Free Form 12 Affidavit Supporting General Judgment - Oregon


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Pages: 4
File Format: PDF
State: Oregon
Category: Court Forms - Local
Word Count: 840 Words, 8,873 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.ojd.state.or.us/LIN/home.nsf/Files/p4f12.pdf/$File/p4f12.pdf

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Preview Form 12 Affidavit Supporting General Judgment
Form 12 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF LINN In the Matter of: ________________________________, Petitioner, and ________________________________, Respondent. STATE OF OREGON County of _________________________ ) ) ) ) ) ) ) ) ) ) ss. )

Case No. ______________________

PETITIONER'S RESPONDENT'S CO-PETITIONER'S
AFFIDAVIT SUPPORTING GENERAL JUDGMENT

If this box is checked, both parties to this custody action have signed this document and are filing as CoPetitioners.

I __________________________________ being first duly sworn, say: I am the petitioner in this proceeding. I __________________________________ being first duly sworn, say: I am the respondent in this proceeding. We ___________________________ _____________________________are Co-Petitioners being first duly sworn,
say: We are Co-Petitioner in this proceeding. I/We are the parents of the following minor child/ren: ____________________________________________________ ______________________________________________________________________________________________ (name(s) and date(s) of birth)

Respondent has not appeared in this matter and an Order of Default has been entered. Respondent filed a response and later signed and filed a Waiver of Further Appearance and Consent to Entry of
Judgment, (or) has waived further hearing by stipulating to the terms of the General Judgment. This case is now ready for a hearing on the merits. I make this affidavit in support of a General Judgment without a hearing. The allegations in my Petition are true and it is just and reasonable the relief requested in the proposed General Judgment be granted.

Child custody or child support is involved in this case and at the time of filing: The child/ren had continuously resided in Oregon for the past six months. List any other basis for child custody jurisdiction: _______________________________________________
______________________________________________________________________________________________

Page 1 of 4, AFFIDAVIT SUPPORTING GENERAL JUDGMENT
Linn County Form UnmarriedParents-3A: Form 12 Affidavit Supporting General Judgment .wpd (7/07)

The current residence of the minor child/ren is: Name of Child Resides With (Name, Address or Contact Address) For how long

Additional page attached, labeled "Information About Children, Continued". Parenting time should not be ordered because my child/ren's health or safety would be endangered. State
supporting facts: _______________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ _____________________________________________________________________________________________.

I have good reason for the court to allow me to move more than 60 miles further distant from the other parent
without giving written advance notice to the other parent. My good cause is: _________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________

Minor Children are involved: Mother's average gross monthly income is $____________. Father's average gross
monthly income is approximately $ _________. Work or school related daycare is $________/month and is paid by

Mother Father. Health insurance for our child/ren costs $___________/month out of pocket and is paid by
` Mother ` Father. The child support amount I have requested does not deviate from the amount presumed correct under Oregon Administrative Rules, or does deviate from the presumed amount of $ ________ per month because: ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________

Child Support is involved and respondent does not live in Oregon.
(If you checked the box above, check any of the following boxes that are true)

Respondent was personally served with the petition in Oregon. Respondent lived in Oregon with the child. Respondent lived in Oregon and paid expenses for the birth or support of the child. The child was possibly conceived in Oregon. The child lives in Oregon because of the wishes of Respondent. Other basis for jurisdiction:_______________________________________________________________________
______________________________________________________________________________________________ Page 2 of 4, AFFIDAVIT SUPPORTING GENERAL JUDGMENT
Linn County Form UnmarriedParents-3A: Form 12 Affidavit Supporting General Judgment .wpd (7/07)

A child support order currently exists and I requested that this court issue a new order because the existing order
was issued by an Oregon court or agency, one of the parents or the child/ren receiving support under the order still resides in Oregon, and circumstances have changed since the first order was entered. The changed circumstances are (explain what has changed since the last order): ___________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________

I request that personal information, such as telephone number, address and employment information, not be
disclosed in the court's General Judgment as otherwise required by ORS 25.020 and ORS 107.085 because my health, safety or liberty, or that of my child __________________________ would unreasonably be put at risk by such disclosure. State supporting facts: ________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ _____________________________________________________________________________________________.

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Page 3 of 4, AFFIDAVIT SUPPORTING GENERAL JUDGMENT
Linn County Form UnmarriedParents-3A: Form 12 Affidavit Supporting General Judgment .wpd (7/07)

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 form myself, and I completed it without paid assistance. I paid or will pay money to ________________________________ for assistance in preparing this form.
Dated: ________________________, 200____.

__________________________________________ Petitioner's Signature

____________________________________________ Print Name

___________________________________________________________________________________________ Address or Contact Address City, State, Zip Telephone or Contact Telephone

SIGNED AND SWORN to before me this _________ day of ______________, 20_____,

___________________________________ Notary Public for ____________/Court Clerk My Commission Expires: ______________ ***********************************************************************************************************************************

CO-PETITIONER / RESPONDENT
I, ________________________, being duly sworn, say that I am the co-petitioner/respondent in this matter and that the foregoing affidavit is true and correct to the best of my knowledge.

__________________________________________ Respondent's Signature

_____________________________________________ Print Name

____________________________________________________________________________________________ Address or Contact Address City, State, Zip Telephone or Contact Telephone

SIGNED AND SWORN to before me this _________ day of ______________, 20_____,

___________________________________ Notary Public for ____________/Court Clerk My Commission Expires: _____________

Page 4 of 4, AFFIDAVIT SUPPORTING GENERAL JUDGMENT
Linn County Form UnmarriedParents-3A: Form 12 Affidavit Supporting General Judgment .wpd (7/07)