IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE THIRD JUDICIAL DISTRICT _____________________________ Plaintiff, Petitioner or Moving Party, vs. _____________________________ Defendant, Respondent or Non-Moving Party. SUPPLEMENTAL AFFIDAVIT (Servicemembers Civil Relief Act) Case No. ________________ I, _______________________________, hereby swear or affirm the following information is true to the best of my knowledge: I am the Plaintiff/Petitioner/or Moving Party, in this proceeding. The Defendant / Respondent / Non-Moving Party is is not in military service. State supporting facts: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ I am unable to determine whether Defendant / Respondent / Non-Moving Party is in the military service. I have made the following efforts to make this determination: ________________________________________________________________ ________________________________________________________________ The Defendant / Respondent / Non-Moving Party has waived his/her rights under the Servicemembers Civil Relief Act, Pub.L. No. 108-189 (2003), as shown by the attached affidavit, labeled as Exhibit ______. For Eviction (FED) cases only: No one in the dwelling from which eviction is sought is dependent on anyone active in the military. State supporting facts: ________________________________________________________________ ________________________________________________________________ I hereby declare that the above statement is true to the best of my knowledge and belief, and that I understand it is made for use as evidence in court and is subject to penalty for perjury. (Sign in front of a notary or court clerk) ________________________________________________________________ Dated Plaintiff /Petitioner/Moving Party (Signature) (Print Name) ________________________________________________________________ Address City State Zip Telephone Number SUBSCRIBED AND SWORN to before me this _______ day of _____________, 20____, by ____________________________________ Deputy Court Administrator/Notary Public SUPPLEMENTAL AFFIDAVIT (Servicemembers Civil Relief Act) ­ Page 1 of 1 FC (11/19/12)