________________
_______________________________________________________________________
____ G. Parenting time details not provided for in the ORDER, including the days or
hours of parenting time, shall be arranged through ___________________________________.
____ H. The parent not awarded custody will pick up and return the children at the curb,
or driveway if no curb, of the residence of the custodial parent or at _________________
__________________________________________ (name and address of different location) no
more than 15 minutes early nor 15 minutes late.
III. Other Relief.
________________________________________________________________________
________________________________________________________________________
Petitioner’s / Respondent’s Motion, Affidavit, Order to Show Cause For Modifying
Restraining Order3
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28 ________________________________________________________________________
IV. If (___ Petitioner) (___ Respondent) fails to appear, I request the court to issue an Order
of Default granting the modification, as described above, and grant any other relief the court
deems appropriate.
AFFIDAVIT
State of Oregon )
) ss
County of ___________ )
I, ______________________________________, swear/affirm that I am the
(print your name)
(___Petitioner) (___Respondent) in this matter. The following facts support this motion:
(check one)
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
________________________________________
Signature
Petitioner’s / Respondent’s Motion, Affidavit, Order to Show Cause For Modifying
Restraining Order4
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28 ________________________________________
Print name
SUBSCRIBED AND SWORN TO before me this ______ day of ________________,
_____.
_____________________________________________
NOTARY PUBLIC FOR OREGON/COURT CLERK
My Commission Expires: ________________________
ORDER TO SHOW CAUSE
TO:__________________________________________________(__Petitioner,___ Respondent)
___________________________________________________(Address)
___________________________________________________(City, State, Zip)
IT IS HEREBY ORDERED that you must appear at a hearing before this Court on:
______ day of ___________________, _____, at ______ o’clock to show cause why the
Restraining Order entered in this matter on ____ day of _____________, ______, should not be
modified as described in the attached motion.
If you do not appear in person for the hearing, the Court shall enter an Order of Default
granting the relief requested, and such other relief as may be appropriate.
Petitioner’s / Respondent’s Motion, Affidavit, Order to Show Cause For Modifying
Restraining Order5
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28 IT IS SO ORDERED this ________ day of ___________________, _____.
_______________________________________
CIRCUIT COURT JUDGE
Petitioner’s / Respondent’s Motion, Affidavit, Order to Show Cause For Modifying
Restraining Order6
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28 NOTICE
READ THESE PAPERS CAREFULLY
IF YOU FAIL TO APPEAR AT THE SCHEDULED HEARING, THE COURT MAY
GRANT THE RELIEF REQUESTED. IF YOU HAVE ANY QUESTIONS, YOU
SHOULD SEE AN ATTORNEY IMMEDIATELY.
Submitted by: _______________________________________
___Petitioner ___Respondent (Print name)
____________________________________________ ___________________________
____Petitioner ____Respondent, Pro Se (signature) City, State, Zip Code
____________________________________________ ___________________________
Address or Contract Address Telephone
Petitioner’s / Respondent’s Motion, Affidavit, Order to Show Cause For Modifying
Restraining Order7
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