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Affidavit Of Service (16B) Form. This is a Oregon form and can be use in Circuit Court Statewide.
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Tags: Affidavit Of Service (16B), 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. ______________________
AFFIDAVIT OF SERVICE
□ Personal Service (ORCP 7D(2)(a)
□ Substitute Service (ORCP 7D(2)(b)
□ Office Service (ORCP 7D(2)(c)
□ Service by Mail, Return Receipt Requested
(ORCP 7D(2)(d)
I,
, declare I am a resident of the County of
, State of
. I am a competent person 18 years of age or older and not
a party to or attorney in this proceeding. I certify that the person, firm, or corporation served is the identical one named in
this action.
(Check one of the following):
1. □ Personal Service. On the _______day of _____________________, 20____, at __________ a.m./p.m., I
served true copies of the original Ex Parte Motion for, and Affidavit in Support of, Post-Judgment Temporary Custody
and Parenting Time Order Under ORS 107.097(3)(a) - “Immediate Danger” and Order for Post-Judgment Temporary
Custody and Parenting Time Order Under ORS 107.097(3)(a) - “Immediate Danger” by delivering them to:□ Petitioner
□ Respondent
(name) in person at the following address:
within the County of
, State of
2. □ Substitute Service. On the
day of
, 20____, at
a.m./p.m., I served true
copies of the original Ex Parte Motion for, and Affidavit in Support of, Post-Judgment Temporary Custody and Parenting
Time Order Under ORS 107.097(3)(a) - “Immediate Danger” and Order for Post-Judgment Temporary Custody and
Parenting Time Order Under ORS 107.097(3)(a) - “Immediate Danger” by delivering them to
(name), who is a person age 14 or older and a member of the household of the party to be
served, at the following address
within the County of
, State of
.
(Complete the section below only if the undersigned performed the followup mailing required by ORCP 7D(2)(b). If a
party or other person other than the undersigned did the follow up mailing, s/he must submit a separate Affidavit of
Service.)
□ On the
day of
, 20
, I personally deposited a true copy of the
original Ex Parte Motion for, and Affidavit in Support of, Post-Judgment Temporary Custody and Parenting Time Order
Under ORS 107.097(3)(a) - “Immediate Danger” and Order for Post-Judgment Temporary Custody and Parenting Time
Order Under ORS 107.097(3)(a) - “Immediate Danger” with the United States Postal Service, via first class mail, in a
sealed envelope, postage prepaid, addressed to the party to be served: □ Petitioner
□ Respondent
(name), at the party’s home address listed above, together with a statement of the
date, time and place that the documents were hand-delivered to the party’s dwelling (residence).
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AFFIDAVIT OF SERVICE - Page 1 of 2
PreJudgTempCustPT – 16B: AffidavitSrv16BVer02.doc (3/08)
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3. □ Office Service. On the
day of
, 20____, at
a.m./p.m., I served true copies
of the original Ex Parte Motion for, and Affidavit in Support of, Post-Judgment Temporary Custody and Parenting Time
Order Under ORS 107.097(3)(a) - “Immediate Danger” and Order for Post-Judgment Temporary Custody and Parenting
Time Order Under ORS 107.097(3)(a) - “Immediate Danger” by delivering them, in person, to the office of the party to
be served, located at:
(address),
during normal working hours for that office, where I left the documents with
(name),
who is a person apparently in charge and who has a business duty to provide the documents to the party to be served.
(Complete the section below only if the undersigned performed the followup mailing required by ORCP 7D(2)(c). If a
party or other person other than the undersigned did the follow up mailing, s/he must submit a separate Affidavit of
Service.)
□ On the
day of
, 20
, I personally deposited a true copy of the Petition for Ex
Parte Motion for, and Affidavit in Support of, Post-Judgment Temporary Custody and Parenting Time Order Under ORS
107.097(3)(a) - “Immediate Danger” and Order for Post-Judgment Temporary Custody and Parenting Time Order Under
ORS 107.097(3)(a) - “Immediate Danger” with the United States Postal Service, via first class mail, in a sealed envelope,
postage prepaid, addressed to the party to be served: □ Petitioner □ Respondent
(name),
at the party’s: □ home address located at:
(address), OR
□ business address, listed above, together with a statement of the date, time and place that the documents were handdelivered to the party’s office.
4. □ Service by Mail, Return Receipt Requested. On the
day of
, 20
,
I personally deposited two true copies of the original Ex Parte Motion for, and Affidavit in Support of, Post-Judgment
Temporary Custody and Parenting Time Order Under ORS 107.097(3)(a) - “Immediate Danger” and Order for PostJudgment Temporary Custody and Parenting Time Order Under ORS 107.097(3)(a) - “Immediate Danger” with the
United States Postal Service, one via first class mail, and the other sent by certified or registered, return receipt requested,
or express mail, with postage on both copies fully paid, addressed to the party to be served: □ Petitioner □ Respondent
(name), at the party’s: □ home address located at:
(address). The party served signed a receipt for the certified, registered or
express mailing, and the return receipt is attached to this Affidavit. (NOTE: The return receipt MUST be attached to
this Affidavit of Service.)
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.
I hereby declare that the above statement is true to the best of my knowledge and belief, and that I understand it
is made for use as evidence in court and is subject to penalty for perjury.
Dated this ________ day of _________________________, 20_____.
Signature of Server
Address or Contact Address
Print Name
City, State, Zip
AFFIDAVIT OF SERVICE - Page 2 of 2
PreJudgTempCustPT – 16B: AffidavitSrv16BVer02.doc (3/08)
Telephone or Contact Telephone
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