Fill and Sign the Oregon Noncompliance 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 ________________ , ) Case No. Plaintiff ) ) vs. ) AFFIDAVIT OF NONCOMPLIANCE MOTION TO REACTIVATE ) , ) Defendant ) I, _______________________________, hereby swear or affirm that on (Print your name) _____________________, _____________________________ and I signed a Mediation (Date agreement signed) (Print other party’s name) Agreement which contained the following terms:______________________________________ _________________________ has not complied with the agreement by failing to do the (Print the Other Party’s name) following:_____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Affidavit of Non-Compliance Motion to Reactivate 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 I did not keep the other party from following the agreement. A copy of this affidavit was mailed to the Defendant on ____________________ or hand delivered on _______________________. (specify date) (specify date) DATED: ______________________, _____ __________________________ (Sign your name) SUBSCRIBED AND SWORN to before me this ____ day of __________, _____. COURT ADMINISTRATOR by _________________________________ Affidavit of Non-Compliance Motion to Reactivate 2