Free Form 4 Respondent's Certificate of Mailing - Oregon

Form 4
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. ______________________ CERTIFICATE OF MAILING

I certify that on ____________________, 20______, I placed a true copy of the Response and (Must list all documents)

. in the above case in the United States mail to ` Petitioner / ` Respondent Attorney's address

` Petitioner's / ` Respondent's home address(ONLY IF NO ATTORNEY):
____________________________________________________________________________________ Address in a sealed envelope with postage paid. 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: City State Zip

` 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:

_____________________________________ Signature of

` Petitioner / ` Respondent

_____________________________________ Print name _____________________________________ Address or Contact Address _____________________________________ City, State, Zip Code Page 1 of 1, RESPONDENT'S CERTIFICATE OF MAILING
Linn County Form Disso-1D: Form 4 Respondent's Certificate of Mailing.wpd (2/27/02)