CERTIFICATE OF MAILING TO ORIGINAL PETITIONER RE: RENEWAL BY FORMER PROTECTED CHILD - Page 1 of 1 (FAPA 12/11) IN THE CIRCUIT COURT OF THE STATE OF OREGON COUNTY OF See CIF Petitioner (Former Protected Child) (date of birth) (your full name) and See CIF Respondent (date of birth) (full name of person to be restrained) ) ) ) ) ) ) ) ) ) ) ))))) ) CERTIFICATE OF MAILING TO ORIGINAL PETITIONER RE: RENEWAL BY FORMER PROTECTED CHILD Case No. See CIF Original Petitioner (date of birth) (full name of person who obtained original restraining order but is not a party to this renewal request) I, (your full name), was a minor child in the custody of the original petitioner who was protected by the order(s) in this case. I certify that on the day of (month), 20 (year), I served the following documents in this case: Petition to Renew Restraining Order Re: Former Protected Child; and Order Renewing Restraining Order Re: Former Protected Child; and Notice of Filing of Confidential Information Form (CIF)/Amended CIF RE: Renewal of Restraining Order (Former Protected Child); and Any other (list each): . on the original petitioner by mailing true copies to her/him by first class mail, in a sealed envelope, with postage prepaid, and deposited in the United States Post Office at: , (city and state where mailed), and that these were mailed to the following address (use contact address that your parent who obtained the restraining order has filed with the Court): 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 (Former Protected Child): American LegalNet, Inc. www.FormsWorkFlow.com