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Certificate Re Pending Child Support Proceedings And Or Existing Child (9A) Form. This is a Oregon form and can be use in Circuit Court Statewide.
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Tags: Certificate Re Pending Child Support Proceedings And Or Existing Child (9A), Oregon Statewide, Circuit Court
FORM 5
IN THE CIRCUIT COURT OF THE STATE OF OREGON
FOR THE COUNTY OF LANE
In the Matter of t the Marriage of:
)
)
_____________________________,
)
Co-Petitioner, )
and
)
)
_____________________________,
)
Co-Petitioner.. )
Case No. ______________________
CERTIFICATE RE: PENDING CHILD SUPPORT
PROCEEDINGS and/or EXISTING CHILD
SUPPORT ORDERS/JUDGMENTS
(UTCR 8.090)
We hereby certify that:
1.
PENDING CHILD SUPPORT PROCEEDINGS (include any child support matter being heard by
either a court or agency as part of a dissolution, separation, annulment, paternity, juvenile court, support or
modification case):
t There is no pending child support proceeding in this or any other state involving the parties’
child[ren].
t There is a pending child support proceeding in t Oregon t in another state which involves the
parties’ child[ren] as follows:
Name/County of Court or Agency where pending:
Agency Case Number: ___________________________________________________________
Court Case Number:
2.
EXISTING CHILD SUPPORT ORDERS OR JUDGMENTS (include any order/judgment whether
made by an agency or a court in this or any other state, and whether or not currently effective):
t There are no other child support orders/judgments in this or any other state involving the parties’
child[ren].
t There is/are other child support orders/judgments involving the parties’ child[ren], as follows:
Page 1 of 2, CERTIFICATE RE: PENDING CHILD SUPPORT PROCEEDINGS and/or EXISTING CHILD
SUPPORT ORDERS/JUDGMENTS (UTCR 8.090)
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ORDER/JUDGMENT #1 (Attach a certified copy of the order):
Name/County of Court or Agency where issued:
Case Number:
Date of Order:
ORDER/JUDGMENT #2 (Attach a certified copy of the order):
Name/County of Court or Agency where issued:
Case Number:
Date of Order:
ORDER/JUDGMENT #3 (Attach a certified copy of the order):
Name/County of Court or Agency where issued:
Case Number:
Date of Order:
ORDER/JUDGMENT #4 (Attach a certified copy of the order):
Name/County of Court or Agency where issued: ________________________________
Case Number: ____________________
Date of Order: ____________________
t
Additional pages attached, labeled “Attachment 1 to Certificate Re: Child Support Proceedings and
Orders.”
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:
t We selected this document for ourselves and completed it without paid assistance.
t We paid or will pay money to ________________________________ for assistance in preparing
this form.
DATED this _____ day of _______________________, 20______.
Signature
Signature
Print name
Print name
Address or Contact Address
Address or Contact Address
City, State, Zip Code
________________________________
City, State, Zip Code
________________________________
Telephone or Contact Telephone
Telephone or Contact Telephone
Page 2 of 2, CERTIFICATE RE: PENDING CHILD SUPPORT PROCEEDINGS and/or EXISTING CHILD
SUPPORT ORDERS/JUDGMENTS (UTCR 8.090)
Disso-1B: CertifSupp1BVer01.wpd (9/03)
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