Fill and Sign the Oregon Service 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 RELEVANT DATA RESPONDENT _________________ Sex _____ Telephone # ____________________ Residence Address _______________________________________________________ City/State/Zip_____________________________________ County ________________ Birth Date ______________ Age ______________ Race _________________________ Height _______ Weight _______ Hair Color ____________ Eye Color ______________ PETITIONER (you)______________ Sex _____ *Telephone # __________________ *Mailing Address ________________________________________________________ City/State/Zip________________________ County _____________________________ Birth Date __________________ Age ____________ Race _______________________ Height ________ Weight _______ Hair Color _________ Eye Color ________________ *If you wish to have your residential address or telephone number withheld from respondent, use a contact address and telephone number so the court and the sheriff can reach you if necessary. PLEASE FILL OUT THIS INFORMATION TO AID IN SERVICE OF THE RESTRAINING ORDER Where is respondent most likely to be located? * Residence Hours __________ * Employment Hours __________ Address: __________________________________ ___________________________________ Relevant Data; Petitioner’s Waiver of Service; Petitioner’s Motion and Order of Dismissal 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 * Other Hours __________ Address:__________________________________ ____________________________________ Description of vehicle _____________________________________________________ Does respondent have any weapons or access to weapons? EXPLAIN: ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________ Has respondent ever been arrested for or convicted of a violent crime? EXPLAIN: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Is there anything about respondent’s character, past behavior, or the present situation that indicates that respondent may be a danger to self or others? EXPLAIN: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Relevant Data; Petitioner’s Waiver of Service; Petitioner’s Motion and Order of Dismissal 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 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF _______________ _____________________________________ ) Petitioner (your name) ) PETITIONER’S WAIVER OF PERSONAL SERVICE ) vs. ) _____________________________________ ) No. ____________________ Respondent (person to be restrained) ) In order to maintain the confidentiality of my residential address. I hereby waive my right to personal service if I am subsequently charged with contempt. I am giving the following contact address for service of process and select the following method of substituted service: (Check ONE blank only.) _____ Mailing address: ___________________________________________________ ___________________________________________________ _____ Business address: ___________________________________________________ ___________________________________________________ Relevant Data; Petitioner’s Waiver of Service; Petitioner’s Motion and Order of Dismissal 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 _____ Specified agent: ___________________________________________________ ___________________________________________________ ___________________________________________________ ___________________________________________________ Signature of Petitioner ___________________________________________________ Print or Type Name of Petitioner Submitted by: ________________________________________________ Print Name ___ Petitioner ___ Attorney for Petitioner OSB No. __________________ ________________________________________________ Address or Contact Address ________________________________________________ City State Zip ________________________________________________ Telephone or Contact Telephone Number(s) Relevant Data; Petitioner’s Waiver of Service; Petitioner’s Motion and Order of Dismissal 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 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF ___________________ ____________________________________ ) Petitioner (your name) ) PETITIONER’S MOTION AND ORDER OF DISMISSAL vs. ) ) ) ____________________________________ ) No. _____________ Respondent (person to be restrained) ) MOTION Comes now petitioner, ______________________________, and moves this court for an order allowing the voluntary withdrawal and dismissal of the Restraining Order on file herein. _____________________________________________ Signature of Petitioner _____________________________________________ Print or Type Name of Petitioner Relevant Data; Petitioner’s Waiver of Service; Petitioner’s Motion and Order of Dismissal 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 SUBSCRIBED AND SWORN TO before me this __________ day of_____________________, _____, by _________________________________. (Print Name of Petitioner) _______________________________________________ NOTARY PUBLIC FOR OREGON/COURT CLERK My Commission Expires: ___________________________ ORDER _____ Motion Granted _____ Motion Denied. IT IS SO ORDERED this _____ day of ____________________, _____. _______________________________________________ JUDGE _______________________________________________ Print, Type or Stamp Name of Judge Submitted by : __________________________________________________________ Print Name ___ Petitioner ___ Attorney for Petitioner; OSB No. __________ ____________________________________________________________ Address or contact address Relevant Data; Petitioner’s Waiver of Service; Petitioner’s Motion and Order of Dismissal 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 ____________________________________________________________ City State Zip ____________________________________________________________ Telephone or Contact Telephone Number (s) Relevant Data; Petitioner’s Waiver of Service; Petitioner’s Motion and Order of Dismissal 7