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Petition For Summary Dissolution Of Marriage Domestic Relations Form. This is a Oregon form and can be use in Lincoln Local County.
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Tags: Petition For Summary Dissolution Of Marriage Domestic Relations, Oregon Local County, Lincoln
IN THE CIRCUIT COURT OF THE STATE OF OREGON
FOR THE COUNTY OF
In the Matter of
the Marriage of:
,
Petitioner,
and
,
Respondent.
and
,
Child who is at least 18 and under 21 years
of age, unmarried and unemancipated.
(ORS 107.108)
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Case No.
PETITION FOR DISSOLUTION OF MARRIAGE/
DOMESTIC PARTNERSHIP
DOMESTIC RELATIONS CASE SUBJECT
TO FEE UNDER ORS 21.111
CLAIM SUBJECT
NOT SUBJECT TO
MANDATORY ARBITRATION
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:
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.
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 or Respondent last resided.
4.
The Petitioner
six months.
5.
By filing this petition, I acknowledge that I am bound by the terms of the statutory restraining order
prohibiting either party from disposing of 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.
Respondent is an Oregon resident and has continuously resided in Oregon for the past
PETITION FOR DISSOLUTION OF MARRIAGE/DOMESTIC PARTNERSHIP - PAGE 1 OF 10
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6.
Children Born to Both Parties.
Name
Date of Birth
Social Security
No.
Do not list here. List
the information on
the UTCR 2.130
Confidential Information Form (CIF).
Do not list here. List
the information on the
UTCR 2.130 Confidential Information
Form (CIF).
Do not list here. List
the information on
the UTCR 2.130
Confidential Information Form (CIF).
Do not list here. List
the information on the
UTCR 2.130 Confidential Information
Form (CIF).
Do not list here. List
the information on
the UTCR 2.130
Confidential Information Form (CIF).
Do not list here. List
the information on the
UTCR 2.130 Confidential Information
Form (CIF).
Address
Additional page attached; labeled “Paragraph 6 continued.”
Petitioner Respondent is pregnant.
The expected date of the child’s birth is
Neither party is now pregnant.
Petitioner
Respondent
is
.
is not the parent of this child.
7.
Child/ren Born During Marriage/Domestic Partnership.
List any child/ren born during the marriage/domestic partnership that spouse/domestic partner is not the
parent of, and that were not conceived when husband and wife/domestic partners were living together:
(Name(s) and Years(s) of birth)
8.
UCCJEA Information.
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 has/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 8 continued.”
///
///
///
///
PETITION FOR DISSOLUTION OF MARRIAGE/DOMESTIC PARTNERSHIP - PAGE 2 OF 10
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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:
Name of Court
State
Case No.
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)
I do not know any person other than my spouse/domestic partner who has physical custody of the
child/ren or who claims to have custody, visitation or parenting time rights
except for:
(List name and address)
9.
Parenting Plan (Custody and Parenting Time).
Custody of the child/ren should be awarded as follows:
Petitioner should be awarded sole custody of the following child/ren (list names):
Respondent should be awarded sole custody of the following child/ren (list names):
The parties have agreed to joint custody of the following child/ren (list names):
Petitioner
Respondent should have parenting time with the child/ren
attached Parenting Plan, labeled Exhibit
, or Other:
as set forth in the
Petitioner
Respondent should not be granted parenting time because this would endanger the
health and safety of the child/ren. State supporting facts:
Parenting time should be supervised by
Any cost of the supervision shall be paid by
Petitioner
Respondent
Other:
Petitioner and Respondent should each provide contact addresses and contact telephone numbers to
the other and notify each other of any emergency circumstances or substantial changes in the child/ren’s health.
Petitioner should be allowed to move more than 60 miles further distant from the other parent
without advance notice because good cause exists.
///
///
///
PETITION FOR DISSOLUTION OF MARRIAGE/DOMESTIC PARTNERSHIP - PAGE 3 OF 10
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10. Child Support, including Health Care Coverage and Cash Medical Support.
A. Other Pending Child Support Cases. (Check one.)
No other agency or court child support proceeding is currently pending (include any child
support matter being heard as part of a dissolution, separation, annulment, paternity, support or
modification case).
There is/are other child support proceeding(s) currently pending in either an agency or court
case as set forth in the CERTIFICATE RE: PENDING CHILD SUPPORT PROCEEDING
and/or EXISTING CHILD SUPPORT ORDER attached to this petition.
B. Other Child Support Orders. (Check one.)
No other child support orders, from an agency or court, are currently in effect in the
State of Oregon or any other state.
There is/are other child support orders from an agency or court as set forth in the
CERTIFICATE RE: PENDING CHILD SUPPORT PROCEEDING and/or EXISTING CHILD
SUPPORT ORDERS/JUDGMENTS attached to this petition.
C. Currently Effective Child Support Order. (Check any that apply.)
The following child support order/s is/are currently in effect:
(List state, court/agency, case number, date of order)
This order should remain in place and includes provisions for medical support for the
child/ren, or
This order is from an Oregon court or agency, one of the parents or the child/ren receiving
support still resides in Oregon and the order should be changed because circumstances have
changed since the last order was entered.
State facts showing how circumstances have changed:
D. Cash Child Support.
Complete either (1) or (2) below:
(1)
Cash child support should be paid by Petitioner to Respondent (or)
Respondent to
Petitioner beginning on the first or
day of the month following
the date of the judgment and continuing on the same day of each month thereafter. The total
payment per month should be $
, which is the presumed correct amount as
reflected on the child support guideline worksheets attached to this petition.
Determined under the Oregon child support guidelines prior to judgment.
The amount of support presumed correct under the guidelines would be unjust or
inappropriate because
.
(The reasons must also be shown on the support worksheets you attach to this petition.)
(2)
No cash child support is ordered in this judgment because:
An order,
$
including medical support, for child support in the monthly amount of
has already been ordered in Circuit Court case number
in
County, Oregon.
PETITION FOR DISSOLUTION OF MARRIAGE/DOMESTIC PARTNERSHIP - PAGE 4 OF 10
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Other reason:
E. Medical Support. Complete section (1) or (2) below. Also complete section (3) or (4) below.
Complete (1) or (2):
(1) Private Health Care Coverage is Appropriate and Available.
Petitioner Respondent Both Petitioner and Respondent has/have appropriate
private health care coverage available for the parties’ child/ren through an employer, spouse,
domestic partner or other source.
Petitioner
Respondent Both Petitioner and
Respondent should be required to obtain and maintain this coverage throughout the period
of the support obligation for the benefit of the parties’ child/ren.
Health care coverage has already been ordered in another case as described in paragraph
D(2) above.
(2) No Private Health Care Coverage is Appropriate or Available.
Neither Petitioner nor Respondent has appropriate private health care coverage available
for the parties’ child/ren.
Petitioner Respondent Both Petitioner and Respondent
should be ordered to provide appropriate private health care coverage for the child/ren when
such coverage becomes available to them at a reasonable cost through any source.
The custodial parent should enroll the child/ren in public health care coverage.
The child/ren are currently enrolled in public health care coverage.
Complete (3) or (4):
(3) Cash Medical Support Should Be Ordered.
Because the parent receiving cash child support is ordered to maintain private health
care coverage and the parent paying cash child support is not, in addition to cash child
support
Petitioner Respondent should pay $
for cash medical support
to
Petitioner Respondent, or
Neither parent has appropriate private health care coverage available for the parties’
child/ren.
Petitioner should pay cash medical support in the monthly amount of
$
to Respondent.
Respondent should pay cash medical support in the
monthly amount of $
to Petitioner.
(4) Cash Medical Support Should Not Be Ordered.
Cash medical support should not be ordered for the following reasons:
The parent paying cash child support is also providing health care coverage.
Petitioner’s
Respondent’s gross monthly income is at or below the Oregon
minimum wage for full-time employment or is eligible for Oregon public assistance.
///
I am requesting that the parties share the cost of the child/ren’s uninsured medical
expenses (see paragraph G. below).
Other reason:
PETITION FOR DISSOLUTION OF MARRIAGE/DOMESTIC PARTNERSHIP - PAGE 5 OF 10
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All payments of child support should be made to the Department of Justice, Child Support
Accounting Unit, P.O. Box 14506, Salem, Oregon, 97309
by electronic payment withdrawal
(EPW) or electronic funds transfer (EFT). In addition, support for a child attending school (between
the ages of 18 and 21) as defined by Oregon law shall be distributed by the Department of Justice
directly to the child subject to ORS 107.108.
(Applies only if support enforcement services are not being provided.)
Petitioner requests an exception to the income withholding requirement of ORS 25.378 allowing
payment to be made directly to Petitioner’s
Respondent’s checking or savings account. A receipt
of deposit should be kept by the parent paying support as proof of payment. The parent receiving
support should provide the paying parent with current deposit slips and/or bank name, account name,
and account number.
F.
RESPONSIBILITY FOR UNINSURED HEALTH EXPENSES.
Petitioner should pay
%
and Respondent should pay
% of the
reasonably incurred uninsured HEALTH, ACCIDENT, DENTAL, ORTHODONTIC, AND
OPTICAL HEALTH costs incurred by the child/ren.
This obligation is in addition to any
cash medical support ordered.
G.
LENGTH OF CHILD SUPPORT.
Unless the child becomes self-supporting, emancipated, or married:
The support ordered in paragraphs D., E., and F. above for each child shall continue until the
child reaches eighteen (18) years of age.
The support ordered in paragraphs D., E., and F. above for each child shall continue until the
child reaches age 21 if the the child qualifies for support as a child attending school as
defined by Oregon law.
H.
TAX DEPENDENTS. (Check one.)
Petitioner Respondent shall be entitled to claim the following child(ren) as dependent(s)
for tax purposes beginning the year this judgment is entered (list names):
OR
Other (specify):
11. Life Insurance Coverage for Child/ren.
Petitioner Respondent should obtain and maintain life insurance for the benefit of the parties’
child/ren throughout the period of the support obligation. The coverage should be in the amount of
$
12. Additional Provisions.
Additional page attached; labeled “Paragraph 12 Continued - Additional Provisions.”
13. Spousal Support and Life Insurance.
No spousal support or spousal life insurance claims are made in this case.
Additional page attached, see Page 5a labeled “Spousal Support and Life Insurance.”
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14. Real Property.
Neither Petitioner nor Respondent has any interest in any real property located in this or any other
state.
Petitioner
Respondent has/have an interest in real property located at the address of:
This property should be distributed:
equitably, or
as follows:
Additional page labeled “Paragraph 14 - Real Property Distribution continued” attached.
The legal description of the real property is attached as Exhibit
and incorporated in this
petition.
Distribution of this property is not within the jurisdiction of this court.
15. Personal Property (including 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 possession
of the other.
The Petitioner should be awarded:
an equitable distribution of the parties’ personal property, or
the following personal property:
Additional page labeled “Paragraph 15 - Petitioner’s Personal Property Distribution continued” attached.
The Petitioner should be awarded his/her retirement benefits, pension plan, profit-sharing plan,
deferred-compensation plan, and /or stock option plan held by Petitioner’s employer, free of any interest in the
Respondent.
The Respondent should be awarded: an equitable distribution of the parties’ personal property, or
the following personal property:
Additional page labeled “Paragraph 15 Respondent’s Personal Property Distribution continued” attached.
The Respondent should be awarded his/her retirement benefits, pension plan, profit-sharing plan,
deferred-compensation plan, and/or stock option plan held by Respondent’s employer, free of any interest in the
Petitioner.
16. Distribution of Debts.
There are no outstanding debts of this marriage/domestic partnership.
The debts should be paid as follows:
Name of Creditor
(who debt is owed to)
What debt is for
Amount
Who should pay
(Petitioner or
Respondent)
Additional page attached, labeled, “Paragraph 16 continued”.
PETITION FOR DISSOLUTION OF MARRIAGE/DOMESTIC PARTNERSHIP - PAGE 7 OF 10
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Each spouse/domestic partner should be responsible for the payment of all debts incurred by him/her
individually since the date of their separation; all debts which are distributed to him/her by the court; and all
debts which are secured by property distributed to that spouse/domestic partner. Also, if any creditor asks the
spouse/domestic partner not responsible for a debt to pay all or a portion of it, and s/he does so, the
spouse/domestic partner responsible for that debt should reimburse the other spouse/domestic partner for any
monies s/he paid to the creditor after the date of the judgment.
17. 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 by the court. The
judgment should operate to convey title to the spouse/domestic partner awarded the property if the other
spouse/domestic partner fails to comply with this requirement.
18. Former Name.
Petitioner’s
Respondent’s former name of
should be restored.
19. 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 or child/ren
for the
following reasons:
Otherwise: (Fill out the information in the table below)
Petitioner
Respondent
Full Name
Do not list here. List the information on
the UTCR 2.130 Confidential Information
Form (CIF).
Do not list here. List the information on the
UTCR 2.130 Confidential Information Form
(CIF).
Social Security Number
Do not list here. List the information on
the UTCR 2.130 Confidential Information
Form (CIF).
Do not list here. List the information on the
UTCR 2.130 Confidential Information Form
(CIF).
Driver License Number
Do not list here. List the information on
the UTCR 2.130 Confidential Information
Form (CIF).
Do not list here. List the information on the
UTCR 2.130 Confidential Information Form
(CIF).
Employer Name
Do not list here. List the information on
the UTCR 2.130 Confidential Information
Form (CIF).
Do not list here. List the information on the
UTCR 2.130 Confidential Information Form
(CIF).
Employer Address
Do not list here. List the information on
the UTCR 2.130 Confidential Information
Form (CIF).
Do not list here. List the information on the
UTCR 2.130 Confidential Information Form
(CIF).
Former Legal Name(s)
Age
Address or Contact
Address
Telephone Number
PETITION FOR DISSOLUTION OF MARRIAGE/DOMESTIC PARTNERSHIP - PAGE 8 OF 10
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Petitioner
Employer Telephone
Do not list here. List the information on
the UTCR 2.130 Confidential Information
Form (CIF).
Respondent
Do not list here. List the information on the
UTCR 2.130 Confidential Information Form
(CIF).
Additional page labeled “Paragraph 19 continued” attached.
20. Court Costs and Fees.
A. Deferred Costs and Fees
Any court costs and service fees (if service completed by the Sheriff) that are deferred (required to be
paid at a later date) by the court should be paid by: Petitioner Respondent Both parties equally
Other:
B. Costs and Fees Paid by the Parties
Each party should be responsible for paying his or her own court costs and service fees for this case.
To be paid by both parties equally
Petitioner Respondent should reimburse the other party for his or her court costs and service fees
for this case.
Other:
Judgment should be entered according to the cost and fee allocation listed above.
21. 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
form.
WHEREFORE, Petitioner requests a Judgment granting the relief asked for above, and other equitable
relief that the Court thinks is just.
STATE OF
County of
)
) ss.
)
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.
Petitioner (signature)
Print Name
Address or Contact Address
City, State, Zip Code
Telephone or Contact Telephone
PETITION FOR DISSOLUTION OF MARRIAGE/DOMESTIC PARTNERSHIP - PAGE 9 OF 10
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SIGNED AND SWORN to before me this
day of
, 20
By:
Notary Public for
My Commission Expires:
/Court Clerk
I certify that this is a true copy:
Petitioner (signature)
PETITION FOR DISSOLUTION OF MARRIAGE/DOMESTIC PARTNERSHIP - PAGE 10 OF 10
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