Certificate of Mailing to DCS Page 1 of 1 (Aug 2019) IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF Case No. Petitioner and CERTIFICATE OF MAILING OR DELIVERY TO DIVISION OF CHILD SUPPORT Respondent I certify that on (date) , I hand-delivered or mailed by first-class mail a true copy of the Petition in the above domestic relations case to the local branch office of the Department of Justice, Division of Child Support at (list address): I hereby declare that the above statements are true to the best of my knowledge and belief. I understand they are made for use as evidence in court and I am subject to penalty for perjury. Date Signature { Petitioner Respondent} Name (printed) Contact Address City / State / ZIP Contact Phone American LegalNet, Inc. www.FormsWorkFlow.com