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Fill and Sign the Uccjea Oregon Form

Fill and Sign the Uccjea Oregon Form

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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 , ) RESPONSE WITH UCCJEA INFORMATION and ) DOMESTIC RELATIONS CASE SUBJECT TO FEE UNDER ORS 21.111 ________________________________, ) Respondent. ) Response Respondent appears and agrees with the petition filed in this case, except as specifically stated below: (I.) _______________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ (II.) _______________________________________________________________ Response with UCCJEA Information 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 ________________________________________________________________________ ________________________________________________________________________ (III ) _______________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ (IV.) _______________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Information Required by the Uniform Child Custody Jurisdiction and Enforcement Act. (Please fill in the following blanks) a. The parties’ minor child/ren are: ____________________________________ ________________________________________________________________________ ________________________________________________________________________ Response with UCCJEA Information 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 b. The child/rens’ present address is: ____________________________________ ________________________________________________________________________ ________________________________________________________________________ c. The places where the minor child/ren of the parties have lived in the last five years and the names of the person with whom the child/ren have resided are: Dates County/State With Whom Which Children From: _____ To: _____ ____________ _______________ __________________ From: _____ To: _____ ____________ _______________ __________________ From: _____ To: _____ ____________ _______________ __________________ From: _____ To: _____ ____________ _______________ __________________ _ Additional page attached; see section labeled “paragraph C continued.” d. The current addresses of the persons listed above with whom the minor child/ren have lived are: Name Address ________________________________________________________________________ Response with UCCJEA Information 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 ________________________________________________________________________ _______________________________________________________________________________________ ____ 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 ________________________________________________________________________ ________________________________________________________________________ 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: ________________________________________________________________________ (Identify court, case number and the nature of the proceeding) ________________________________________________________________________ Response with UCCJEA Information 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 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) ________________________________________________________________________ STATE OF OREGON ) ) County of ___________ ) I, _______________________________, being duly sworn, say that I am the (print name) respondent in this matter, and that the statements in this Response are true and correct to the best of my knowledge. _________________________________________ Signature _________________________________________ Print Name _________________________________________ Address _________________________________________ City, State, Zip Code Response with UCCJEA Information 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 _________________________________________ Telephone SUBSCRIBED AND SWORN TO before me this ______ day of ____________________, ______, by _________________________________________. __________________________________________ Notary Public for ____________/Court Clerk My Commission Expires: ____________________ 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/form. Response with UCCJEA Information 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 __________________________________________ Respondent, Pro Se (Signature) I certify that this is a true copy. _____________________________________ Respondent, Pro Se (Signature) Response with UCCJEA Information 7

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