Free Form 6 Certificate of Mailing to SED - Oregon

Form 6 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF LINN In the Matter of: ___________________________________, Petitioner, and ___________________________________, Respondent. ) ) ) ) ) ) ) )

Case No. ______________________ PETITIONER'S CERTIFICATE OF MAILING TO THE DIVISION OF CHILD SUPPORT

I certify that on __________________, 20______, I mailed a true copy of the Petition for Custody, Parenting Time and Child Support in the above case to the local branch office of the Department of Justice, Division of Child Support: Albany Office 118 SE 2nd Ave Suite B Albany, OR 97321. 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.
DATED this _____ day of _______________________, 20______. Submitted by: ________________________________________ Petitioner, Signature ________________________________________ Print name ________________________________________ Address or Contact Address ________________________________________ City, State, Zip Code ________________________________________ Telephone or Contact Telephone
Page 1 of 1, PETITIONER'S CERTIFICATE OF MAILING TO THE DIVISION OF CHILD SUPPORT
Linn Co unty Fo rm U nma rried Pa ren ts-3 A: Form 6 Certificate of Mailing to SED.wpd (3/22/02)