Free Affidavit of Noncompliance - Oregon

IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE THIRD JUDICIAL DISTRICT ________________________________ Plaintiff, vs. ) ) ) ) ) ) )

FED DECLARATION OF NONCOMPLIANCE Case No. _____________________

________________________________ Defendant.

I, _________________________, hereby swear or affirm that _____________________________
(Print your name)

(Print other party's name)

(Choose one) 9signed a Mediation Agreement 9 agreed to a Stipulated Order in front of the Judge with me on ____________________, which contained the following terms (write out or attach
(Date of Agreement)

copy): ________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ___________________________ has not complied with the agreement by failing to do the
(Print other party's name)

following:_____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ I did not keep the other party from following the agreement. I hereby declare that the above statement is true to the best of my knowledge and belief, and that I understand it is made for use as evidence in court and is subject to penalty for perjury. DATED: ______________________, 20______ ____________________________________
(Sign your name)

FED DECLARATION OF NONCOMPLIANCE - PAGE 1 OF 1

FC (1/1/08)