Fill and Sign the Petitioner Application 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 AFFIDAVIT APPLICATION FOR DECREE and ) ) , ) Respondent. ) STATE OF ) ) ss. County of _ ) I, ____________________________________, being first duly sworn, say: (Print name) I am the Petitioner in this proceeding. Respondent and I were married on ____________________, in the County of ___________________, State of (Date) Petitioner’s Affidavit; Application for Decree 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 _______________________ and have been and are now husband and wife. Respondent and I have been living apart since _______________________. Irreconcilable (Date) differences have caused an irremediable breakdown of the marriage. ____ Petitioner ____ Respondent was a resident of Oregon for more than six months prior to filing this action. Respondent is in default and an Order of Default has been entered. No other divorce or child support suit regarding this marriage is now in process to my knowledge. ____ There are no children born or adopted into this marriage who are now minors. ____ The wife is not now pregnant. ____ The children born or adopted into this marriage are: Name Date of Birth Currently lives with: Since: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ The gross monthly income of each of the parties, to the best of my knowledge is: Name Gross Monthly Income ______________________________________________________________________________ ______________________________________________________________________________ Petitioner’s Affidavit; Application for Decree 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 claims of the petition are true. I make this affidavit in support of my Motion for Decree of Dissolution without a hearing. ______________________________________ Petitioner, Pro Se (Signature) ______________________________________ Print name ______________________________________ Address ______________________________________ City, State, Zip Code ______________________________________ Telephone SUBSCRIBED AND SWORN to before me this ___________ day of ______________, ______, by ______________________________________________. ___________________________________ Notary Public for ____________/Court Clerk My Commission Expires: ______________ Petitioner’s Affidavit; Application for Decree 3