IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF LINN Case No. ___________________ Petitioner and Respondent CERTIFICATE OF MAILING OR DELIVERY TO DIVISION OF CHILD SUPPORT I certify that on (date) ,I hand-delivered or mailed by first-class mail a true copy of the Petition in the above domestic relations case to the local branch office of the Department of Justice, Division of Child Support at 1245 Clay Street SE, Albany OR 97322 or other:(list address): Certificate of Document Preparation. Check all that apply: I chose this form for myself and completed it without paid help. A legal help organization helped me choose or complete this form, but I did not pay money to anyone. I paid (or will pay) for help choosing, completing, or reviewing this form. TurboCourt selected and completed this form and I did not pay anyone to review the completed form. I hereby declare that the above statements are true to the best of my knowledge and belief. I understand they are made for use as evidence in court and I am subject to penalty for perjury. Date Signature Name (printed) Contact Address City / State / ZIP Contact Phone { Petitioner Respondent} Certificate of Mailing or Delivery to Division of Child Support Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com