Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Affidavit In Support Of Ex Parte Motion For Order Prohibiting Disclosure Of Personal Identification Information Form. This is a Oregon form and can be use in Circuit Court Statewide.
Tags: Affidavit In Support Of Ex Parte Motion For Order Prohibiting Disclosure Of Personal Identification Information, Oregon Statewide, Circuit Court
IN THE CIRCUIT COURT OF THE STATE OF OREGON
FOR THE COUNTY OF________________________
In the Matter of:
)
)
)
)
)
)
)
)
)
)
________________________________,
Petitioner,
and
________________________________.
Respondent.
STATE of ________________________
County of _________________________
Case No.:
Petitioner’s Respondent’s
AFFIDAVIT IN SUPPORT OF
EX PARTE MOTION FOR
ORDER PROHIBITING DISCLOSURE OF
PERSONAL IDENTIFICATION
INFORMATION ORS 25.020(8)(d)(A)
ORS 110.375 ORS 109.767(5)
)
) ss.
)
I, Petitioner Respondent, being first duly sworn, say that the following is true:
1.
2.
Petitioner
Respondent should not be given:
my residential address
my mailing address
my email address
my telephone number
my contact telephone/cell phone number
other personal information as set forth below:
my fax number
my social security number
my driver license number
the name, address, and telephone number of my employer
emergency notice about the child/ren
This information should not be disclosed for the following reasons:
A.
An existing order (a copy of which is attached and labeled “Exhibit 1") requires
nondisclosure:
Case No.
Name of Court
Date of Order
B.
Because the health, safety, or liberty of myself or of my child/ren would be jeopardized by
disclosure of this information due to the following circumstance(s):
AFFIDAVIT IN SUPPORT OF EX PARTE MOTION FOR ORDER PROHIBITING DISCLOSURE OF
PERSONAL IDENTIFICATION INFORMATION - Page 1 of 2
American LegalNet, Inc.
NonDisclose - 8: NDAffidavit-8Ver02.doc (3/08)
www.FormsWorkFlow.com
3.
To keep my identification information confidential, I request that the court waive the requirement that
the other party have me personally served with court documents, hearing notices, and other paperwork while
this case is pending (being decided.) While this case is pending, I request that process shall be served on me by
mailing a certified, true copy of paperwork and hearing notices to the following contact address:
I understand that if I wish to select a different method of service during the pendency of the proceedings, I must
file an amended waiver of personal service form changing the waiver, setting out a substitute method of service,
or selecting a substitute address for service.
4.
In order that I may receive notices from the court about future court proceedings after the current matter
has been decided, I select the following contact address for post-judgment notification:
I understand that if I wish to change my selected post-judgment notification address, I must inform the court in
writing of my preferred contact address.
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.
Dated
day of
, 20
.
Petitioner/Respondent, Signature
Service Address as set out on page 2, question 3.
this
SIGNED AND SWORN to before me by
day of
, 20
.
Notary Public for
My Commission Expires:
/ Court Clerk
AFFIDAVIT IN SUPPORT OF EX PARTE MOTION FOR ORDER PROHIBITING DISCLOSURE OF
PERSONAL IDENTIFICATION INFORMATION - Page 2 of 2
American LegalNet, Inc.
NonDisclose – 8: NDAffidavit-8Ver02.doc (3/08)
www.FormsWorkFlow.com
