Fill and Sign the Oregon Motion 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, ) )  PETITIONER’S  _ RESPONDENT’S EX PARTE MOTION, AFFIDAVIT AND vs. ) ORDER FOR NONDISCLOSURE OF INFORMATION REQUIRED BY ) ORS 25.020 ) ) ,_____ ) Respondent. ) MOTION On the basis of ORS 25.020 (statutory note) and the following affidavit, (___ Petitioner) (___ Respondent) requests that the court to issue an Order allowing nondisclosure of my address, Social Security number, telephone number, driver license number and information about my employer to the other party. I understand I will still be required to submit this information to the Department of Human Resources and/or the District Attorney’s Office. Petitioner’s / Respondent’s Ex Parte Motion; Affidavit and Order for Non-Disclosure of Information Required by ORS 25.0201 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 Statement of Points and Authorities ORS 25.020 (statutory note) requires a court entering an order with a provision concerning paternity or support to order that personal information otherwise required by statute not be contained in a document provided to the other party when the court finds that the health, safety, or liberty of a party or child would unreasonably be put at risk by disclosure of the information. This finding may be made ex part e. Affidavit State of Oregon ) ) ss County of ____________ ) I, ______________________________________, swear/affirm that I am the (___ Petitioner) (___ Respondent) in this matter. The disclosure of the information listed above would put the health, safety, or liberty of _________________________________ (list name of party or child) at risk because of the following reasons: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Petitioner’s / Respondent’s Ex Parte Motion; Affidavit and Order for Non-Disclosure of Information Required by ORS 25.0202 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 ______________________________________________________________________________ ______________________________________________________________________________ _________________________________________ Signature ________________________________________ Print name SUBSCRIBED AND SWORN TO before me this ______ day of ________________, ______. _____________________________________________ NOTARY PUBLIC FOR OREGON/COURT CLERK My Commission Expires: ________________________ Order ____ Motion granted. ____ Motion denied. IT IS SO ORDERED this ________ day of ___________________, _____. _______________________________________ CIRCUIT COURT JUDGE Petitioner’s / Respondent’s Ex Parte Motion; Affidavit and Order for Non-Disclosure of Information Required by ORS 25.0203 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 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. ____ 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 Submitted by: _______________________________________ (Print name) ____ Petitioner ____ Respondent _______________________________________ (Signature) _______________________________________ Address or Contact Address _______________________________________ City, State, Zip Code _______________________________________ Telephone Petitioner’s / Respondent’s Ex Parte Motion; Affidavit and Order for Non-Disclosure of Information Required by ORS 25.0204