IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF TILLAMOOK (Landlord) __________________________________) ___________________________________________) Plaintiff(s) VS. ) ) (Tenant) ___________________________________) ___________________________________________) Defendant(s) Case No.________________ AFFIDAVIT OF NONCOMPLIANCE Under Section 4(1), Chapter 603, 1999 OR Laws I, ___________________________________, plaintiff (landlord), swear/affirm that ___________________________________ defendant (tenant), has failed to comply with the attached order or judgment by stipulation in the following manner: _______________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Date: ________________ Signature: _____________________________________________ Plaintiff (Landlord) Subscribed and sworn/affirmed to before me this _______ day of _________________________, 20 ____. TRIAL COURT ADMINISTRATOR BY: __________________________________ Judicial Services Specialist III American LegalNet, Inc. www.FormsWorkFlow.com