Form 13 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF LINN In the Matter of the Marriage of: ________________________________, Petitioner, and ________________________________, Respondent. STATE OF OREGON County of _________________________ ) ) ) ) ) ) ) ) Case No. ______________________ PETITIONER’S AFFIDAVIT SUPPORTING GENERAL JUDGMENT OF DISSOLUTION ) ) ss. ) ‘ If this box is checked, both parties to this dissolution action have signed this document and are filing as Co-Petitioners. ‘ I, ______________________________, being first duly sworn, say: I am the petitioner in this proceeding. ‘ We _________________________ ___________________________ are Co-Petitioners being first duly sworn, say: We are Co-Petitioners in this proceeding. The parties were married on (date): _____________________, in the County of _________________, State of ___________________________. Irreconcilable differences between the spouses have caused the irremediable breakdown of the marriage. ‘ Petitioner ‘ Respondent was an Oregon resident continuously for at least six months immediately prior to commencement of this suit. ‘ No domestic relations suits involving this marriage of Petitioner and Respondent are pending in any other court. ‘ There are ________ child/ren of the marriage. ‘ The wife is pregnant with husband’s child. The wife was cohabiting with the husband when the child was conceived. The expected date of the child’s birth is___________. ‘ The wife is not now pregnant. ‘ Child(ren) named _______________________________ were born to wife on the following dates _________________________________, during this marriage. The husband is not the father of the child/ren. The wife was not cohabiting with the husband when the child/ren were conceived. ‘ The wife is pregnant at this time and the husband is not the father of this child. The wife was not cohabiting with the husband when this child was conceived. The expected date of the child’s birth is____________________. Page 1 of 4 - PETITIONER’S AFFIDAVIT SUPPORTING JUDGMENT OF DISSOLUTION Linn County Disso-1B: Form 13 Affidavit Supporting General Judgment.wpd (1/06) American LegalNet, Inc. www.FormsWorkflow.com ‘ Respondent has not appeared in this matter and an Order of Default has been entered. ‘ Respondent filed a response and later ‘ signed and filed a Waiver of Further Appearance and Consent to Entry of Judgment, (or) ‘ has waived further hearing by stipulating to the terms of the General Judgment of Dissolution of Marriage. This case is now ready for a hearing on the merits. I/We make this affidavit in support of a Judgment of Dissolution of Marriage without a hearing. The allegations in my/our Petition are true and it is just and reasonable to grant the relief requested in the proposed General Judgment of Dissolution. ‘ Child custody or child support is involved in this case and at the time of filing. ‘ The child/ren had continuously resided in Oregon for six months before this case was filed. ‘ List any other basis for child custody jurisdiction: ______________________________________________________ _______________________________________________________________________________________________________ The current residence of the minor child/ren is: Name of Child Resides With (Name, Address or Contact Address) For how long ‘ Additional page attached, labeled “Information About Children, Continued”. ‘ Parenting time should not be ordered because my child/ren’s health or safety would be endangered. State supporting facts: __________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________. ‘ I have good reason for the court to allow me to move more than 60 miles further distant from the other parent without giving written advance notice to the other parent. My good cause is:________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ ‘ Minor children are involved: Wife’s average gross monthly income is approximately $____________. Husband’s average gross monthly income is approximately $ _________. Work or school related daycare is $________/month and is paid by ‘ Wife ‘ Husband. Health insurance for our child/ren costs $___________/month out of pocket and is paid by ‘ Wife ‘ Husband. The child support amount I have requested ‘ does not deviate from the amount presumed correct under Oregon Administrative Rules, or ‘ does deviate from the presumed amount of $ _____________ per month because:________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Page 2 of 4 - PETITIONER’S AFFIDAVIT SUPPORTING JUDGMENT OF DISSOLUTION Linn County Disso-1B: Form 13 Affidavit Supporting General Judgment.wpd (1/06) American LegalNet, Inc. www.FormsWorkflow.com ‘ Child support is involved and Respondent does not live in Oregon. (If you checked the box above, check any of the following boxes that are true) ‘ Respondent was personally served with the petition in Oregon. ‘ Respondent lived in Oregon with the child. ‘ Respondent lived in Oregon and paid expenses for the birth or support of the child. ‘ The child was possibly conceived in Oregon. ‘ The child lives in Oregon because of the wishes of Respondent. ‘ Respondent and I both lived in Oregon at the same time (either together or separately) during for a period of six months, beginning (list dates) _______________ and ending on and less than one year has passed since respondent moved to a new the marriage __________________ residence out of state. ‘ Other basis for jurisdiction: ________________________________________. ‘ A child support order currently exists and I requested that this court issue a new order because 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 the first order was entered. The changed circumstances are (explain what has changed since the last order): ______________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ ‘ The request for spousal support is supported by the following facts:________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ ‘ I request that personal information, such as telephone number, address and employment information, not be disclosed in the court’s judgment as otherwise required by ORS 25.020 and ORS 107.085 because my health, safety or liberty, or that of my child __________________________ would unreasonably be put at risk by such disclosure. State supporting facts:_________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ /// /// /// Page 3 of 4 - PETITIONER’S AFFIDAVIT SUPPORTING JUDGMENT OF DISSOLUTION Linn County Disso-1B: Form 13 Affidavit Supporting General Judgment.wpd (1/06) American LegalNet, Inc. www.FormsWorkflow.com 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 form myself, and I completed it without paid assistance. ‘ I paid or will pay money to ________________________________ for assistance in preparing this form. Dated: ________________________, 20_____. __________________________________________________ ___________________________________________________ Petitioner’s Signature Print Name _______________________________________________________________________________________________________ Address or Contact Address City, State, Zip Telephone or Contact Telephone SIGNED AND SWORN to before me this _________ day of ______________, 20_____, ___________________________________ Notary Public for ____________/Court Clerk My Commission Expires: ______________ ‘ CO-PETITIONER / ‘ RESPONDENT I, ___________________________, being duly sworn, say that I am the co-petitioner/respondent in this matter and that the foregoing affidavit is true and correct to the best of my knowledge. __________________________________________________ Respondent’s Signature ___________________________________________________ Print Name _______________________________________________________________________________________________________ Address or Contact Address City, State, Zip Telephone or Contact Telephone SIGNED AND SWORN to before me this _________ day of ______________, 20_____, ___________________________________ Notary Public for ____________/Court Clerk My Commission Expires: ______________ Page 4 of 4 - PETITIONER’S AFFIDAVIT SUPPORTING JUDGMENT OF DISSOLUTION Linn County Disso-1B: Form 13 Affidavit Supporting General Judgment.wpd (1/06) American LegalNet, Inc. www.FormsWorkflow.com