IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF In the Matter of □ the Marriage of: , Petitioner, and , Respondent. ) ) ) ) ) ) ) ) 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 Motion, Affidavit and Order re: Modification of 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, by delivering them to □ Petitioner □ Respondent (name) in person at the following address within the County of , State of . , 20____, at a.m./p.m., I 2. □ Substitute Service. On the day of served true copies of the original Motion, Affidavit and Order re: Modification of 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, by delivering (name), who is a person age 14 or older and a member of the them to 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 use a separate Affidavit/Certificate of Mailing.) □ On the day of , 20 , I personally deposited a true copy of the original Motion, Affidavit and Order re: Modification of 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, 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). AFFIDAVIT OF SERVICE - PAGE 1 OF 2 Modification-4A: AffSrv4AVer10.doc (9/10) American LegalNet, Inc. www.FormsWorkFlow.com 3. □ Office Service. On the day of , 20____, at a.m./p.m., I served true copies of the original Motion, Affidavit and Order re: Modification of 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, 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 (name), who is a person apparently in charge and who has a business duty with 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 use a separate Affidavit/Certificate of Mailing.) □ On the day of , 20 , I personally deposited a true copy of the original Motion, Affidavit and Order re: Modification of 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, with the United States Postal Service, via first class mail, in a sealed envelope, postage prepaid, addressed to the party to be served: □ Petitioner , at the party’s: □ home address located at: □ Respondent (name) (address), OR □ business address, listed above, together with a statement of the date, time and place that the documents were hand-delivered 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 Motion, Affidavit and Order re: Modification of 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, with the United States Postal Service, one via first class mail, and the other by certified or registered, return receipt requested, or by express mail, with postage on both copies fully paid, addressed to the party to be served: □ Petitioner or □ Respondent (name), at the party’s: □ home address located at: (address). (NOTE: If mailed return receipt requested, the return receipt should 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 Signature of Server Address or Contact Address AFFIDAVIT OF SERVICE - PAGE 2 OF 2 Modification-4A: AffSrv4AVer10.doc (9/10) , 20 . Print Name City, State, Zip Telephone or Contact Telephone American LegalNet, Inc. www.FormsWorkFlow.com