DOCUMENT 3A - 2 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR JACKSON COUNTY In the Matter of: □ the Marriage of □ the Domestic Partnership of ) ) ) ) ______________________________ ) Petitioner, ) ) vs. ) ) ______________________________ ) Respondent. ) _________________________________ ) 1. CASE NO.__________________________ PETITION FOR DISSOLUTION OF □ MARRIAGE □ DOMESTIC PARTNERSHIP DOMESTIC RELATIONS CASE SUBJECT TO FEE UNDER ORS 21.111 Date of marriage/domestic partnership: _____________________________________ Place of marriage/domestic partnership: _____________________________________ (County, State) 2. Irreconcilable differences between the parties have caused the irremediable breakdown of their marriage/domestic partnership. 3. Certificate of Residency A. Marriage Only: I certify that one or both of the parties to this case currently live in the county in which this petition is being filed. The □ Petitioner □ Respondent is an Oregon resident and has continuously resided in Oregon for the past six months. B. Domestic Partnership Only: I certify that one or both of the parties to this case currently live in the county in which this petition is being filed or, □ neither party currently resides in Oregon but I certify that this petition is filed in the county where □ Petitioner □ Respondent last resided. 4. By filing this petition, I acknowledge that I am bound by the terms of the statutory restraining order prohibiting either party from disposing of the marital/domestic partnership assets, a copy of which I have received and read, and understand that this restraining order is effective immediately upon service of this petition and the summons upon the Respondent. 5. Spousal Support; Life Insurance; and Medical Insurance A. Spousal Support □ No spousal support; medical insurance; and/or life insurance claims are made in this case. OR □ Spousal support; medical insurance; and/or life insurance claims are made in this case. PETITION FOR DISSOLUTION OF MARRIAGE/DOMESTIC PARTNERSHIP - PAGE 1 OF 5 American LegalNet, Inc. www.FormsWorkFlow.com (11/26/08) OJIN CODE: PT_____ DOCUMENT 3A - 2 Support should by paid □ Petitioner to Respondent or □ Respondent to Petitioner □ In the amount of $_____ per month for the following period of time:__________ OR □ In the amount of $__________ by __________ (date) OR □ In an amount to be determined at trial or before entry of judgment. List reason(s) why spousal support should be paid: _____________________________ ______________________________________________________________________ ______________________________________________________________________ The spousal support shall be called (check all that apply) □ Transitional □ Compensatory □ Spousal Maintenance based on consideration of the following factor(s): ______________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Payments should be made on the first of each month beginning the month following the date the judgment is signed by a judge. All payments of spousal support should be made. (check one) □ Directly into the □ Petitioner’s □ Respondent’s checking or saving account. A receipt of deposit should be kept by the paying party as proof of payment. The party receiving support should provide the paying party with current deposit slips and/or bank name; account name; and account number. B. Life Insurance □ Petitioner □ Respondent should buy and maintain life insurance throughout the period of the spousal support obligation in the amount of $___________________ for the benefit of the □ Petitioner □ Respondent. C. Medical Insurance □ Petitioner □ Respondent should buy and maintain health, accident, dental, and optical insurance for the benefit of the □ Petitioner □ Respondent if insurance is available through his/her employment; group; or union. The insurance payments should be additional spousal support and should be treated as such for tax purposes. If coverage for a former spouse is available through the purchasing party’s employment; group; or union and this membership is later terminated the purchasing party should notify the other party of this before or immediately upon termination. 6. Real Property □ Neither Petitioner nor Respondent has any interest in any real property located in this or any other state. OR □ Petitioner □ Respondent has/have an interest in real property located at the address of:___________________________________________________________________ □ The legal description of the real property is attached as Exhibit _____ and incorporated in this petition. This property should be distributed □ equitably, or □ as follows: ___________________ ______________________________________________________________________ ______________________________________________________________ □ The distribution of this property is not within the jurisdiction of this court. PETITION FOR DISSOLUTION OF MARRIAGE/DOMESTIC PARTNERSHIP - PAGE 2 OF 5 American LegalNet, Inc. www.FormsWorkFlow.com (11/26/08) OJIN CODE: PT_____ DOCUMENT 3A - 2 7. Personal Property (Including All Motor Vehicles) □ The Petitioner and Respondent have divided between them all personal effects; household goods; and other personal property they own separately or together; and neither should claim those items now in the possession of the other. □ The Petitioner should be awarded □ an equitable distribution of the parties’ personal property, □ the following personal property: __________________________________ ______________________________________________________________________ □ The Respondent should be awarded □ an equitable distribution of the parties’ personal property, □ the following personal property: __________________________________ ______________________________________________________________________ 8. Retirement Benefit(s); Pension Plan(s); Deferred Compensation Plan(s); Profit Sharing Plan(s); Stock Option Plan(s) Held by Employer(s) □ The Petitioner should be awarded his/hers free of any interest in the Respondent. □ The Respondent should be awarded his/hers free of any interest in the Petitioner. 9. Distribution of Debts □ There are no outstanding debts of the marriage/domestic partnership. OR □ There are outstanding debts of the marriage/domestic partnership. They should be paid as follows. Name of Creditor What Debt is For Amount Who Should Pay (Who Debt is Owed to) Each party should be responsible for the payment of all debts incurred by him/her individually since the date of separation; all debts distributed to him/her by judgment; and all debts secured by property distributed to him/her. If any creditor asks the party not responsible for a debt to pay all or a portion of that debt, and he/she does so, the party responsible for that debt should reimburse the other party for any monies he/she paid to the credit after the date of the judgment. 10. Transfer Of Debts And Property Within 30 days of the date of judgment each party should execute; acknowledge; and deliver whatever documents are necessary to accomplish the distribution of debts and property ordered in the judgment. The judgment should operate to convey title to the party awarded the property if the other party fails to comply with this requirement. 11. Former Name(s) □ Petitioner’s former name of ______________________________ should be restored. □ Respondent’s former name(s) of __________________________ should be restored. PETITION FOR DISSOLUTION OF MARRIAGE/DOMESTIC PARTNERSHIP - PAGE 3 OF 5 American LegalNet, Inc. www.FormsWorkFlow.com (11/26/08) OJIN CODE: PT_____ DOCUMENT 3A - 2 12. Additional Provisions ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ 13. Information Required By ORS 25.020 And ORS 107.085 □ Disclosure of the following information would unreasonably put to risk the health; safety; or liberty of □ Petitioner □ Respondent for the following reason(s): __________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ □ Otherwise, complete the following Petitioner Respondent Full Name Former Legal Name(s) Age Address/Contact Telephone Driver’s License Employer Name Employer Address Employer Telephone 20. Court Costs And Fees A. Deferred Costs and Fees Any court costs and/or service fees (if service completed by the Jackson County Sheriff) that are deferred by the court should be paid by □ Petitioner □ Respondent □ Both Parties Equally B. Costs and Fees Paid by the Parties □ Each party should be responsible for paying his/her own court costs and/or service fees for this case. □ The parties should be equally responsible for paying the court costs and/or service fees for this case. □ Petitioner □ Respondent should reimburse the other party for his/her court costs and/or service fees for this case. Judgment should be entered according to the cost and fee allocation listed above. PETITION FOR DISSOLUTION OF MARRIAGE/DOMESTIC PARTNERSHIP - PAGE 4 OF 5 American LegalNet, Inc. www.FormsWorkFlow.com (11/26/08) OJIN CODE: PT_____ DOCUMENT 3A - 2 WHEREFORE, the petitioner requests a judgment granting the relief asked for above and Other equitable relief that the court thinks is just. STATE OF OREGON ) ) ss. County of Jackson ) I, ______________________________, being duly sworn, say that I am the petitioner in this matter and that the foregoing petition is true and correct to the best of my knowledge. Dated:_________________________ Signed:_________________________________ Name:__________________________________ (Please Print) Address:________________________________ _________________________________ Phone:__________________________________ Subscribed and Sworn to before me ____________________________________, 200_____. _________________________________________ Clerk of the Court/Notary Public PETITION FOR DISSOLUTION OF MARRIAGE/DOMESTIC PARTNERSHIP - PAGE 5 OF 5 American LegalNet, Inc. www.FormsWorkFlow.com (11/26/08) OJIN CODE: PT_____