Oregon Judicial Segregated Information Sheet

Instructions for the UTCR 2.100 Forms

These instructions contain basic information about the UTCR 2.100 forms. These forms appear in many of the packets on the Optional Statewide Family Law Forms website ( www.ojd.state.or.us/familylaw).

WHAT UTCR 2.100 FORM TO USE

Oregon law requires that Social Security numbers be given but kept confidential from the public in dissolution, separation and annulment proceedings filed after January 1, 2004 (ORS 107.840).

SHORT VERSION: The “short version” of the UTCR 2.100 forms are the way in which you comply with this requirement if you do not want to keep other information about yourself confidential (see “Long Version” below).

LONG VERSION: The long version of the UTCR 2.100 forms allows you to protect personal identifying information from disclosure in addition to your social security number. For example, you can protect credit card numbers, bank or other financial account numbers and locations, driver license numbers, maiden names, birth dates, and birthplace. You cannot protect “contact information” such as telephone numbers, personal or business addresses, e-mail addresses, or employer identification and addresses by using this form. IF YOU FEAR FOR YOUR OR YOUR CHILDREN’S SAFETY, you may use a “contact address” or you may be eligible for an order of nondisclosure (see Packet #8).

FILLING OUT THE “SHORT FORM” VERSION OF THE UTCR 2.100 FORM

Page 1 - Affidavit

• On page 1 of the Short Form, in the box under “A. Protected Personal Information” check those boxes for the social security numbers you are protecting. Your social security number, and that of the other party’s, if you know it, and of your child/ren should be protected if you know them.

• Check the appropriate box that applies to you under the “Certificate of Document Preparation.”

• Date, sign and print your name on the bottom of page 1. The “OSB #” will be provided by your attorney if you have one.

Page 2 - Segregated Information Sheet

• You are the “requestor.” Fill out the lines for your name, address, and telephone number. Mark the box for whether you are the “petitioner” or “respondent”. If you are not called the “petitioner” or “respondent” in your other court papers, put what you are called on the “other” line.

• Provide names and social security numbers on the appropriate lines.

FILLING OUT THE “LONG FORM” VERSION OF THE UTCR 2.100 FORM

• Page 1 - Affidavit: In the column marked “A”, describe the TYPE of personal information you want protected BUT DO NOT WRITE THE ACTUAL INFORMATION. For example, if you want to protect your driver’s license number, write “my driver’s license number” but do not write the actual number itself.

Page 1 - Affidavit (Form Entry Fields)

• Page 1 - Affidavit: In the column marked “B”, put the applicable law that permits you to keep this information confidential, if you know it.

NOTE: In most cases, you may simply write “Oregon Public Records Law.” The Oregon Public Records Law provides that “[i]nformation of a personal nature such as but not limited to that kept in a personal, medical or similar file....” may be exempt from disclosure if showing this information to the public would be “an unreasonable invasion of privacy.” ORS 109.502(2)

• Page 2 - Affidavit: Write your initials for each of Paragraphs 1 through 6 as follows:

1. Required - Initial #1 and make sure you fill out and give the court clerk the form called “UTCR 2.100 (LONG FORM) SEGREGATED INFORMATION SHEET.”

2. Required - Initial #2 because you will be filing other documents with the court clerk where you or the form itself has the words “Provided by UTCR 2.100 Affidavit” (or something similar to that) in it.

3. Not required - If you want the court clerk to send you a postcard informing you of the court’s response to your request to keep information about yourself confidential, you should initial #3 (not required) AND PROVIDE THE COURT WITH POSTCARD ADDRESSED TO YOURSELF AND STAMPED.

4. Required - Initial #4 showing that you understand that, even though you have requested certain information about yourself be kept confidential, it may still be provided to certain persons and government agencies as required by other Oregon laws, in particular UTCR 2.100(7).

5. May not be required - Initial #5 (may not be required) if you or someone who is not an attorney prepared the UTCR 2.100 Long Form AND ATTACH A “CERTIFICATE OF DOCUMENT PREPARATION.”

6. Required - Initial #6 and mail or deliver a copy of ONLY the “UTCR 2.100 AFFIDAVIT (LONG FORM) REQUEST TO SEGREGATE PROTECTED PERSONAL INFORMATION FROM CONCURRENTLY FILED DOCUMENT” to the other party in your case.

• Page 2 - Affidavit: Date, sign and print your name in the middle of page 2. The “OSB #” will be provided by your attorney if you have one. DO NOT FILL OUT THE BOTTOM PART OF PAGE 2. It is reserved for court use.

• Page 3 - Segregated Information Sheet: You are the “requestor.” In Paragraph #1, fill out the lines for your name, address, and telephone number, and on the line called “Relationship to case”, write whether you are the “petitioner” or “respondent.” If you are a party who is not called the “petitioner” or “respondent” in the court papers, write down what you are called. If you are not a party to the case, indicate why you are involved in the case on this line.

Page 3 - Requestor Information

• Page 4 - Segregated Information Sheet: In Paragraph #2, in the table provided, write the following:

1. In the column called “Row number used to identify on affidavit” - Go back to page 1 to the box under the column called “A.” For each row marked with a number that you have filled out, put the same number in this column on page 4.

2. In the column called “General - Description of the protected personal information” - Go back to page 1 to the box under the column called “A.” Write the same description for the same row number on page 4.

3. In the column called “Related to (Person’s Name)” - Write the name of the person whose information it is.

4. In the column that begins with “The following is the specific Protected Personal Information to be segregated....” - Write down the actual information, such as the actual social security number, the actual bank account number, the actual birthdate, the actual driver’s license number.

• Page 4 - Segregated Information Sheet: In Paragraph #3, put an “X” if there are additional sheets attached beyond page 4 to your UTCR 2.100 Long Form.

Page 4 - Segregated Information Table

Additional sheets attached:

SUBMITTING THE UTCR 2.100 FORM TO THE COURT

Submit either the UTCR 2.100 SHORT FORM or LONG FORM to the court clerk together with your other court documents.

IMPORTANT: In your court papers, where a social security number or other item of personal information that should be protected appears, write in the phrase: