Free SEGREGATING SOCIAL SECURITY NUMBERS ONLY - Oregon

In the Matter of Out-of-Cycle Amendment of UTCR 2.100(4) and Adoption of New UTCR Forms 2.100.4c and 2.100.4d

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CHIEF JUSTICE ORDER No. 04-054 ORDER OF OUT-OF-CYCLE AMENDMENT OF UTCR 2.100(4) AND ADOPTION OF NEW UTCR FORMS 2.100.4c AND 2.100.4d

I HEREBY ORDER, pursuant to ORS 1.002(1)(a) and (3), the following: 1. UTCR 2.100(4) is amended as shown in the attachment to this order. For the convenience of the reader, deleted wording is shown in [brackets and italics] and new wording is shown in underline and bold. When this rule, as amended, is posted and published as part of the UTCR, these highlights will be not be shown. New UTCR Forms 2.100.4c and 2.100.4d are adopted as shown in the attachment to this order. UTCR 2.100(4), as amended, and new UTCR Forms 2.100.4c and 2.100.4d, as adopted, shall be included with the 2004 proposed changes to UTCR that are posted for public comment. UTCR 2.100(4), as amended, and new UTCR Forms 2.100.4c and 2.100.4d, as adopted, shall be placed on the regular spring agenda (for the meeting currently scheduled for April 1, 2005) of the UTCR Committee to allow public comment and discussion of any proposed changes.

2. 3.

4.

This order takes effect immediately. UTCR 2.100(4), as amended, and new UTCR Forms 2.100.4c and 2.100.4d, as adopted, become effective on the date this order is signed.

DATED this

22nd

day of December, 2004

/s/ Wallace P. Carson, Jr. Wallace P. Carson, Jr. Chief Justice

2.100 PROTECTED PERSONAL INFORMATION, NOT CONTACT INFORMATION, REQUIREMENTS AND PROCEDURES TO SEGREGATE WHEN SUBMITTING (1) ***** (4) Procedure to follow. A person may only request protected personal information be segregated and protected under this rule when submitting it to a court in a case. The procedures under this rule may be used to identify and separately present protected personal information from any submitted document or form that is used to give information to a court. To do so, a person must do [all of] the following: (a) (b) *** Complete an affidavit in substantially the form provided in UTCR Form 2.100.4a. If the person is requesting segregation of only social security numbers, the person may use the alternative form of affidavit provided in UTCR Form 2.100.4c. The affidavit: (I) Need not be notarized but must be signed by the requestor and contain language that the person knowingly gives the information under an oath or affirmation attesting to the truth of what is stated and subject to sanction by law if the person provides false information to the court. Must describe generally the protected personal information and set out the legal authority for protecting the information. ***

(ii)

(c)

Complete an information sheet in substantially the form provided in UTCR Form 2.100.4b to duplicate the protected personal information sought to be segregated and attach the information sheet to the affidavit. If the person is requesting segregation of only social security numbers, the person may use the alternative information sheet form provided in UTCR Form 2.100.4d. ***

(d) ***** (5) ***** ***

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

In the Matter of: ____________________________ Petitioner, and ____________________________ Respondent.

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Case No. ____________________ UTCR 2.100 AFFIDAVIT WITH REQUEST TO SEGREGATE SOCIAL SECURITY NUMBERS ONLY

By this affidavit under UTCR 2.100 and as required by ORS 107.840, I request that the social security number(s) in the attached "Segregated Information Sheet" be segregated (kept separate) from information that the general public can see. The social security numbers that I request be segregated are as follows: A. Protected Personal Information G Petitioner's Social Security Number G Respondent's Social Security Number G Child/Children's Social Security Number(s), if applicable B. Legal Authority ORS 107.840 ORS 107.840 ORS 107.840

I have mailed or delivered copies of this request (not including the attached information sheet) to the opposing party in this matter. 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 for myself and I completed it without paid assistance. I paid or will pay money to ________________________________ for assistance in
preparing this form. I knowingly give the information in this affidavit and the attached information sheet under an oath or affirmation attesting to the truth of what is stated and subject to sanction by law if I knowingly provide false information to the court. Date: OSB # (if applicable): Signature: Type or Print Name:

Page 1 - FORM 2.100.4c LINN COUNTY AFFIDAVIT WITH REQUEST TO SEGREGATE SOCIAL SECURITY NUMBERS ONLY ­ UTCR 2.100

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

In the Matter of: _____________________________, Petitioner, and , Respondent.

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Case No. UTCR 2.100 SEGREGATED INFORMATION SHEET ­ SOCIAL SECURITY NUMBERS ONLY

ATTENTION COURT STAFF: The information set forth below must be kept separate from the applicable court file and may not be shown to any member of the public except by order of the court.

1.

Requestor Information (Contact address and telephone number may be used): Name: Address: Telephone Number: Other contact information: Relationship to Case: 9 Petitioner 9 Respondent 9 Other:

2.

Segregated Social Security Numbers: Petitioner Name: Respondent Name: Children of the parties (if applicable): Name: Name: Name: Name: Name: SSN: SSN: SSN: SSN: SSN: SSN: SSN:

Page 1 - FORM 2.100.4c LINN COUNTY SEGREGATED INFORMATION SHEET - SOCIAL SECURITY NUMBERS ONLY ­ UTCR 2.100