Fill and Sign the Oregon Petition Custody 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: ) ________________________________, ) Case No. ______________________ Petitioner, ) ) PETITION FOR CUSTODY AND and PARENTING TIME under ORS 109.103 ________________________________, )_____ and CHILD SUPPORT Respondent. ) DOMESTIC RELATIONS CASE) SUBJECT TO FEE UNDER ORS 21.111 I. ____________________________ is the mother and _______________________ is the father of _______________________________________born ________________ (names of children) _____________________________________________________________________________. II. Paternity of the child/ren has been established: _ by filing with the State Registrar of Vital Statistics a voluntary acknowledgment of paternity:_____________________________________________________________. (names of children involved) Petition for Custody and Parenting Time under ORS 109..103 and Child Support 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 _ by administrative order docketed with the ____________________ County Circuit Court: _____________________________________________________________________________. (name of children involved) _ by judicial order entered by the ____________________ County Circuit Court in Case No. __________________: _______________________________________________________. (names of children involved) _ b y: _____________________________________________________________________________________ ___________________: ________________________________________________________________________. (names of children involved) III. The minor child/ren reside(s) in _________________________ County, State of _________________. The petitioner resides in __________________________ County, State of _________________. The respondent resides in ________________________ County, State of _________________. IV. (Check all boxes that apply) ____ The child/ren have lived in Oregon continuously for the last six months. _____ The child/ren have lived in Oregon continuously for six months sometime during the last twelve months and the child/ren are not now in Oregon but one parent lives in this state. Petition for Custody and Parenting Time under ORS 109..103 and Child Support 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 have lived in another state continuously for six months but a court in that state has declined to exercise jurisdiction on the ground that this state is the more appropriate forum, and ____ The child/ren and ______________________________ have significant connections to (name of parent or caretaker) Oregon and substantial evidence about them is available here. ____ The child/ren are physically present in Oregon, 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. The current residence or mailing address of the minor child/ren is: ________________________ ______________________________________________________________________________ VI. The places where the minor child/ren have lived in the last five years and the names of the person with whom these child/ren have resided are: Dates County/State With Whom Which Children From: _____To: _____ ____________ _______________ __________________ From: _____ To: _____ ____________ _______________ __________________ From: _____ To: _____ ____________ _______________ __________________ From: _____ To: _____ ____________ _______________ __________________ Petition for Custody and Parenting Time under ORS 109..103 and Child Support 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 VII. The current addresses of the persons listed in paragraph 6 are: Name Address ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ VIII. _ I have not participated in any litigation concerning the custody, visitation, parenting time or placement of the children in this or any other state. _ I have participated in the following litigation regarding the child/ren’s custody, visitation, parenting time or placement: Name of Court State Case No . Date Result ______________________________________________________________________________ IX. I do not know of any other domestic violence, custody, visitation, parenting time or placement proceeding involving the child/ren pending in this or any other state ___ except for: Petition for Custody and Parenting Time under ORS 109..103 and Child Support 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 ______________________________________________________________________________ (Identify court, case number and the nature of the proceeding) ______________________________________________________________________________ X. I do not know any person (other than the respondent) who has physical custody of the child/ren or who claims to have custody, visitation or parenting time rights __ except for: _____________________________________________________________________________ (List name and address) _____________________________________________________________________________ PARENTING PLAN XI. ____ _______________________________ is/are a fit and proper person(s) to be awarded custody of the parties’ minor children. Custody of the child/ren should be awarded as follows: ___ Mother should be awarded custody of the following child/ren: ______________________________________________________________________________ ___ Father should be awarded custody of the following child/ren: ______________________________________________________________________________ ____ ______________________________________ should have parenting time in accordance with __________ County ____________. ____ Specific parenting time should be as follows: Petition for Custody and Parenting Time under ORS 109..103 and Child Support 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 ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ____ Additional page(s) attached; see “Exhibit A.” ____ Mother and father should each provide contact addresses and contact telephone numbers to the other and notify each other of any emergency circumstances or substantial changes in the child/ren’s health. ____ __________________________ should not be granted parenting time because this would endanger the health or safety of the child/ren. ____ Petitioner should be allowed to move more than 60 miles distant from the other parent without advance written notice because good cause exists. CHILD SUPPORT XII. ____ There are no existing child support orders, administrative or judicial, currently in effect in the State of Oregon or any other state. ____ The following child support order(s) is/are currently in effect: ______________________________________________________________________________ ______________________________________________________________________________ (List name of court or agency, case number, date of order and amount of arrearage (if any)) A certified copy of this order(s) is attached to this petition. Petition for Custody and Parenting Time under ORS 109..103 and Child Support 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 XIII. ____ No child support should be ordered in this case because: ____ Child support in the amount of $ __________ monthly has already been ordered and docketed with the _________________________ County Circuit Court ___ Other reason: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ____ Child support should be paid by _______________________ to _______________________ beginning on the first day of the month following the date of the judgment and continuing on the first (1st) day of each month thereafter. The support for each child should be paid until that child reaches eighteen (18) years of age, or is otherwise emancipated. The support should 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. The total payment of child support per month should be $ __________________ for ________ children. The support amount was calculated pursuant to the support guidelines set out in Oregon’s Administrative Rules. The support amount: ____ does not deviate from the amount presumed correct under the guidelines ____ does deviate from the amount presumed correct under these guidelines because ______________________________________________________________________________ ______________________________________________________________________________ XIV. Petition for Custody and Parenting Time under ORS 109..103 and Child Support 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 Oregon law requires that child support on all new or modified orders be collected by income withholding. Exceptions may be granted under the provisions of ORS 25.317. All payments of child support should be made to the Oregon Department of Justice, Child Support Accounting Unit, P. O. Box 14506, Salem, Oregon, 97309. Petitioner requests that collection, accounting, disbursement, and enforcement services be provided by the State of Oregon’s Department of Justice. In addition, support for a child attending school (between 18 and 21 years of age) as defined in ORS107.108, should be distributed by the Oregon Department of Justice, Child Support Accounting Unit directly to the child subject to ORS 107.108. LIFE INSURANCE COVERAGE FOR CHILD/REN XV. ____ ____________________________ should obtain and maintain life insurance for the benefit of the parties’ child/ren throughout the period of the support obligation. The coverage should be in an amount sufficient to provide continued support, in the event of the paying parent’s death, at least at the level of and for the duration of the support obligation. MEDICAL INSURANCE COVERAGE FOR CHILD/REN XVI. Throughout the period of the support obligation, ________________________________ should name the child/ren as beneficiaries of any health, accident, dental, orthodontic, and optical insurance plan, available through that parent’s employment, group, or union, at a cost not to exceed the amount of child support awarded in the final judgment. If that parent fails to maintain insurance under these circumstances for the child/ren, that parent should be liable for any of those expenses incurred after the date of the court order requiring the coverage. If that Petition for Custody and Parenting Time under ORS 109..103 and Child Support 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 parent maintains this insurance but the insurance does not provide complete coverage, that parent should pay ___ one-half ___ all of the uninsured costs. If the insurance coverage for the child/ren is provided through the parent’s employment, group, or union, and if this employment, or group of union membership is then terminated, that parent shall notify the other parent of this fact prior to or immediately upon termination. If health insurance is not available to this parent when the final judgment is entered, that parent should provide health 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 of union membership, that parent should pay ____ one-half ____ all uninsured costs incurred by the child/ren throughout that period, including costs for prescriptions. COURT COSTS AND FEES XVII. Deferred Costs and Fees: ___ Father __ _ Mother should be liable for all the court costs that were deferred. ___ Father and Mother should each be liable for one-half the court costs that were deferred. ___ The State of Oregon should have judgment against ___ Father ___ Mother for ___ one-half ___ all the court costs. Petition for Custody and Parenting Time under ORS 109..103 and Child Support 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 Court Costs and Fees Paid by the Parties ____ Father ___ _ Mother should be liable for ___ _ one-half ____ _ all the court costs and service fees that have been paid in this suit. ____ Father ____ Mother should have a judgment against ____ Father ___ _ Mother for ___ _ one-half _ all of these costs. WHEREFORE, petitioner prays for a Judgment granting the relief petitioned for above. STATE OF ____________________) ) County of ______________________) I, __________________________________ being duly sworn, say that I am the petitioner in this matter and that the foregoing Petition is true and correct to the best of my knowledge. ______________________________________________ Petitioner, Pro Se (signature) ______________________________________________ Print name ______________________________________________ Address ______________________________________________ City, State, Zip Code ______________________________________________ Telephone Petition for Custody and Parenting Time under ORS 109..103 and Child Support 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 SUBSCRIBED AND SWORN to before me this ___________ day of ______________, ______, by _______________________________________________. _______________________________________________ Notary Public for ____________/Court Clerk My Commission Expires: __________________________ Certificate of Document Preparation 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. __________________________________________ Petitioner’s Signature I certify that this is a true copy. _____________________________________ Petitioner (Signature) Petition for Custody and Parenting Time under ORS 109..103 and Child Support 11