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General Judgement Of Custody And Parenting Time Form. This is a Oregon form and can be use in Linn Local County.
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Tags: General Judgement Of Custody And Parenting Time, Oregon Local County, Linn
IN THE CIRCUIT COURT OF THE STATE OF OREGON
FOR THE COUNTY OF LINN
In the Matter of:
)
)
)
)
and
)
)
________________________________,
)
Respondent,
)
and
)
)
□ ________________________________, )
Child who is at least 18 and under 21 years )
of age, unmarried and unemancipated.
)
(ORS 107.108)
)
________________________________,
Petitioner,
Case No. ____________________
GENERAL JUDGMENT OF CUSTODY
AND PARENTING TIME
□ and SUPPORT
□ ORDER RE: JURISDICTION
AND MONEY AWARD
1. This matter came before the Court:
□ On the motion and affidavit of Petitioner, the default of Respondent having been found.
□ On the motion of Petitioner, the default of Respondent having been found, and Respondent being
represented by a guardian ad litem or another person described in Rule 27.
□ On the motion and affidavit of Petitioner, Respondent having filed a Waiver of Further Appearance.
□ On the stipulations of the parties, as shown by the signatures below.
□ At a hearing held
, at which the following persons were present:
(Date)
□ Petitioner
□ Petitioner’s attorney
□ Respondent
□ Respondent’s attorney
2. Findings. The Court considered the: □ Affidavit □ Affidavit and stipulations □ Evidence presented and
found that:
A. Children of the Parties. List names, dates of births, and ages.
Name
Date of Birth
Age
GENERAL JUDGMENT OF CUSTODY AND PARENTING TIME □ and SUPPORT □ ORDER RE:
JURISDICTION AND MONEY AWARD - PAGE 1 of 10
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B. Child Custody Jurisdiction. (Check appropriate boxes)
□ Oregon has jurisdiction under the Uniform Child Custody Jurisdiction and Enforcement Act
to hear the □ custody □ parenting time issue because:
□ Oregon is the child/ren’s home state (i.e., the child/ren have lived here continuously
for the six month period immediately before this case was filed).
□ Other reason:
□ Oregon does not have jurisdiction under the Uniform Child Custody Jurisdiction Act
because:
C. Child/ren Who Are At Least 18 and Under 21 Years of Age.
(child/ren’s name/s) is/are at least 18
and under 21 years of age, is unmarried and unemancipated and has:
□ Waived further appearance in these proceedings.
□ Signed and stipulated to the terms of judgment evidenced by the signature below.
□ Fully participated in the proceedings and the judgment effectively binds him/her to the terms.
NOW, THEREFORE, IT IS HEREBY ORDERED:
The terms of this judgment are effective immediately.
1. Parenting Plan
Custody of the child/ren is awarded as follows:
□ Petitioner is awarded sole custody of the following child/ren (list names):
□ Respondent is 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 □ as set forth in the
attached Parenting Plan, labeled Exhibit ____, or □ Other:
□ Petitioner □ Respondent shall not have parenting time because this would endanger the health and
safety of the child/ren.
□ Parenting time shall be supervised by
□ Any cost of the
supervision shall be paid by □ Petitioner □ Respondent □ Other:
□ Petitioner and Respondent shall 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.
GENERAL JUDGMENT OF CUSTODY AND PARENTING TIME □ and SUPPORT □ ORDER RE:
JURISDICTION AND MONEY AWARD - PAGE 2 of 10
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□ Neither parent shall move to a residence more than 60 miles further distant from the other parent
without giving the other parent reasonable notice of the change of residence and providing a copy of
such notice to the court, or □ the requirement of ORS 107.159 regarding notice of move is suspended
for good cause found.
2. Child Support, including Cash Medical Support.
Check either A or B below:
(A)
□ No child support shall be ordered at this time because:
□ Child support in the amount of $
monthly has already been ordered and docketed
with the
County Circuit Court, case number
□ Other reason:
(B)
□ Child support shall be paid by □ Petitioner to Respondent (or) □ Respondent to Petitioner
beginning on the □ first or □
of the month following the date of the
judgment and continuing on the same day of each month thereafter. The support for each child
shall continue until the child reaches eighteen (18) years of age, or is otherwise emancipated,
unless the child is a student attending school as defined by Oregon law, in which case support
shall continue until the child reaches 21 years of age. Until further order, the total payment per
month shall be $
for
children.
Cash Medical Support: Of the amount ordered above in paragraph 2B, $
is cash medical. The cash medical support amount ordered is in addition to any percentage of
uninsured costs either of the parties is ordered to pay below in paragraph 4(C).
(Check if applicable)
□ Neither Petitioner or Respondent have appropriate private or public health care coverage
available for the parties’ child/ren (see 4(3) below). Cash medical support □ is □ is not ordered
and the court’s findings in this regard are as follows:
□ Petitioner □ Respondent and/or □ Child/ren are eligible for public medical assistance and
cannot be ordered to pay cash medical support.
(Check if applicable)
□ This order shall modify and replace the following existing order:
(list court/agency and case no.)
because the court finds that the existing order was issued by an Oregon court or agency, one of
the parents or the child/ren receiving support under the order still resides in Oregon and
circumstances have changed since this order was entered.
3. Child Support Calculation (check any that apply).
□ The child support worksheet on which the support amount was calculated is labeled “Exhibit "
and attached to and incorporated in this judgment.
□ The support award does not deviate from the amount presumed correct under the guidelines set out
in the Oregon Administrative Rules.
GENERAL JUDGMENT OF CUSTODY AND PARENTING TIME □ and SUPPORT □ ORDER RE:
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□ The support amount presumed correct under the guidelines set out in Oregon Administrative Rules is
$
The support award deviates from this amount because this Court finds that application
of the formula would be unjust or inappropriate in this case because of (check one or more that apply):
□ Recurring medical expenses of
□ Other
4. Health Care Coverage. (Check one.)
A.) PRIVATE INSURANCE IS AVAILABLE □ Petitioner □ Respondent shall name the child/ren
as beneficiaries of the following appropriate private health care coverage for the duration of the
support obligation (describe type/s of coverage):
B.) NO PRIVATE INSURANCE IS AVAILABLE NOW Neither Petitioner nor Respondent has
appropriate private health care coverage available for the parties’ child/ren.
1.) □ Petitioner □ Respondent is ordered to apply to enroll the child/ren in public health care
coverage. If the child/ren is/are accepted for enrollment, this coverage shall be maintained.
2.) □ Petitioner □ Respondent has already applied to enroll the child/ren in public health
care coverage. If the child/ren is/are accepted for enrollment, this coverage shall be maintained.
3.) □ The child/ren are currently enrolled in public health care coverage. This coverage
shall be maintained.
4.) □ Petitioner, □ Respondent □ Both Petitioner and Respondent are ordered to provide
appropriate private health care coverage when such coverage becomes available to them through
any source.
C.) RESPONSIBILITY FOR UNINSURED HEALTH EXPENSES □ Petitioner should pay
% and Respondent should pay
% of the uninsured health, accidental, dental,
orthodontic, and optical costs incurred by the child/ren, including costs for prescriptions. This
obligation is in addition to any cash medical support ordered above in paragraph 2 as part of the child
support award.
NOTICE ABOUT PERIODIC REVIEWS
If you are receiving child support services through the Department of Justice pursuant to option (a) above, either
parent may request that the Department of Justice/Division of Child Support review the amount of support
ordered after three years from the date the order took effect or at any time upon a substantial change of
circumstances.
5. Payment of Child Support
Pursuant to ORS 25.378(1), an income withholding order shall be issued to enforce the child support obligation
unless an exception is indicated below.
□ Exceptions to withholding. Income withholding is not ordered at this time because there is no
support arrearage, the paying parent has not previously been granted an exemption from withholding, and:
□ The parents, and the State, if support rights are assigned, have agreed in writing to an alternative
arrangement; or
□ Good cause not to require withholding is found because there is proof of timely payment of
previously-ordered support and income withholding would not be in the best interests of the child.
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GENERAL JUDGMENT OF CUSTODY AND PARENTING TIME □ and SUPPORT □ ORDER RE:
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All payments of child support shall be made (check either (a) or (b) below):
(a)
□ To the Oregon Department of Justice, Child Support Accounting Unit, P.O. Box 14506,
Salem, Oregon, 97309 or □ by electronic payment withdrawal (EPW) or electronic funds
transfer (EFT). By petitioner’s request, collection, accounting disbursement, and enforcement
services of this obligation shall be through the State of Oregon’s Department of Justice.
(b)
□ Pursuant to the above exception, directly to □ Petitioner’s □ Respondent’s checking or
savings account. A receipt of deposit shall be kept by the parent paying support as proof of
payment. A canceled check is also prima facie evidence that payment has been made. The
person receiving support shall provide the paying parent with current deposit slips and/or bank
name, account name and account number.
NOTICE OF INCOME WITHHOLDING
This child support order is enforceable by income withholding under ORS 25.378 to 25.390, 25.414 to
25.372 and 25.375. Withholding shall occur immediately, whenever there is an arrearage at least equal to
the support payment for one month, whenever the obligated parent requests such withholding, or whenever
the obligee requests withholding for good cause. The District Attorney or, as appropriate, the Division of
Child Support of the Department of Justice, will assist in securing such withholding. Exceptions may apply
in some circumstances.
6. Dependents for Tax Purposes.
□ 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):
7. The support obligations ordered in paragraphs 2 through 6 above shall continue until the child reaches
18years of age or is otherwise emancipated, or until the child reaches age 21, so long as the child is a student
attending school, as defined by Oregon law.
8. Life Insurance Coverage for Child/ren.
□ Petitioner □ Respondent shall obtain and maintain life insurance for the benefit of the parties’
child/ren throughout the period of the support obligation if he/she is insurable. The coverage shall be in the
amount of $
.
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GENERAL JUDGMENT OF CUSTODY AND PARENTING TIME □ and SUPPORT □ ORDER RE:
JURISDICTION AND MONEY AWARD - PAGE 5 of 10
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NOTICE ABOUT PARENTING TIME AND CHILD SUPPORT
The terms of child support and parenting time (visitation) are designed for the child’s benefit and not the
parents’ benefit. You must pay support even if you are not receiving parenting time. You must comply with
parenting time and visitation orders even if you are not receiving child support.
Violation of child support orders and visitation or parenting time orders is punishable by fine, imprisonment
or other penalties.
Publicly funded help is available to establish, enforce, and modify child support orders. Paternity
establishment services are also available. Contact your local district attorney, the domestic relations court
clerk, or the Department of Justice at 1-800-850-0228 or 503-378-5567 for information.
Publicly funded help may be available to establish, enforce, and modify parenting time or visitation orders.
Forms are available to enforce parenting time or visitation orders. Contact the domestic relations, civil court
clerk or courthouse facilitator for information.
NOTICE ABOUT PERIODIC REVIEW AND
MODIFICATION OF CHILD SUPPORT ORDERS
If your child support case is handled by the District Attorney or the Department of Justice Division of
Child Support, this agency will review your child support order if at least three years have passed since the
order was entered, modified, or last reviewed. This review will take place only if a parent requests.
The purpose of the review is to see if the amount ordered is still within the guidelines for child support set
out in Oregon law. The review could result in an increase or decrease in the support amount, depending on
the parents’ financial circumstances and the needs of the child.
This “periodic review” service is provided at no cost to parents, but is available only for cases handled by
the District Attorney or the Department of Justice.
The support agency handling your case will also review your support order for compliance with the
guidelines whenever a substantial change in circumstance has occurred. You can request this “change in
circumstance” modification from the support agency. But any support order (not just orders handled by the
District Attorney or Department of Justice) can be modified because of a change in circumstance, so a private
attorney is able to assist you with this, too. You may also represent yourself.
9. Additional Provisions:
□ Additional page attached labeled “Paragraph 9 - Additional Provisions continued”.
10. Court Costs and Fees.
A. Deferred Costs and Fees
Any court costs and service fees (if service was completed by the Sheriff) that were deferred (required to
be paid at a later date) by the court shall be paid by:
□ Petitioner
□ Respondent.
□ Both parties equally
□ Other:
.
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GENERAL JUDGMENT OF CUSTODY AND PARENTING TIME □ and SUPPORT □ ORDER RE:
JURISDICTION AND MONEY AWARD - PAGE 6 of 10
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B. Costs and Fees Paid by the Parties
□ Each party shall be responsible for paying his/her own court costs and service fees for this case.
□ To be paid by both parties equally
□ Petitioner □ Respondent shall reimburse the other spouse for his/her court costs and service fees
for this case.
Other:
Judgment shall be entered according to the cost and fee allocation listed above.
11. Information Required by ORS 25.020.
□ Based on a finding that the health, safety, or liberty of □ Petitioner □ Respondent or a child/ren
would unreasonably be put at risk by disclosure of the following
information, □ Petitioner □ Respondent has been allowed not to disclose this information.
□ Otherwise: (Fill in the blanks in the table below.)
Petitioner
Respondent
Address or Contact
Address
Telephone Number
Social Security
Number
Do not list. Provided by UTCR 2.100 Do not list. Provided by UTCR 2.100
Affidavit
Affidavit
Drivers License
Number
Employer Name
Employer Address
Employer Telephone
□ Additional page labeled “Paragraph 11 continued” attached.
Both parties shall inform the Court and the Department of Justice (P.O. Box 14506, Salem, Oregon
97309) in writing of any change in the above information required by ORS 25.020 within ten (10) days of such
change, unless a finding of unreasonable risk has been made in this case. If the court has ordered that a party be
allowed not to disclose information by means of this Judgment in Paragraph 17 above, the Department of
Justice or the District Attorney shall not disclose the information in the preceding section to the other parent.
12. Money Award. Child Support Obligation □included □not included.
JUDGMENT CREDITOR
(This is the party receiving
payment from Judgment Debtor)
□ Petitioner □ Respondent
JUDGMENT DEBTOR
(This is the party required to pay
Judgment Creditor)
□ Petitioner □ Respondent
Full Name
Address or Contact
Address
GENERAL JUDGMENT OF CUSTODY AND PARENTING TIME □ and SUPPORT □ ORDER RE:
JURISDICTION AND MONEY AWARD - PAGE 7 of 10
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.
JUDGMENT CREDITOR
(This is the party receiving
payment from Judgment Debtor)
□ Petitioner □ Respondent
JUDGMENT DEBTOR
(This is the party required to pay
Judgment Creditor)
□ Petitioner □ Respondent
Attorney’s Name,
Telephone Number
and Address
The following information is required ONLY for the party designated as the “Judgment Debtor” above.
Date of Birth
Social Security
Number
Do not list. Provided by UTCR 2.100 Do not list. Provided by UTCR 2.100
Affidavit
Affidavit
Driver’s License
Number and State of
Issuance
The following information is to be provided by the party designated as the “Judgment Creditor” above.
Others Entitled to
The following person(s) or public bod(ies) are known by judgment creditor to be
Portions of Judgment entitled to a portion of a payment made on the judgment (other than the judgment
creditor’s attorney): □ None or □
Type of Judgment
Child Support
Award
Prejudgment
Interest
(Note: ORS
21.607(1)
disallows interest
on fees that have
been deferred.)
Amount of Judgment
WHO PAYS
□ Petitioner
□ Respondent
WHO RECEIVES
□ Petitioner
□ Respondent
WHO PAYS
□ Petitioner
□ Respondent
WHO RECEIVES
□ Petitioner
□ Respondent
1. $
□ Other:
the judgment
□ per month or □ Other:
, starting on the □ first day or
of the month following the date of
□ Of this Child Support Award, $ ________________
constitutes “cash medical support”
$___________________________________________
$___________________________________________
GENERAL JUDGMENT OF CUSTODY AND PARENTING TIME □ and SUPPORT □ ORDER RE:
JURISDICTION AND MONEY AWARD - PAGE 8 of 10
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Postjudgment
Interest
(Note: ORS
21.607(1)
disallows interest
on fees that have
been deferred.)
Accrued Arrears
(if any, on
judgments to be
paid on a periodic
basis)
Costs and Service
Expenses
(e.g., filing fees,
hearing fees, trial
fees, process fees)
Attorneys Fees
(if any)
JUDGMENT CREDITOR
JUDGMENT DEBTOR
(This is the party receiving
(This is the party required to pay
payment from Judgment Debtor)
Judgment Creditor)
□ Petitioner □ Respondent
□ Petitioner □ Respondent
WHO PAYS
Nine percent (9 %) per annum simple interest on the unpaid
balance of the total judgment amount(s) of
□ Petitioner
$
.
□ Respondent
Interest accrues from the date the judgment is entered and
continues until fully paid.
WHO RECEIVES
□ Petitioner
□ Respondent
WHO PAYS
□ Petitioner
□ Respondent
WHO RECEIVES
□ Petitioner
□ Respondent
WHO PAYS
□ Petitioner
□ Respondent
WHO RECEIVES
□ Petitioner
□ Respondent
WHO PAYS
□ Petitioner
□ Respondent
WHO RECEIVES
□ Petitioner
□ Respondent
1. $
per month, starting on the
□ first day or □ Other:
of the month following the date of the
judgment until the total amount of $
is paid
in full; or
2. A lump sum payment of $
to be paid by:
(date).
$___________________________________________
$___________________________________________
$___________________________________________
$___________________________________________
DATED this ________ day of ________________________________, 20______.
Circuit Court Judge
Print Name
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GENERAL JUDGMENT OF CUSTODY AND PARENTING TIME □ and SUPPORT □ ORDER RE:
JURISDICTION AND MONEY AWARD - PAGE 9 of 10
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□ All parties have agreed (stipulated) to the terms of this judgment.
□Petitioner, Signature
□Respondent, Signature
APPLICATION FOR CHILD SUPPORT PROGRAM SERVICES: By signing below, I apply for child
support services from the Child Support Program(CSP). (Note: If you never received TANF, tribal TANF or
AFDC in any state, an annual $25 fee will apply if over $500 is collected and distributed to the family each
year.)
□ Petitioner Signature
Date
□Respondent Signature
Date
□If applicable, child who is at least 18 and under 21 years of age, has agreed (stipulated to the terms of this judgment):
□Child, Signature
State of
County of
)
)
This instrument was acknowledged before me on
, 20
, (date)
by
(name of person(s)).
Notary Public for
My Commission Expires:
/Court Clerk
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.
Submitted by:
□Petitioner □Respondent, Signature
Address or Contact Address
Print Name
City, State, Zip
Telephone or Contact Telephone
I certify that this is a true copy:
______________________________
□Petitioner □Respondent, Signature
GENERAL JUDGMENT OF CUSTODY AND PARENTING TIME □ and SUPPORT □ ORDER RE:
JURISDICTION AND MONEY AWARD - PAGE 10 of 10
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