Free Form 2 Affidavit Responding Motion to Modify - Oregon

Form 2
IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF LINN

IN THE MATTER OF THE MARRIAGE OF SEPARATION OF CUSTODY OF

_________________________________________, Petitioner, and _________________________________________, Respondent.

) ) ) ) ) ) ) ) ) ) ) )

Case No. ______________________ PETITIONER'S RESPONDENT'S AFFIDAVIT RESPONDING TO MOTION TO MODIFY JUDGMENT RE: CUSTODY PARENTING TIME CHILD SUPPORT [ORS 107.174]

STATE OF ______________________ County of _______________________

) ) ss. )

I, Petitioner Respondent, being first duly sworn, say that the following is true: I make this affidavit to respond to the motion to modify that has been filed. 1.

I disagree with the following request(s) made by the other party to:
a. Change custody of the minor child/ren because:________________________________________________

_________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ b. Change the current court-ordered parenting time (visitation) because:_______________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ c. Terminate Petitioner's Respondent's child support obligation due to the requested change in custody because:__________________________________________________________________________________________ _________________________________________________________________________________________________

Page 1 of 4, AFFIDAVIT RESPONDING MOTION TO MODIFY
Linn County Form Modification-4B: Form 2 Affidavit Responding Motion to Modify.wpd (3/22/02)

d. Require Petitioner Respondent to pay child support in the amount of $__________________________ per month beginning _____________, 20____.

e. This amount

is is not in accordance with the child support guidelines because_____________________

_________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ f. . Require Petitioner Respondent to obtain and maintain life insurance for the benefit of the parties' child/ren throughout the period of the support obligation because: ____________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ g. .Require Petitioner Respondent to name the child/ren as beneficiaries of any health, accident, dental, orthodontic, and optical insurance plan available through that parent's employment, group, or union, and require Petitioner Respondent to pay ______% of the uninsured costs incurred by the child/ren including costs for prescriptions because:_______________________________________________________________________________ _________________________________________________________________________________________________ h. That court costs and service fees be paid by Petitioner Respondent Other Each party responsible for paying his or her own court costs and services fees because:______________________________________________ _________________________________________________________________________________________________

i. Other: ___________________________________________________________________________________ because: ________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________

Page 2 of 4, AFFIDAVIT RESPONDING MOTION TO MODIFY
Linn County Form Modification-4B: Form 2 Affidavit Responding Motion to Modify.wpd (3/22/02)

2.

Information Required by the Uniform Child Custody Jurisdiction and Enforcement Act. List the places where the minor child/ren of the parties have lived in the last five years and the names of the

people they lived with at that time. Dates County, State Parent(s)/Caretaker Current Address or Contact Address of Parent/Caretaker Which Children

Additional page attached; see section labeled "UCCJEA Information Continued".
I have have not participated in any litigation concerning the custody, visitation, parenting time or placement of the child/ren in this or any other state. I have participated in the following litigation: Name of Court State Case Number Date Result

I do not know of any other domestic violence, custody, visitation, parenting time or placement proceeding involving the child/ren, or of any other court case which could affect this case, pending in this or any other state except for:_______________________________________________________________________________________________
(identify court, case number and kind of proceeding)

I do not know any person other than petitioner who has physical custody of the child/ren or who claims to have custody, visitation or parenting time rights except for: ____________________________________________________ __________________________________________________________________________________________________
(list name and address)

Page 3 of 4, AFFIDAVIT RESPONDING MOTION TO MODIFY
Linn County Form Modification-4B: Form 2 Affidavit Responding Motion to Modify.wpd (3/22/02)

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.
__________________________________________________________________________________________________ Petitioner Respondent, 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: _______________

I certify that this is a true copy. ____________________________________

. Petitioner . Respondent, Signature

Page 4 of 4, AFFIDAVIT RESPONDING MOTION TO MODIFY
Linn County Form Modification-4B: Form 2 Affidavit Responding Motion to Modify.wpd (3/22/02)