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 MOTION FOR ORDER TO SHOW CAUSE RE: MODIFICATION OF JUDGMENT ) ) ss. ) I, □ Petitioner □ Respondent, being first duly sworn, say that the following is true: 1. The names, ages and birth dates of the child/ren involved in this case are: 2. □ I want to change CUSTODY because of a change of circumstances since the last custody order. This change of circumstances is (describe): The current child support obligation should be terminated if the custody change is ordered. 3. □ I want to change PARENTING TIME (visitation) because I believe the change is in my child/ren’s best interests. The specific reason(s) I want the change and believe the change would be best for my child/ren is/are: 4. □ I want to change CHILD SUPPORT because of a change of circumstances since the last support order. The change of circumstances is as follows: AFFIDAVIT IN SUPPORT OF MOTION FOR ORDER TO SHOW CAUSE RE: MODIFICATION OF American LegalNet, Inc. JUDGMENT - PAGE 1 OF 3 www.FormsWorkFlow.com Modification-4A: AffSuppMo4AVer06.doc (1/08) 5. UCCJEA Information. a. Check the appropriate box below ONLY IF Oregon is the state that issued the order or judgment sought to be modified: □ The child/ren has/have continuously resided in Oregon for six months before this case was filed; OR □ Other basis for Oregon jurisdiction: b. Check the appropriate box below ONLY IF Oregon is NOT the state that issued the order or judgment sought to be modified: □ Neither the child/ren nor the parents presently reside in (name the state that issued the order or judgment sought to be modified, if not Oregon). □ Other basis for Oregon jurisdiction: 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 To/From County, State Parent(s)/Caretaker Current Address/ Contact Address of Parent/Caretaker Which Children □ Additional page attached; see section labeled “Paragraph 5 continued.” 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 agency proceeding or court case which could affect this case, previously filed or currently pending in this or any other state □ except for: (identify agency or court, case number, date filed, and kind of proceeding) /// /// /// AFFIDAVIT IN SUPPORT OF MOTION FOR ORDER TO SHOW CAUSE RE: MODIFICATION OF American LegalNet, Inc. JUDGMENT - PAGE 2 OF 3 www.FormsWorkFlow.com Modification-4A: AffSuppMo4AVer06.doc (1/08) 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) 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 Print Name Address or Contact Address Telephone or Contact Telephone City, State, Zip SIGNED AND SWORN to before me this day of , 20 , by, Notary Public for My Commission Expires: /Court Clerk I certify that this is a true copy. ____________________________________ □ Petitioner □ Respondent, Signature AFFIDAVIT IN SUPPORT OF MOTION FOR ORDER TO SHOW CAUSE RE: MODIFICATION OF American LegalNet, Inc. JUDGMENT - PAGE 3 OF 3 www.FormsWorkFlow.com Modification-4A: AffSuppMo4AVer06.doc (1/08)