Free Form 15.010.1d - Oregon

IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR _________________ COUNTY Small Claims Division - _____________________________________________________
(court's address and phone number)

__________________________________________
Plaintiff

v. __________________________________________
____________________________________________________________ Defendant(s)

) ) ) ) ) ) ) )

CASE No. _________________ SMALL CLAIMS JUDGMENT; MONEY AWARD G General G Limited G Supplemental G Plaintiff Submitted by: ________________ G Defendant

JUDGMENT. I hereby give judgment in this case for the Judgment Creditor named in the money judgment/money award below and against the judgment debtor(s) named therein. In addition to or in lieu of the money award below, this judgment establishes the following requirements: NONE, OR ________________________________________________________________________________________ ___________________________________________________________________________________________ MONEY JUDGMENT/MONEY AWARD 1. Judgment Creditor: _________________________________________________________________________
Name(s)/Address

2. Judgment Creditor's Attorney: G None, OR _____________________________________________________
Name/Address/Phone No.

________________________________________________________________________________ in this case. 3. Judgment Debtor(s). Information for any additional debtor(s) is provided in attachments and incorporated herein by reference: 4a. Name: ____________________________________ 4b. Name: ___________________________________ 5a. Address: __________________________________ 7a. SSN or Tax ID: _____________________________ 5b. Address: _________________________________ 7b. SSN or Tax ID: ____________________________ 6a. DOB: _____________________________________ 6b. DOB: ____________________________________ 8a. Dr Lic. No./State: ____________________________ 8b. Dr Lic. No./State: __________________________ 9. Judgment Debtor's Attorney: G None, OR ____________________________________________ in this case.
Name

10. I know the following person or public body is entitled to a portion of the money award: G NO ONE, OR ________________________________________________________________________________________
Name

11. Judgment is for a total judgment award of $____________ , which includes the following money amounts (and postjudgment interest at rate shown): 12. Money award of $___________ 13. Prejudgment interest of $____________ 15. Accrued arrearages of $__________ 16. Costs and service expenses of $__________

14. Postjudgment interest on 11" will be at _____% per _____. 17. Prevailing party fee of $__________ DATED SIGNED: _______________________ _____________________________________________ Circuit Court Judge _____________________________________________
Print Judge's Name

Form 15.010.1d ­ SMALL CLAIMS JUDGMENT; MONEY AWARD ­ UTCR 15.010(1)(d) (Revised 8-1-05)

UTCR App. Page 46