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Affidavit In Support Of Motion For Waiver Or Deferral Of Fees And Costs (Notary Public) Form. This is a Oregon form and can be use in Lincoln Local County.
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Tags: Affidavit In Support Of Motion For Waiver Or Deferral Of Fees And Costs (Notary Public), Oregon Local County, Lincoln
IN THE CIRCUIT COURT OF THE STATE OF OREGON
FOR LINCOLN COUNTY
In the Matter of the Marriage of
)
)
_____________________________________ )
9 Co-Pe titioner 9 Petitioner
)
and
)
)
______________________________________ )
9 Co-Petitioner 9 Respondent )
STATE OF OREGON
County of Lin coln
)
)
Case No. ____________________
AFFIDAVIT IN SUPPORT OF MOTION
FOR WAIVER OR DEFERRAL OF
FEES AND COSTS
ss.
I, __ ____________________________________ being first duly sworn, depose and say:
I am a party in this case. I have insufficient income and resources to pay the filing fees, service fees and
cou rt cos ts neces sary to proc eed in this su it.
My m onthly household income which supports _______ persons is as follows:
W ages . . . . . . . . . . . . $_____________
Child Support / Alimony . . . . . . . $____________
W elfare Grant . . . . . . . $_____________
Veteran s Be nefits . . . . . . . . . . . $____________
Unem ployment . . . . . . $_____________
Other
Social Se curity . . . . . . $_____________
Other . . . . . . . . . . . . . . . . . . . . . $____________
. . . . . . . . . . . . . . . . . . . . $____________
TO TAL . . . . . . . . . . . $____________
My monthly expenses are as follows:
Rent/Mortgage . . . . . . $_____________
Transportation . . . . . . . . . . . . . . $____________
Utilities . . . . . . . . . . . . $_____________
Clothing . . . . . . . . . . . . . . . . . . . $____________
Food . . . . . . . . . . . . . . $_____________
De bt Pa ym ents . . . . . . . . . . . . . $____________
Other . . . . . . . . . . . . . $_____________
Other . . . . . . . . . . . . . . . . . . . . . $____________
TO TAL . . . . . . . . . . . $____________
My asse ts, other than househo ld goods and furnishings consist of:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
My present debts are as follows:
________________________________ $_______
________________________________ $_______
________________________________ $_______
________________________________ $_______
________________________________ $_______
________________________________ $_______
________________________________ $_______
TOT AL DEBTS
$_______
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Other facts relevant to this affidavit: ________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
I understand that the cou rt rules allow a sum m ons and certa in othe r doc um ents to be served (d elivered to
the other party) b y any com petent person, other than m yself, who is 18 years of age or older and who is
also a res ident of the state where service is m ade. I understa nd that an Oregon sheriff will norm ally
charge a fee for doing this for me. I am requesting that the court waive the normal service fee of any
Oregon sheriff. The reason I need the Sheriff to serve the docum ents inste ad of h aving them serve d by a
friend, acquaintance or other third person is:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
I understan d that th e fe es and costs w hich have not been waived which rem ain unpaid at the tim e
jud gm ent is ente red shall becom e a jud gm ent in favor of the Sta te of O regon, and that failure or d efault in
paym ent of said judgm ent by a date certa in given by the court o r on the ha ppe ning of on e or m ore e vents
sub jects m e to being cha rged with be ing in conte m pt of c ourt.
Dated ________________________________
_______________________________________
Signature
SUBSCR IBED AND SW ORN to before me this ____ day of __________________, 20 _____.
______________________________________
Notary Public / Court Clerk
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