Form 2 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF LINN IN THE MATTER OF THE MARRIAGE OF SEPARATION OF CUSTODY OF _________________________________________, Petitioner, and _________________________________________, Respondent. ) ) ) ) ) ) ) ) ) ) ) ) Case No. ______________________ PETITIONER'S RESPONDENT'S AFFIDAVIT RESPONDING TO MOTION TO MODIFY JUDGMENT RE: CUSTODY PARENTING TIME CHILD SUPPORT [ORS 107.174] STATE OF ______________________ County of _______________________ ) ) ss. ) I, Petitioner Respondent, being first duly sworn, say that the following is true: I make this affidavit to respond to the motion to modify that has been filed. 1. I disagree with the following request(s) made by the other party to: a. Change custody of the minor child/ren because:________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ b. Change the current court-ordered parenting time (visitation) because:_______________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ c. Terminate Petitioner's Respondent's child support obligation due to the requested change in custody because:__________________________________________________________________________________________ _________________________________________________________________________________________________ Page 1 of 4, AFFIDAVIT RESPONDING MOTION TO MODIFY Linn County Form 2 Affidavit Responding to Motion to Modify.doc (8/09) American LegalNet, Inc. www.FormsWorkFlow.com d. Require Petitioner Respondent to pay child support in the amount of $__________________________ per month beginning _____________, 20____. e. This amount is is not in accordance with the child support guidelines because_____________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ f. . Require Petitioner Respondent to obtain and maintain life insurance for the benefit of the parties' child/ren throughout the period of the support obligation because: ____________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ g. .Require Petitioner Respondent to name the child/ren as beneficiaries of any health, accident, dental, orthodontic, and optical insurance plan available through that parent's employment, group, or union, and require Petitioner Respondent to pay ______% of the uninsured costs incurred by the child/ren including costs for prescriptions because:_______________________________________________________________________________ _________________________________________________________________________________________________ h. That court costs and service fees be paid by Petitioner Respondent Other Each party responsible for paying his or her own court costs and services fees because:______________________________________________ _________________________________________________________________________________________________ i. Other: ___________________________________________________________________________________ because: ________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ Page 2 of 4, AFFIDAVIT RESPONDING MOTION TO MODIFY Linn County Form 2 Affidavit Responding to Motion to Modify.doc (8/09) American LegalNet, Inc. www.FormsWorkFlow.com 2. Information Required by the Uniform Child Custody Jurisdiction and Enforcement Act. List the places where the minor child/ren of the parties have lived in the last five years and the names of the people they lived with at that time. Dates County, State Parent(s)/Caretaker Contact Address of Parent/Caretaker Which Children Additional page attached; see section labeled "UCCJEA Information Continued". 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 Number 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 kind of proceeding) I do not know any person other than petitioner 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) Page 3 of 4, AFFIDAVIT RESPONDING MOTION TO MODIFY Linn County Form 2 Affidavit Responding to Motion to Modify.doc (8/09) American LegalNet, Inc. www.FormsWorkFlow.com 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 _______