Free Form 4 Certificate of Residency - Oregon

IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF LINN

IN THE MATTER OF THE MARRIAGE OF

SEPARATION OF
CUSTODY PROCEEDING
_____________________________ PETITIONER, AND _____________________________ RESPONDENT.

) ) ) ) ) ) ) ) ) )

Case No.

CERTIFICATE OF RESIDENCY

For purposes of ORS 14.080 and UTCR 8.010 (1), I hereby certify that the Petitioner or Co-Petitioner/Respondent in the above entitled proceeding currently resides in Linn County.

__________________________________________ Signature

______Petitioner ______ Co-Petitioner/Respondent ______Attorney for Petitioner/Respondent OSB No. _________________

Submitted by:

_________________________________________ Print or type name _________________________________________ Add ress

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City State Zip

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Linn Co unty Form Form 5 Certificate of Residency.wpd (3/04)