Form 5 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF LINN IN THE MATTER OF THE MARRIAGE OF SEPARATION OF CUSTODY PROCEEDING _____________________________ PETITIONER, AND _____________________________ RESPONDENT. ) ) ) ) ) ) ) ) ) ) ) ) Case No. ____________________ CERTIFICATE OF RESIDENCY For purposes of ORS 14.080 and UTCR 8.010 (1), I hereby certify that the in the above entitled proceeding currently resides in Linn County. Petitioner or Co-Petitioner/Respondent __________________________________________ Signature ______Petitioner ______ Co-Petitioner/Respondent ______Attorney for Petitioner/Respondent OSB No. _________________ Submitted by: ________________________________________ Print or Type Name ________________________________________ Contact Address ________________________________________ City State Zip Page 1 of 1, CERTIFICATE OF RESIDENCY Linn County Form 5 Certificate of Residency.wpd (8/09) American LegalNet, Inc. www.FormsWorkFlow.com