IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF __________________ In the Matter of the Marriage of: ) ) ) ) ) ) ) ) ) ______________________________, Petitioner, and ______________________________, Respondent. 1. This matter came before the court: a. On the Motion of Petitioner Case No. _______________________ CORRECTED SUPPLEMENTAL JUDGMENT CORRECTING JUDGMENT OR MONEY AWARD (ORCP 71A) Respondent the State of Oregon; b. On the court’s own motion; c. On the stipulation of the parties, as shown by the signatures below d. At a hearing held __________________ (date), at which the following persons were present: Petitioner Petitioner’s Attorney Respondent Respondent’s Attorney Other: 2. Findings. The court considered the: Documents on file herein; Stipulations; Evidence presented and found that (title of document) a. Due to a clerical mistake, the entered on (date) should be amended to accurately reflect the court’s ruling. IT IS HEREBY ORDERED that the above-described judgment shall be corrected as set forth below. The judgment document is not otherwise modified and all other terms remain in full force and effect. 1. The body of the judgment should be corrected to read (attach additional pages if necessary): (Additional pages labeled “Paragraph 1 - Corrections to Body of Judgment” attached.) CORRECTED SUPPLEMENTAL JUDGMENT CORRECTING JUDGMENT OR MONEY AWARD (ORCP 71A) - Page 1 of 5 American LegalNet, Inc. CorrectJudgment-Packet12: CorrectedMoneyJgmt12Ver12.doc (9/10) www.FormsWorkFlow.com 2. Money Award. Child Support Obligation □ included □ not included. Spousal Support □ included □ not included. Additional information PETITIONER RESPONDENT Full Name Address or Contact Address Attorney’s Name, Telephone Number and Address (if applicable) Year of Birth Last Four Digits of Driver License Number and State of Issuance Last Four Digits of the Support Obligor’s Social Security Number The following information is to be provided by any party entitled to receive a money award (a “judgment creditor”) as listed in this Judgment. Others Entitled to Portions of Judgment Payable to PETITIONER The following person(s) or public bod(ies) are known by Petitioner to be entitled to a portion of a payment made on the judgment (other than Petitioner’s attorney): □ None or □ Others Entitled to Portions of Judgment Payable to RESPONDENT The following person(s) or public bod(ies) are known by Respondent to be entitled to a portion of a payment made on the judgment (other than the Respondent’s attorney): □ None or □ Type of Judgment Child Support Award Amount of Judgment WHO PAYS □ Petitioner □ Respondent WHO RECEIVES □ Petitioner □ Respondent $ □ per month, of which $ is cash medical support. Starting on □ the first day or (day) month following the date of the judgment of the CORRECTED SUPPLEMENTAL JUDGMENT CORRECTING JUDGMENT OR MONEY AWARD (ORCP 71A) - Page 2 of 5 CorrectJudgment-Packet12: CorrectedMoneyJgmt12Ver12.doc (9/10) American LegalNet, Inc. www.FormsWorkFlow.com Spousal Support Award WHO PAYS □ Petitioner □ Respondent WHO RECEIVES □ Petitioner □ Respondent per month starting on □ the first day 1. $ or of the month following the date of □ Other: the judgment, lasting until (date) , or the death of either party, whichever comes first; or 2. A lump sum payment of $ by (date): to be paid SPOUSAL SUPPORT PAYMENTS ARE TAXABLE TO THE OBLIGEE SPOUSE AND DEDUCTIBLE TO THE OBLIGOR SPOUSE. ALL PAYMENTS TERMINATE UPON THE DEATH OF EITHER PARTY. Property Division (if applicable) WHO PAYS □ Petitioner □ Respondent WHO RECEIVES □ Petitioner □ Respondent Prejudgment Interest (Note: ORS 21.607(1) disallows interest on fees that have been deferred.) Postjudgment Interest (Note: ORS 21.607(1) disallows interest on fees that have been deferred.) WHO PAYS □ Petitioner □ Respondent 1. $ per month, starting on the □ first day or □ Other: of the month following the date of the judgment until the total amount of $ is paid in full; or 2. A lump sum payment of $ to be paid by: (date). $ WHO RECEIVES □ Petitioner □ Respondent WHO PAYS □ Petitioner □ Respondent Nine percent ( 9 %) per annum simple interest on the unpaid balance of the total judgment amount(s) of $ . Interest accrues from the date the judgment is entered and continues until fully paid. WHO RECEIVES □ Petitioner □ Respondent CORRECTED SUPPLEMENTAL JUDGMENT CORRECTING JUDGMENT OR MONEY AWARD (ORCP 71A) - Page 3 of 5 American LegalNet, Inc. CorrectJudgment-Packet12: CorrectedMoneyJgmt12Ver12.doc (9/10) www.FormsWorkFlow.com Accrued Arrears (if any, on judgments to be paid on a periodic basis) Costs and Service Expenses (e.g., filing fees, hearing fees, trial fees, process fees) Attorneys Fees (if any) WHO PAYS □ Petitioner □ Respondent WHO RECEIVES □ Petitioner □ Respondent per month, starting on the 1. $ □ first day or □ Other: of the month following the date of the judgment until the total amount of $ is paid in full; or 2. A lump sum payment of $ to be paid by: (date). WHO PAYS □ Petitioner □ Respondent $ WHO RECEIVES □ Petitioner □ Respondent WHO PAYS □ Petitioner □ Respondent $ WHO RECEIVES □ Petitioner □ Respondent DATED this ____ day of ___________________, 20____. Circuit Court Judge Print Name APPLICATION FOR CHILD SUPPORT PROGRAM SERVICES: By signing below, I apply for child support services from the Child Support Program(CSP). (Note: If you never received TANF, tribal TANF or AFDC in any state, an annual $25 fee will apply if over $500 is collected and distributed to the family each year.) □Petitioner, Signature Date □Respondent, Signature Date CORRECTED SUPPLEMENTAL JUDGMENT CORRECTING JUDGMENT OR MONEY AWARD (ORCP 71A) - Page 4 of 5 American LegalNet, Inc. CorrectJudgment-Packet12: CorrectedMoneyJgmt12Ver12.doc (9/10) www.FormsWorkFlow.com □ All parties have agreed (stipulated) to the terms of this judgment. Sign before a Notary Public or Court Clerk only. Petitioner, Signature ) ) State of County of This instrument was acknowledged before me on of , 20 , (date) (name of person). by Notary Public for My Commission Expires: /Court Clerk of , (date) Respondent, Signature State of County of ) ) This instrument was acknowledged before me on , 20 by (name of person). Notary Public for My Commission Expires: /Court Clerk 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_____. Submitted by: Petitioner Respondent, Address or Contact Address State of Oregon, Signature City, State, Zip Print Name Telephone or Contact Telephone I certify that this is a true copy: _________________________________________________ Petitioner Respondent, State of Oregon, Signature CORRECTED SUPPLEMENTAL JUDGMENT CORRECTING JUDGMENT OR MONEY AWARD (ORCP 71A) - Page 5 of 5 American LegalNet, Inc. CorrectJudgment-Packet12: CorrectedMoneyJgmt12Ver12.doc (9/10) www.FormsWorkFlow.com