FORM 12 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF LINN In the Matter of the Marriage of: ________________________________, Petitioner, ) ) ) ) ) ) ) ) ) ) ) Case No. GENERAL JUDGMENT OF DISSOLUTION OF MARRIAGE/DOMESTIC PARTNERSHIP and MONEY AWARD STIPULATED GENERAL JUDGMENT OF MARRIAGE/DOMESTIC PARTNERSHIP and MONEY AWARD and ________________________________, Respondent If this box is checked, both parties to this dissolution action have signed this document and are filing as Co-Petitioners. 1. This matter came before the Court: On the motion and affidavit of Petitioner, the default of Respondent having been found. On the motion and affidavit of Petitioner, Respondent having filed a Waiver of Further Appearance. On the affidavit of Co-Petitioner signatures. On the stipulations of the parties, as shown by the signatures below. The court has waived the 90 day waiting period based on the following: the parties have entered into a stipulated (agreed to) judgment, or other: 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. Irreconcilable differences have caused the irremediable breakdown of this marriage/domestic partnership. B. Spouses Only: Petitioner Respondent has/have been a resident of and domiciled in the state of Oregon continuously for six months immediately prior to the filing of the Petition for Dissolution of Marriage. Domestic Partnership Only: One or both of the parties to this case currently live in the county where this petition has been filed, or neither party currently resides in Oregon but the petition has been filed in the county where Petitioner or Respondent last resided. GENERAL JUDGMENT OF DISSOLUTION OF MARRIAGE/DOMESTIC PARTNERSHIP; AND MONEY AWARD - Page 1 of 7 American LegalNet, Inc. Linn County Dissolution without Children (9/10) www.FormsWorkFlow.com C. There are no unemancipated children under the age of 18 of this marriage, OR no child of this marriage is age 18 to 21 and a "child attending school" as defined in ORS 107.108. D. Neither party is now pregnant. Petitioner Respondent is now pregnant. Petitioner Respondent is not the parent of the child/ren due (date). NOW, THEREFORE, IT IS HEREBY ORDERED: The terms of this judgment are effective immediately. The marital/domestic partner status of the parties shall terminate on the date this judgment is signed by the judge. 3. Spousal Support and Life Insurance. No spousal support or spousal life insurance is ordered in this case. The terms set out below shall be in effect. Spousal Support. Support shall be paid by: Petitioner to Respondent (or) Respondent to Petitioner In the amount of:$ per month, or $ by (date). Period support payments shall last: , or the death of either party, whichever comes first. The support shall be called (check one or more): transitional compensatory spousal maintenance, based on consideration of the following factors: Spousal support payments are taxable to the obligee spouse and deductible to the obligor spouse. All payments terminate upon the death of either party. Judgment is entered accordingly. Payments. Payments shall be made on the first day of each month beginning the month following the date the judgment is signed by a judge. All payments of spousal support shall be made: (check (a) or (b)) (a) To the Department of Justice, Child Support Accounting Unit, P.O. Box 14506, Salem, Oregon, 97309. Petitioner requests that collection, accounting, disbursement, and enforcement services be provided through the Department of Justice. (b) Directly into 's checking or savings account. A receipt of deposit shall be kept by the paying spouse/domestic partner as proof of payment. The spouse/domestic partner receiving support should provide the paying spouse/domestic partner with current deposit slips and/or bank name, account name, and account number. Withholding. If child support is also ordered in this case and if enforcement services are provided through the State of Oregon's Department of Justice, the spousal support order shall be enforceable by income withholding under ORS 25.311. Life Insurance. Petitioner Respondent shall buy and maintain life insurance for the benefit of Petitioner Respondent throughout the period of the spousal support obligation in the amount of $ GENERAL JUDGMENT OF DISSOLUTION OF MARRIAGE/DOMESTIC PARTNERSHIP; AND MONEY AWARD - Page 2 of 7 American LegalNet, Inc. Linn County Dissolution without Children (9/10) www.FormsWorkFlow.com Medical Coverage. Petitioner Respondent shall buy and maintain health, accident, dental and optical insurance for the benefit of Petitioner Respondent if insurance is available through his/her employment, group or union. The insurance payments shall be additional spousal support, and shall be treated as such for tax purposes. If coverage for a former spouse is available through the purchasing spouse's employment, group or union, and this membership is later terminated, the purchasing spouse shall notify the other spouse of this before or immediately upon termination. 4. Real Property Distribution. Neither Petitioner nor Respondent has any interest in any real property located in this or in any other state. Petitioner Respondent has/have an interest in real property located at the address of OR This address is provided for in UTCR 2.130 Confidential Information Form. This property shall be distributed as follows: Additional page labeled "Paragraph 4 - Real Property Distribution continued" attached. The legal description of the property is attached as "Exhibit " and incorporated into this Judgment. Petitioner Respondent shall be responsible for the preparation, signing and recording of a deed, transferring the real property as required by this judgment. Distribution of this property is not within the jurisdiction of this court. 5. Personal Property Distribution (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 each shall be awarded those items now in their possession. The Petitioner is awarded the following personal property: Additional page labeled "Paragraph 5 - Petitioner's Personal Property Distribution continued" attached. The Petitioner is awarded his/her retirement be