Free Form 8.090 - Oregon

IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF ___________________ In the Matter of G the Marriage of: , Petitioner, and , Respondent. I hereby certify that: 1. PENDING CHILD SUPPORT PROCEEDINGS (include any child support matter being heard by either a court or agency as part of a dissolution, separation, annulment, paternity, juvenile court, support, or modification case): G There is no pending child support proceeding in this or any other state involving the parties' child[ren]. G There is a pending child support proceeding G in Oregon G in another state which involves the parties' child[ren] as follows: Name/County of Court or Agency where pending: Agency Case Number: Court Case Number: 2. EXISTING CHILD SUPPORT ORDERS OR JUDGMENTS (include any order/judgment whether made by an agency or a court in this or any other state, and whether or not currently effective): G There are no other child support orders/judgments in this or any other state involving the parties' child[ren]. G There is/are other child support orders/judgments involving the parties' child[ren], as follows: ) ) ) ) ) ) ) ) Case No. ______________________ CERTIFICATE RE: PENDING CHILD SUPPORT PROCEEDINGS and/or EXISTING CHILD SUPPORT ORDERS/JUDGMENTS (UTCR 8.090)

Page 1 - From 8.090 -- CERTIFICATE RE: PENDING CHILD SUPPORT PROCEEDINGS and/or EXISTING CHILD SUPPORT ORDERS - UTCR 8.090 UTCR App. Page 31

ORDER/JUDGMENT #1 (Attach a certified copy of the order) Name/County of Court or Agency where issued: Case Number: Date of Order: ORDER/JUDGMENT #2 (Attach a certified copy of the order) Name/County of Court or Agency where issued: Case Number: Date of Order: ORDER/JUDGMENT #3 (Attach a certified copy of the order) Name/County of Court or Agency where issued: Case Number: Date of Order: ORDER/JUDGMENT #4 (Attach a certified copy of the order) Name/County of Court or Agency where issued: Case Number: Date of Order: Attach additional sheets if necessary, labeled Attachment 1 to Certificate Re: Child Support Proceedings and Orders. 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: G I selected this document for myself and I completed it without paid assistance. G I paid or will pay money to for assistance in preparing this form. DATED this day of , 20 .

G Petitioner G Respondent, Signature Print name Address or Contact Address City, State, Zip Code Telephone or Contact Telephone

Page 2 - Form 8.090 -- CERTIFICATE RE: PENDING CHILD SUPPORT PROCEEDINGS and/or EXISTING CHILD SUPPORT ORDERS - UTCR 8.090 UTCR App. Page 32