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 OTHER _______________________________________ PETITIONER, AND _______________________________________ RESPONDENT, ) ) ) ) ) ) ) ) ) ) ) Motion Case No.________________________ MOTION AND AFFIDAVIT FOR ORDER TO INITIATE MEDIATION WAIVE MEDIATION WAIVE CO-PARENTING CLASS I, ______________________________, request that the court issue an Order to Initiate Mediation, Order to Waive Mediation, Order to Waive Co-Parenting Class. Affidavit in Support of Motion STATE OF OREGON ) County of Linn ) ss. I, Petitioner Respondent, being first duly sworn, say that the following is true: Custody and Parenting time issues are are not in dispute. Other Dated: ________________________, 20____. _________________________________________ _______________________________________________ Petitioner, Signature Print Name _________________________________________________________________________________________ Address or Contact Address City, State, Zip Telephone or Contact Telephone SIGNED AND SWORN to before me this _________ day of ______________, 20_____, by _________________________________________________. ____________________________________ Notary Public for ____________/Court Clerk My Commission Expires: ______________ Page 1 of 2, MOTION/AFFIDAVIT/ORDER FOR MEDIATION LINN COUNTY FOR M Motion Mediation.wpd (4/05) American LegalNet, Inc. www.USCourtForms.com ORDER REFERRING CASE TO MEDIATION COME NOW THE COURT, upon consideration of Local Trial Court, Chapter 8, and finds that the above matter has been filed in Linn County Circuit Court, and that the matter involves a potential controversy over custody or parenting time of minor children and is therefore subject to mediation. Based upon the Motion and Affidavit of the Petitioner Respondent on file herein, the request for and an Order to Initiate Mediation, Order to Waive Mediation, Order to Waive Co-Parenting Class is hereby: Allowed Denied DATED this ____ day of ______________, 20______. __________________________________ Circuit Court Judge __________________________________ Print Name You are required to truthfully complete this certificate regarding the documents you are filing with the court. Check all boxes and complete all blanks that apply: I selected these documents for myself, and I completed them without paid assistance. I paid or will pay money to ____________________________ for assistance in preparing this document. Dated: ___________________, 20______. Submitted by: ______________________________________________ ________________________________________________ Signature Print Name _______________________________________________________________________________________________ Address or Contact Address City, State, Zip Telephone or Contact Telephone I certify that this is a true copy: _______________________________________ Petitioner, Signature Page 2 of 2, MOTION/AFFIDAVIT/ORDER FOR MEDIATION LINN COUNTY FOR M Motion Mediation.wpd (4/05) American LegalNet, Inc. www.USCourtForms.com