Affidavit In Support Of Ex Parte Motion For temporary custody And Parenting Time Under ORS 107.097(3)(a) (16A)
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Affidavit In Support Of Ex Parte Motion For temporary custody And Parenting Time Under ORS 107.097(3)(a) (16A) Form. This is a Oregon form and can be use in Circuit Court Statewide.
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Tags: Affidavit In Support Of Ex Parte Motion For temporary custody And Parenting Time Under ORS 107.097(3)(a) (16A), 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.
STATE OF ________________________
County of _________________________
Case No.
AFFIDAVIT IN SUPPORT OF EX PARTE
MOTION FOR TEMPORARY CUSTODY AND
PARENTING TIME UNDER ORS 107.097(3)(a) –
“IMMEDIATE DANGER”
)
) ss.
)
, being first duly sworn, say: I am the
1.
I, (print your name)
□ Petitioner □ Respondent in this proceeding.
2.
The name(s) and year(s) of birth of my minor child/ren that should be protected by this order are:
NAME
YEAR OF BIRTH
3.
My child/ren are in “immediate danger” because of the following detailed facts (be specific):
□ Additional page attached
4.
List the places where the minor child/ren of the parties have lived in the last five years and the names of
the people they lived with at that time.
Dates
County, State
Parent(s)/Caretaker
Current Address/Contact
Address of
Parent/Caretaker
Which Children
□ Additional page attached
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AFFIDAVIT IN SUPPORT OF EX PARTE MOTION FOR TEMPORARY ORDER FOR CUSTODY AND
PARENTING TIME UNDER ORS 107.097(3)(a) – “IMMEDIATE DANGER” - Page 1 of 2
American LegalNet, Inc.
PreJudgTempCustPT – 16A: Affidavit-16AVer02.doc (9/10)
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5.
I □ have □ have not participated in any litigation concerning the custody, visitation, parenting time or
placement of the child/ren in this or any other state. □ I have participated in the following litigation:
Name of Court
State
Case No.
Date
Result
6.
I do not know of any other domestic violence, custody, visitation, parenting time or placement
proceeding involving the child/ren, or of any other court case which could affect this case, pending in this or any
other state □ except for:
(identify court, case number and the kind of proceeding)
7.
I do not know any person other than the other parent who has physical custody of the child/ren or who
claims to have custody, visitation or parenting time rights □ except for:
(list name and address)
8.
Dated:
There □ are □ are not any other custody, parenting time, visitation or restraining orders affecting the
child/ren. I have attached copies of any existing orders to this affidavit.
day of
, 20
.
□ Petitioner □ Respondent, Signature
SIGNED AND SWORN to before me this ___________ day of
, 20
by:
Notary Public for ____________/Court Clerk
My Commission Expires:
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.
□ I paid or will pay money to
for assistance in preparing this form.
□ Petitioner □ Respondent, Signature
Address or Contact Address
Print Name
City, State, Zip Telephone or Contact Telephone
I certify that this is a true copy: ____________________________________
□ Petitioner □ Respondent, Signature
AFFIDAVIT IN SUPPORT OF EX PARTE MOTION FOR TEMPORARY ORDER FOR CUSTODY AND
PARENTING TIME UNDER ORS 107.097(3)(a) – “IMMEDIATE DANGER” - Page 2 of 2
American LegalNet, Inc.
PreJudgTempCustPT – 16A: Affidavit-16AVer02.doc (9/10)
www.FormsWorkFlow.com
