IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF In the Matter □ of the Marriage of: , Petitioner, and , Respondent ) ) ) ) ) ) ) ) ) Case No. GENERAL JUDGMENT OF ANNULMENT; and MONEY AWARD 1. This matter came before the Court: □ On the motion and affidavit of Petitioner, the default of Respondent having been found. □ On the motion of Petitioner, the default of Respondent having been found, and Respondent being represented by a guardian ad litem or another person described in Rule 27. □ On the motion and affidavit of Petitioner, Respondent having filed a Waiver of Further Appearance. □ On the stipulations of the parties, as shown by the signatures below. □ At a hearing held , at which the following persons were present: (date) □ Petitioner □ Petitioner’s attorney □ Respondent □ Respondent’s attorney 2. Findings. The Court considered the: □ Affidavit □ Affidavit and stipulations □ Evidence presented and found that: A. The marriage shall be annulled on the grounds that:  The marriage/domestic partnership is void because:  Petitioner Respondent was currently married/registered to/with a living spouse/partner when the parties married/registered.  The parties are first cousins or more closely related  by blood or  by adoption.  The marriage/domestic partnership is voidable and was not afterwards ratified because:  Consent was obtained by fraud  Consent was obtained by force  One or both of the parties was incapable of entering into a contract of marriage/domestic partnership or giving consent due to insufficient age or understanding. B. □ Spouses Only: □ Petitioner □ Respondent has/have been a resident of and domiciled in the state of Oregon continuously for six months immediately prior to the filing of the Petition for Dissolution of Marriage. □ Domestic Partnership Only: One or both of the parties to this case currently live in the county where this petition has been filed, or □ neither party currently resides in Oregon but the petition has been filed in the county where □ Petitioner or □ Respondent last resided. GENERAL JUDGMENT OF ANNULMENT; AND MONEY AWARD [No Children] - PAGE 1 OF 8 Annul-17A: Judgment17A-Ver03.doc (3/08) American LegalNet, Inc. www.FormsWorkFlow.com NOW, THEREFORE, IT IS HEREBY ORDERED: The terms of this judgment are effective immediately. The marriage/partnership between Petitioner and Respondent is hereby annulled and terminated as of the ____________ day of ________(year). 3. Spousal Support and Life Insurance. □ No spousal support or spousal life insurance is ordered in this case. A. Spousal Support. Support shall be paid by  Petitioner to Respondent  Respondent to Petitioner:  In the amount of $ per month for the following period of time: , or  In the amount of $ by (date), or  In an amount to be determined before trial or entry of judgment. List reason(s) support should be paid: The support shall be called (check one or more):  transitional compensatory spousal maintenance based on consideration of the following factors (list):  Payments shall be made on the first day of each month beginning the month following the date the judgment is signed by a judge.  All payments of spousal support shall be made directly into ’s checking or savings account. A receipt of deposit shall be kept by the paying spouse/partner as proof of payment. The spouse/partner receiving support shall provide the paying spouse/partner with current deposit slips and/or bank name, account name, and account number. Spousal support payments are taxable to the obligee spouse and deductible to the obligor spouse. All payments terminate upon the death of either party. 4. Real Property Distribution. □ Neither Petitioner nor Respondent has any interest in any real property located in this or in any other state. □ Petitioner □ Respondent has/have an interest in real property located at the address of □ This property shall be distributed as follows: □ Additional page labeled “Paragraph 4 - Real Property Distribution continued” attached. □ The legal description of the property is attached as “Exhibit ” and incorporated into this Judgment. □ Petitioner □ Respondent shall be responsible for the preparation, signing and recording of a deed, transferring the real property as required by this judgment. □ Distribution of this property is not within the jurisdiction of this court. GENERAL JUDGMENT OF ANNULMENT; AND MONEY AWARD [No Children] - PAGE 2 OF 8 Annul-17A: Judgment17A-Ver03.doc (3/08) American LegalNet, Inc. www.FormsWorkFlow.com 5. Personal Property Distribution (including motor vehicles). □ The Petitioner and Respondent have divided between them all personal effects, household goods and other personal property they own separately or together, and each shall be awarded those items now in their possession. □ The Petitioner is awarded the following personal property: □ Additional page labeled “Paragraph 5 - Petitioner’s Personal Property Distribution continued” attached. □ The Petitioner is awarded his/her retirement benefits, pension plan, profit-sharing plan, deferred compensation plan, and/or stock option plan held by Petitioner’s current or past employer, free of any interest in the Respondent. □ The Respondent is awarded his/her retirement benefits, pension plan, profit-sharing plan, deferred compensation plan, and/or stock option plan held by Respondent’s current or past employer, free of any interest in the Petitioner. □ The Respondent is awarded the following personal property: □ Additional page labeled “Paragraph 5 - Respondent’s Personal Property Distribution continued” attached. 6. Distribution of Debts. □ The debts shall be paid as follows: Name of Creditor (who money is owed to) What debt is for Amount Who shall pay (Petitioner or Respondent) □ Additional page attached, labeled “Paragraph 6 continued”. Each party shall be responsible for the payment of all debts incurred by him or her individually since the date of the separation; all debts which are distributed to him or her by the court; and all debts which are secured by property distributed to that party. Also, if any creditor asks the spouse/domestic partner not responsible for a debt to pay all or a portion of it, and he or she does so, the spouse/domestic partner responsible for that debt shall reimburse the other spouse/domestic partner for any monies he/she paid to the creditor after the date this judgment was entered. The date of separation (when you began living apart) was: 7. Transfer of Property and Debts. Within thirty (30) days of the date of this judgment, each party shall execute, acknowledge and deliver whatever documents are necessary to accomplish the distribution of debts and property ordered by the court. The judgment shall operate to convey title to the party awarded the property if the other party fails to comply with this requirement. GENERAL JUDGMENT OF ANNULMENT; AND MONEY AWARD [No Children] - PAGE 3 OF 8 Annul-17A: Judgment17A-Ver03.doc (3/08) American LegalNet, Inc. www.FormsWorkFlow.com 8. Former Name. □ Petitioner’s □ Respondent’s former name of is restored. 9. Additional Provisions: □ Additional page attached labeled “Paragraph 9 - Additional Provisions continued”. 10. Court Costs and Fees. A. Deferred Costs and Fees Any court costs and service fees (if service was completed by the Sheriff) that were deferred (required to be paid at a later date) by the court shall be paid by: □ Petitioner □ Respondent. □ Both parties equally □ Other: . B. Costs and Fees Paid by the Parties □ Each party shall be responsible for paying his/her own court costs and service fees for this case. □ To be paid by both parties equally □ Petitioner □ Respondent shall reimburse the other spouse for his/her court costs and service fees for this case. Other: . Judgment shall be entered according to the cost and fee allocation listed above. 11. Information Required by ORS 25.020 and ORS 107.085. □ Based on a finding that the health, safety, or liberty of □ Petitioner □ Respondent or a child, , would unreasonably be put at risk by disclosure of the following information, □ Petitioner □ Respondent has been allowed not to disclose this information. □ Otherwise: Petitioner Respondent Full Name Former Legal Name(s) Age Address or Contact Address Telephone Number Social Security Number Do not list. Provided by UTCR 2.100 Affidavit Do not list. Provided by UTCR 2.100 Affidavit Drivers License Number Employer Name Employer Address Employer Telephone □ Additional page labeled “Paragraph 11 continued” attached. GENERAL JUDGMENT OF ANNULMENT; AND MONEY AWARD [No Children] - PAGE 4 OF 8 Annul-17A: Judgment17A-Ver03.doc (3/08) American LegalNet, Inc. www.FormsWorkFlow.com Both parties shall inform the Court and the Department of Justice (P.O. Box 14506, Salem, Oregon 97309) in writing of any change in the above information required by ORS 25.020 within ten (10) days of such change, unless a finding of unreasonable risk has been made in this case. If the court has ordered that a party be allowed not to disclose information by means of this Judgment in Paragraph 11 above, the Department of Justice or the District Attorney shall not disclose the information in the preceding section to the other parent. Date of marriage/domestic partnership: Place of marriage/domestic partnership: . . 12. Effective Date: The marriage/domestic partnership of the parties is declared void and annulled as of (date): . 13. Money Award. Child Support Obligation □ included □ not included. Spousal Support □ included □ not included. Additional information required by ORS 18.042 PETITIONER RESPONDENT Full Name Address or Contact Address Attorney’s Name, Telephone Number and Address (if applicable) Date of Birth Driver’s License Number and State of Issuance 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 □ GENERAL JUDGMENT OF ANNULMENT; AND MONEY AWARD [No Children] - PAGE 5 OF 8 Annul-17A: Judgment17A-Ver03.doc (3/08) American LegalNet, Inc. www.FormsWorkFlow.com Type of Judgment Spousal Support Award Amount of Judgment WHO PAYS □ Petitioner □ Respondent WHO RECEIVES □ Petitioner □ Respondent 3. $ per month or Other: , starting on the first day or □ Other: of the month following the date of the judgment, lasting until (date), or the death of either party, whichever comes first; or 4. A lump sum payment of $ by (date): to be paid SPOUSAL SUPPORT PAYMENTS ARE TAXABLE TO THE OBLIGEE SPOUSE/DOMESTIC PARTNER AND DEDUCTIBLE TO THE OBLIGOR SPOUSE/DOMESTIC PARTNER. 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.) 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 PAYS □ Petitioner □ Respondent $ WHO RECEIVES □ Petitioner □ Respondent WHO PAYS □ Petitioner □ Respondent WHO RECEIVES □ 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. /// /// /// /// /// /// GENERAL JUDGMENT OF ANNULMENT; AND MONEY AWARD [No Children] - PAGE 6 OF 8 Annul-17A: Judgment17A-Ver03.doc (3/08) American LegalNet, Inc. www.FormsWorkFlow.com Accrued Arrears (if any, on judgments to be paid on a periodic basis) 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 WHO RECEIVES □ Petitioner □ Respondent Costs and Service Expenses (e.g., filing fees, hearing fees, trial fees, process fees) 2. A lump sum payment of $ to be paid by: (date). WHO PAYS □ Petitioner □ Respondent $ WHO RECEIVES □ Petitioner □ Respondent Attorneys Fees (if any) WHO PAYS □ Petitioner □ Respondent $ WHO RECEIVES □ Petitioner □ Respondent DATED this day of , 20 Circuit Court Judge Print Name □ 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 by , 20 , (date) (name of person). Notary Public for My Commission Expires: /Court Clerk GENERAL JUDGMENT OF ANNULMENT; AND MONEY AWARD [With Children} - PAGE 7 OF 8 Annul-17A: Judgment17A-Ver03.doc (3/08) American LegalNet, Inc. www.FormsWorkFlow.com Respondent, Signature State of County of ) ) This instrument was acknowledged before me on by , 20 , (date) (name of person). _______________________________________ Notary Public for ______________/Court Clerk My Commission Expires:__________________ □ If applicable, child who is at least 18 and under 21 years of age, has agreed (stipulated) to the terms of this judgment: (sign only your name) Child, Signature State of County of ) ) This instrument was acknowledged before me on by , 20 , (date) (name of person). _______________________________________ Notary Public for ______________/Court Clerk My Commission Expires:__________________ 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. Submitted by: □ Petitioner □ Respondent, Signature Address or Contact Address Print Name City, State, Zip Telephone or Contact Telephone Certificate of Mailing. I certify that I mailed a copy of this judgment and attachments thereto by U.S. Mail with postage paid to the other party at the following address: on the following date: □ Petitioner □ Respondent, Signature Print Name I certify that this is a true copy: □ Petitioner □ Respondent, Signature GENERAL JUDGMENT OF ANNULMENT; AND MONEY AWARD [With Children} - PAGE 8 OF 8 Annul-17A: Judgment17A-Ver03.doc (3/08) American LegalNet, Inc. www.FormsWorkFlow.com