1 FORM 8 2 3 4 5 IN THE CIRCUIT COURT OF THE STATE OF OREGON 6 FOR THE COUNTY OF LANE 7 8 In the Matter of the Marriage of: 9 ________________________________, Co-Petitioner, and 10 11 ________________________________, Co-Petitioner. ) ) ) ) ) ) ) ) Case No. ______________________ CO-PETITIONER’S AFFIDAVIT SUPPORTING JUDGMENT OF DISSOLUTION 12 13 STATE OF ________________________ 14 County of _________________________ ) ) ss. ) 15 W e, _____________________________ and _________________________, being first duly sworn, say: 16 17 we are co-petitioners in this proceeding. W e were m arried on __________________________, in the (Date) County of ______________________, State of _____________________. Irreconcilable differences between 18 us have caused the irrem ediable breakdown of our m arriage. 19 9 Husband was an Oregon resident continuously for m ore than six m onths im m ediately prior to com m encem ent of this suit. 9 No dom estic 20 relations suits involving this m arriage are pending in any other court. 21 9 W ife 9 There are ________ child/ren of the m arriage. 9 The wife is pregnant with husband’s child. 22 The wife was cohabiting with the husband when the child was conceived. The expected date of the 23 child’s birth is ________________________. 24 25 9 The wife is not now pregnant. 9 Child(ren) nam ed ____________________________ were born to wife on the following dates 26 ____________________________________________ , during this m arriage. The husband is not the father of 27 the child/ren. The wife was not cohabiting with the husband when the child/ren were conceived. 28 PETITIONER’S AFFIDAVIT SUPPORTING JUDGMENT - PAGE 1 X:\Local Documents\Family Court\2008\Affjudgment-CoPet9A.wpd Revised 3/2008 American LegalNet, Inc. www.FormsWorkFlow.com 1 9 The wife is pregnant at this tim e and the husband is not the father of this child. 2 cohabiting with the husband when this child was conceived. The expected date of the child’s birth is 3 _____________________________. 4 This case is now ready for a hearing on the m erits. W e m ake this affidavit in support of a Judgm ent of Dissolution 5 of Marriage without a hearing. The allegations in our Petition are true and it is just and 6 reasonable that we be granted the relief request. 7 9 Child custody or child support is involved in this case: 8 9 The wife was not CHILD CUSTODY JURISDICTION Home State Jurisdiction: 11 9The child(ren) have lived in Oregon for the last six months. 9The child(ren) are not now living in Oregon, but have lived in Oregon for at least six consecutive 12 months (at least part of which period occurred in the last six months), and a parent or acting parent continues 13 to live in Oregon. 10 14 Significant Connection Jurisdiction: 15 9 The child(ren) and have significant connections to Oregon and substantial (Nam e of parent or caretaker) 16 17 18 evidence about the child(ren)’s care, protection, training, and personal relationships is available here, AND: 9 There is no ‘home state’ because the child(ren) have not lived in any one state for six consecutive months, at least a part of which period occurred in the last six months: or 19 9 20 Temporary Emergency Jurisdiction: 21 9 The ‘home state’ has declined jurisdiction in favor of Oregon. The chid(ren) are physically present in Oregon and have been abandoned or an emergency exists 22 requiring the child(ren)’s protection because the child(ren), sibling(s), and/or parent are subjected to or 23 threatened with mistreatment or abuse. 24 9 There is not another child custody proceeding pending in a court of a state having jurisdiction und 25 ORS 109.741 - 109.747. This Order based on Temporary Emergency Jurisdiction remains in effect until and 26 Order is obtained from a Court of a state having ‘home state’ or ‘significant connection” jurisdiction. If a child 27 custody proceeding has not been or is not commenced in a court of a state having either ‘home state’ or 28 ‘significant connection’ jurisdiction, this Order becomes a final determination if Oregon becomes the ‘home PETITIONER’S AFFIDAVIT SUPPORTING JUDGMENT - PAGE 2 X:\Local Documents\Family Court\2008\Affjudgment-CoPet9A.wpd Revised 3/2008 American LegalNet, Inc. www.FormsWorkFlow.com 1 2 3 state’ of the child(ren). 9 There is another child custody proceeding pending in a court of a state having jurisdiction under ORS 109.741 - 109.747. This Order based on Temporary Emergency Jurisdiction remains in effect until the 4 day of 5 9 ,20 , or until an Order is obtained from the other state within that period. Oregon does not have jurisdiction under the Uniform Child Custody Jurisdiction Act because: 6 7 8 9 The current residence of the m inor child/ren is: 10 Nam e of Child 11 ___________________________________________________________________________________ 12 ___________________________________________________________________________________ 13 __________________________________________________________________________________ 14 __________________________________________________________________________________ Child support is involved: Husband’s gross m onthly incom e is approxim ately $____________. 15 Resides with For how long 9 W ife’s gross m onthly incom e is approxim ately $ _________. The child support am ount we have requested 16 not deviate from the am ount presum ed correct under Oregon Adm inistrative Rules, or 17 presum ed am ount of $ 9 does 9 does deviate from the ___________because:_____ _ _ _ __ _ _ _ __ _ _ _ __ _ _ _ __ _ _ _ __ _ _ _ 18 _______________________________________________________________________________________ 19 ________________________________________________________________________________________ 20 21 22 23 24 25 9 There is an existing child support order, a certified copy of which is on file in this case. As of today’s date, the back child support owed is _________________. The next paym ent of ______________ (Total amount not paid to date) (Monthly payment) is due on _____________________. (Date due) 9 Co-Petitioner/s, (print name)____________________________________ has/have appropriate private health care coverage available for the parties’ child/ren either through an em ployer, union, or other source, or through a dom estic partner, spouse or other fam ily m em ber residing with them (describe type of coverage:)_______________________________________________________________________________ 26 ________________________________________________________________________________________ 27 ___________________________________________________________________________________________ 28 PETITIONER’S AFFIDAVIT SUPPORTING JUDGMENT - PAGE 3 X:\Local Documents\Family Court\2008\Affjudgment-CoPet9A.wpd Revised 3/2008 American LegalNet, Inc. www.FormsWorkFlow.com 9 Co-Petitioner, (print name)_______________________________be ordered to m aintain this 1 W e request that 2 coverage throughout the period of the support obligation for the benefit of the parties’ child/ren. 3 9 Both Co-Petitioners have appropriate private health care coverage available for the parties’ child/ren. 4 W e select the following health care coverage to be m aintained throughout the period of the support obligation: 5 9Co-Petitioner’s, (print name)______________________________9Both Co-Petitioner’s (describe type/s of 6 coverage):_______________________________________________________________________________ 7 _______________________________________________________________________________________ 8 ___________________________________________________________________________________________ 9 and, 10 11 9 Neither Co-Petitioner has appropriate private health care coverage available for the parties’ child/ren 9 Co-Petitioner, (print name)_____________________________9 Both Co-Petitioners should be ordered to apply for and enroll the child/ren in public health care coverage. 12 13 9 Co-Petitioner, (print name)_____________________________has already applied to enroll the child/ren in public health care coverage. This coverage should be m aintained if the child/ren are accepted for 14 enrollm ent. 15 16 9 The child/ren are currently enrolled in public health care coverage. This coverage should be m aintained. 17 18 9 Both Co-Petitioners should be ordered to provide appropriate private health care coverage when such coverage becom es available to them through any source. 19 20 9 Co-Petitioner, (print name)_____________________________should pay_____% 9 and 9 CoPetitioner, (print name)_______________________________________should pay_____% of the uninsured 21 HEALTH, ACCIDENT, DENTAL, ORTHODONTIC, AND OPTICAL HEALTH costs incurred by the child/ren. This 22 obligation is in addition to any cash m edical support requested as part of the child support award. 23 9 Spousal support is involved in this case. 24 9Husband 9 wife is e n title d to tra n s itio n a l spousal support because 25 _______________________________________________________________________________________ 26 ________________________________________________________________________________________ 27 9 Husband 9W ife is entitled to com pensatory spousal support based upon the following contribution 28 PETITIONER’S AFFIDAVIT SUPPORTING JUDGMENT - PAGE 4 X:\Local Documents\Family Court\2008\Affjudgment-CoPet9A.wpd Revised 3/2008 American LegalNet, Inc. www.FormsWorkFlow.com 1 to 2 _______________________________________________________________________________________ 3 ________________________________________________________________________________________ 4 the education, 9Husband training, 9W ife vocational is skills, entitled career to or earning spousal capacity of the m aintenance other party: because: 5 _______________________________________________________________________________________ 6 ________________________________________________________________________________________ 7 8 ______________________________________ Co-Petitioner, Pro Se (Signature) ______________________________________ Print nam e 9 10 11 Address ______________________________________ City, State, Zip Code ______________________________________ Telephone 12 SUBSCRIBED AND SW ORN to before m e this ____day of ______________, 20____, 13 by ___________________________________. 14 15 ___________________________________ Notary Public for ____________/Court Clerk My Com m ission Expires: ______________ 16 17 18 19 20 21 ______________________________________ Co-Petitioner, Pro Se (Signature) ______________________________________ Print nam e ______________________________________ Address ______________________________________ City, State, Zip Code ______________________________________ Telephone 22 SUBSCRIBED AND SW ORN to before m e this ____day of ______________, 20____, 23 by __________________________________. 24 25 ___________________________________ Notary Public for ____________/Court Clerk My Com m ission Expires: ______________ 26 27 28 PETITIONER’S AFFIDAVIT SUPPORTING JUDGMENT - PAGE 5 X:\Local Documents\Family Court\2008\Affjudgment-CoPet9A.wpd Revised 3/2008 American LegalNet, Inc. www.FormsWorkFlow.com 1 Certificate of Docum ent Preparation 2 You are required to truthfully com plete this certificate regarding the docum ent you are filing with the court. Check all boxes and com plete all blanks that apply: 3 9 W e selected this docum ent for ourselves. 4 9 W e were provided this docum ent by an attorney. 5 9 W e com pleted this docum ent without paid assistance. 6 7 8 9 W e paid or will pay m oney to _____________________________ for assistance in preparing this docum ent. ___________________________________ Co-Petitioner Signature __________________________________ Co-Petitioner Signature 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 PETITIONER’S AFFIDAVIT SUPPORTING JUDGMENT - PAGE 6 X:\Local Documents\Family Court\2008\Affjudgment-CoPet9A.wpd Revised 3/2008 American LegalNet, Inc. www.FormsWorkFlow.com