1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 IN THE CIRCUIT COURT OF THE STATE OF OREGON COUNTY OF DESCHUTES Plaintiff(s), vs. Defendant(s). ) ) ) ) ) ) ) ) ) ) Case No. PLAINTIFF(S)222 AFFIDAVIT OR DECLARATION OF NON -COMPLIANCE (FED) I hereby swear or affirm that on , the Plaintiff(s) and Defendant(s) signed a Mediation Agreement which was filed with the Court and that Defendant(s) has not complied with the Mediation Agreement by failing to do the following:. I further swear or affirm that a copy of this Affidavit or Declaration of Non-Compliance will be attached to a Notice of Restitution and served on the other party pursuant to ORS 105.158 by first class mail AND by personal delivery to the Defendant(s) or, if the Defendant(s) is not available for personal service, by attaching a copy of the notice in a secure manner to the main entrance to that portion of the premises of which the Defendant(s) has possession. Page 1 226 PLAINTIFF(S)222 AFFIDAVIT/DECLARATION OF NON-COMPLIANCE (FED) Rev 08/13 American LegalNet, Inc. www.FormsWorkFlow.com 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 I am requesting a general judgment in accordance with the proposed general judgment filed herewith. DATED this day of , 20. Signature Print name Address Phone SUBSCRIBED AND SWORN TO this day of , 20. TRIAL COURT ADMINISTRATOR By NOTICE TO DEFENDANT(S) Information on how to request a hearing If you believe that you have complied with the mediated Agreement and that a general judgment should not be entered against you, then you must do ALL of the following immediately: 1. Fill out the attached Defendant(s)222 Request for Hearing to Contest the Affidavit of Non-Compliance. 2. Take it to the information counter at the Justice Building, 1100 NW Bond Street, Bend, Oregon, and give it to the court clerk at the counter. 3. Mail a copy of your Defendant(s)222 Request for Hearing to the Plaintiff. If you do not file a Defendant(s)222 Request for Hearing to Contest the Affidavit of Non-Compliance with the court clerk within four (4) days after you were served with a notice of restitution or within four (4) days after you were served by mail with an affidavit of non-compliance, then the General Judgment attached hereto will be enforceable. If the four-day period ends on a weekend or holiday, then the period will be extended to the end of the next day that the courthouse is open. Page 2 226 PLAINTIFF(S)222 AFFIDAVIT/DECLARATION OF NON-COMPLIANCE (FED) Rev 08/13 American LegalNet, Inc. www.FormsWorkFlow.com