Free Form 10 Affidavit Supporting Supplemental Judgment Modifying Custody, Parenting Time and Support - Oregon

Form 10
IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF LINN In the Matter of: _______________________________, Petitioner, and ) ) ) ) ) ) ) ) ) ) ) ) )

Case No. ______________________

PETITIONER'S RESPONDENT CO-PETITIONERS
AFFIDAVIT SUPPORTING SUPPLEMENTAL JUDGMENT MODIFYING CUSTODY PARENTING TIME CHILD SUPPORT ORDER RE: JURISDICTION STIPULATED

________________________________, Respondent.

STATE OF ________________________ ) ss. County of _________________________ )



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.

The Custody Parenting Time Child Support order dated ________________________ shall be modified according to the attached Supplemental Judgment signed by the Petitioner/ Respondent.

There are ________ child/ren born to the Petitioner and Respondent. 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 Supplemental Judgment. This case is now ready for a hearing on the merits. I/We make this affidavit in support of a Supplemental Judgment without a hearing. The allegations in my Motion for Order to Show Cause are true and it is just and reasonable to grant the relief requested in the proposed Supplemental Judgment.

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 six months. List any other basis for child custody jurisdiction: ______________________________________________________
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Linn Co unty Form D isso -1B : Form 10 Affidavit Supporting General Judgment .wpd( 1/06)

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 approximately $____________. 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.
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Linn Co unty Form D isso -1B : Form 10 Affidavit Supporting General Judgment .wpd( 1/06)

The child was possibly conceived in Oregon. The child lives in Oregon because of the wishes of Respondent. Respondent and I both lived in Oregon at the same time (either together or separately) during the marriage for
a period of six months, beginning (list dates) _______________ and ending on __________________ and less than one year has passed since respondent moved to a new residence out of state.

Other basis for jurisdiction: ________________________________________. 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): _______________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________

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/// Page 3 of 4 - AFFIDAVIT SUPPORTING GENERAL JUDGMENT
Linn Co unty Form D isso -1B : Form 10 Affidavit Supporting General Judgment .wpd( 1/06)

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: ______________

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Linn Co unty Form D isso -1B : Form 10 Affidavit Supporting General Judgment .wpd( 1/06)