Free Affidavit in Support of Registration - Oregon

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. STATE OF ________________________ County of _________________________ ) )ss. ) ) ) ) ) ) ) ) ) ) ) )

Case No. ______________________

AFFIDAVIT IN SUPPORT OF REGISTRATION OF AN OUT OF STATE CHILD CUSTODY DETERMINATION

I, petitioner respondent, being furst duly sworn, say the following is true: 1.

The child custody determination that I am requesting the Court to register to the best of my knowledge and
belief has not been modified in any other court [109.787 (b)]. There is not an order from any other court that has changed or modified any provision in this order and this order is currently in effect.

2.

UCCJEA Information. [109.767 (1)]

The child/ren listed above has/have continuously resided in Oregon for the six months preceding the filing of
this case. 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 From/To County, State Parent(s)/Caretaker Current Address/Contact Address of Parent/Caretaker Which Children

Additional Page Attached: see section labeled "paragraph 2 continued." ///

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Page 1 of 2 - AFFIDAVIT IN SUPPORT OF REGISTRATION OF AN OUT OF STATE CHILD CUSTODY DETERMINATION
Linn County Form AFFID AVIT IN S UPP ORT OF RE GIST RAT ION O F AN OUT OF ST ATE CHILD CU STO DY DE TE RM INAT ION ( 11/05)

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: (Please list below) 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 the kind of proceeding)

3.

My name and address or contact address is: ______________________________________________________

________________________________________________________________________________________________ 4. The name(s) and address or contact address(es) of any other person(s) that were awarded custody, parenting time or visitation in the child custody determination I am asking the Court to enforce is/are: _______________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 5. Petitioner Respondent has legal custody of the child(ren) and is seeking an Order of Assistance to recover the following child(ren) ________________________________________________________________________ _________________________________________________________________________________________ I believe the children are located at ____________________________________________________________.
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 document. DATED this _______ day of ____________________, 20_____. _______________________________________________________________________________________________ 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: ______________
Page 2 of 2 - AFFIDAVIT IN SUPPORT OF REGISTRATION OF AN OUT OF STATE CHILD CUSTODY DETERMINATION
Linn County Form AFFID AVIT IN S UPP ORT OF RE GIST RAT ION O F AN OUT OF ST ATE CHILD CU STO DY DE TE RM INAT ION ( 11/05)