Acceptance Of Service (4A)
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Acceptance Of Service (4A) Form. This is a Oregon form and can be use in Circuit Court Statewide.
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Tags: Acceptance Of Service (4A), Oregon Statewide, Circuit Court
IN THE CIRCUIT COURT OF THE STATE OF OREGON
FOR THE COUNTY OF
In the Matter of □ the Marriage of:
,
Petitioner,
and
,
Respondent.
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Case No.
ACCEPTANCE OF SERVICE
)
)ss.
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STATE OF
County of
, being first duly sworn, say: I am the □ Petitioner □ Respondent
I,
in this matter and on
I received a true copy of the Motion, Affidavit and Order re:
Modification of Judgment Re: Custody and/or Parenting Time and/or Child Support, Notice of CIF Filing,
□ and a Notice About a Written Response to a Motion to Modify, □ with attached notices on mediation and
other information:
provided by the court clerk in the County of
,
State of
.
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 for myself and I completed it without paid assistance.
for assistance in preparing this form.
□ I paid or will pay money to
Signature of □ Petitioner □ Respondent
Print Name
Address or Contact Address
Telephone or Contact Telephone
City, State, Zip
SIGNED AND SWORN to before me this
by
day of
, 20
Notary Public for
My Commission Expires:
ACCEPTANCE OF SERVICE - PAGE 1 OF 1
Modification-4A: AccSrv4AVer03.doc (9/10)
,
.
/Court Clerk
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