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. ______________________ PETITIONER'S RESPONDENT'S CERTIFICATE OF MAILING I certify that on ____________________, 20______, I placed a true copy of the PETITIONER'S RESPONDENT'S STATEMENT OF ASSETS AND LIABILITIES in the above case in the United States mail addressed to Petitioner Respondent at (specify address): in a sealed envelope with postage paid. 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 this _____ day of _______________________, 20_____. Signature of Petitioner Respondent Print Name Address or Contact Address City, State, Zip Code Telephone or Contact Telephone RESPONDENT'S CERTIFICATE OF MAILING - Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com