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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Page 1 of 1, CERTIFICATE OF RESIDENCY
Linn Co unty Form Form 5 Certificate of Residency.wpd (3/04)