DECLARATION re ACCEPTANCE OF SERVICE - PAGE 1 OF 1 Modification-4D: AccSrv4DVer01.doc (8/12) IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF In the Matter of the Marriage of: ) ) , ) Case No. Petitioner, ) and ) ) DECLARATION re ) ACCEPTANCE OF SERVICE ) , ) Respondent, ) ) ) and , ) Child who is at least 18 and under 21 years of ) age and unmarried. (ORS 107.108) ) ) Respondent. ) I, , declare that I am the Petitioner Respondent in this matter and on I received a true copy of the Motion, Affidavit and Order re: Temporary Modification of Judgment Re: Custody and/or Parenting Time and/or Child Support Due to Military Deployment, Notice of CIF Filing, and a Notice About a Written Response to a Motion to Modify, with attached notices on mediation and other information: provided by the court clerk in the County of , State of . 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. I HEREBY DECLARE THAT THE ABOVE STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF, AND THAT I UNDERSTAND THEY ARE MADE FOR USE AS EVIDENCE IN COURT AND ARE SUBJECT TO PENALTY FOR PERJURY. DATED this day of , 20 . Signature of Petitioner Respondent Print Name Address or Contact Address City, State, Zip Telephone or Contact Telephone American LegalNet, Inc. www.FormsWorkFlow.com