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General Judgment Of Dissolution Of Marriage (With Children) And Money Award Form. This is a Oregon form and can be use in Circuit Court Statewide.
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Tags: General Judgment Of Dissolution Of Marriage (With Children) And Money Award, 1B, Oregon Statewide, Circuit Court
IN THE CIRCUIT COURT OF THE STATE OF OREGON
FOR THE COUNTY OF
In the Matter of □ the Marriage of:
________________________________,
Petitioner,
and
________________________________,
Respondent
and
□ ________________________________,
Child who is at least 18 and under 21 years
of age, unmarried and unemancipated.
(ORS 107.108)
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Case No.
GENERAL JUDGMENT OF DISSOLUTION
OF MARRIAGE/DOMESTIC PARTNERSHIP
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.
□ The court has waived the 90 day waiting period based on the following: □ the parties have entered into
a stipulated (agreed to) judgment, or □ other:
□ 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. Irreconcilable differences have caused the irremediable breakdown of this marriage/domestic
partnership.
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.
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□ 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.
C. Children of the Marriage/Domestic Partnership. The following children were born to/ adopted by
the parties before or during this marriage/domestic partnership (list name(s), date of birth(s) and age(s)):
Name
Date of Birth
Age
Do not list here. List the
information on the UTCR
2.130 Confidential
Information Form (CIF).
Do not list here. List the
information on the UTCR
2.130 Confidential
Information Form (CIF).
Do not list here. List the
information on the UTCR
2.130 Confidential
Information Form (CIF).
Do not list here. List the
information on the UTCR
2.130 Confidential
Information Form (CIF).
□ Petitioner □ Respondent is not the father, or paternity has not been established, of the
children (list names):
born during the marriage/domestic partnership on the following date(s):
□ Neither party is now pregnant.
□ Petitioner □ Respondent is now pregnant. □ Petitioner □ Respondent is not the parent of
the child/ren due
(date).
D. Child Custody Jurisdiction. (Check appropriate boxes)
I. □ Oregon has jurisdiction under the Uniform Child Custody Jurisdiction and Enforcement Act to
hear the □ custody □ parenting time issue because:
□ Oregon is the child/ren’s home state (i.e., the child/ren have lived here continuously for
the six month period immediately before this case was filed).
□ Other reason:
II. □ Oregon does not have jurisdiction under the Uniform Child Custody Jurisdiction Act because:
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E. Child/ren Who Are At Least 18 and Under 21 Years of Age.
(child/ren’s name) is at least 18, 19, or 20
years of age, is unmarried and unemancipated and has:
□ Waived further appearance in these proceedings.
□ Signed and stipulated to the terms of judgment evidenced by the signature below.
□ Fully participated in the proceedings and the judgment effectively binds him/her to the terms.
NOW, THEREFORE, IT IS HEREBY ORDERED:
The terms of this judgment are effective immediately. The marital/domestic partner status of the parties
shall terminate on the date this judgment is signed by the judge.
1. Parenting Plan
Custody of the child/ren is awarded as follows:
□ Petitioner is awarded sole custody of the following child/ren (list names):
□ Respondent is awarded sole custody of the following child/ren (list names):
□ The parties have agreed to joint custody of the following child/ren (list names):
□ Petitioner □ Respondent should have parenting time with the child/ren □ as set forth in the
attached Parenting Plan, labeled Exhibit ____, or □ Other:
□ Petitioner □ Respondent shall not have parenting time because this would endanger the health and
safety of the child/ren.
□ Any cost of the
□ Parenting time shall be supervised by
supervision shall be paid by □ Petitioner □ Respondent □ Other:
□ Petitioner and Respondent shall each provide contact addresses and contact telephone numbers to the
other and notify each other of any emergency circumstances or substantial changes in the child/ren’s
health.
□ Neither parent shall move to a residence more than 60 miles further distant from the other parent
without giving the other parent reasonable notice of the change of residence and providing a copy of
such notice to the court, or □ the requirement of ORS 107.159 regarding notice of move is suspended
for good cause found.
2. Cash Child Support.
Complete either (a) or (b) below:
(a)
□ Cash child support must be paid by □ Petitioner to Respondent (or) □ Respondent to
Petitioner beginning on the □ first or □
of the month following the date of
the judgment and continuing on the same day of each month thereafter. The total payment per
for
children.
month is $
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The cash child support:
□ Is the amount presumed to be appropriate under the support guidelines.
□ Is different from the presumed appropriate amount of $
reasons)
(b)
because (list
.
□ No cash child support is ordered in this judgment because:
□ An order, □ including medical support, for child support in the monthly amount of
$
has already been ordered in Circuit Court case number
in
County, Oregon.
□ Other reason:
3. Medical Support. Complete section (a) or (b) below. Also complete section (c) or (d) below.
Complete (a) or (b):
(a)
Private Health Care Coverage is Appropriate and Available.
□ Petitioner □ Respondent □ Both Petitioner and Respondent has/have appropriate private
health care coverage available for the parties’ child/ren through an employer, spouse, domestic
partner or other source. □ Petitioner □ Respondent □ Both Petitioner and Respondent is/are
ordered to obtain and/or maintain this coverage throughout the period of the support obligation
for the benefit of the parties’ child/ren.
□ Health care coverage is not ordered in this judgment because it has already been ordered in
another case as described in section 2(b) above.
(b)
No Private Health Care Coverage is Appropriate or Available.
□ Neither Petitioner nor Respondent has appropriate private health care coverage available for
the parties’ child/ren. □ Petitioner □ Respondent □ Both Petitioner and Respondent must
provide appropriate private health care coverage for the child/ren when such coverage becomes
available to them at a reasonable cost through any source.
□ The custodial parent shall enroll or maintain the child/ren in public health care coverage.
Complete (c) or (d):
(c)
Cash Medical Support Ordered.
□ Because the parent receiving cash child support is ordered to maintain private health care
coverage and the parent paying cash child support is not ordered to maintain private health
insurance, in addition to cash child support □ Petitioner □ Respondent must pay $
for cash medical support to □ Petitioner □ Respondent, or
□ Because neither parent has appropriate private health care coverage available for the parties’
child/ren: □ Petitioner must pay cash medical support in the monthly amount of
$
to Respondent and/or □ Respondent must pay cash medical support in the
to Petitioner.
monthly amount of $
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(d)
Cash Medical Support Not Ordered.
□ Cash medical support is not ordered for the following reasons:
□ The parent paying cash child support is also providing health care coverage.
□ Section (e) below requires the parties to share the cost of the child/ren’s uninsured
medical expenses.
□ Petitioner’s □ Respondent’s gross monthly income is at or below the Oregon minimum
wage for full-time employment.
□ Other reason:
(e)
Responsibility for Uninsured Health Expenses.
After the custodial parent pays the first $250 per year per child, □ Petitioner must pay
%
% of the reasonably incurred uninsured health, accidental,
and Respondent must pay
dental, orthodontic, and optical costs incurred by the child/ren, including costs for prescriptions.
This obligation is □ in addition to □ instead of any cash medical support ordered above in
paragraph 2 as part of the child support award.
4. Length of Child Support.
Unless the child becomes self-supporting, emancipated, or married:
□ The support ordered in paragraphs 2 and 3 above for each child shall continue until the child reaches
eighteen (18) years of age.
□ The support ordered in paragraphs 2 and 3 above for each child shall continue until the child reaches
age 21 if the child qualifies for support as a child attending school as defined by Oregon law.
NOTICE ABOUT PERIODIC REVIEWS
If you are receiving child support services through the Department of Justice, either parent may request that the
Department of Justice/Division of Child Support review the amount of support ordered after three years from the
date the order took effect or at any time upon a substantial change of circumstances.
5. Payment of Child Support
Pursuant to ORS 25.378(1), an income withholding order shall be issued to enforce the child support
obligation unless an exception is indicated below.
□ Exceptions to withholding. Income withholding is not ordered at this time because there is no
support arrearage, the paying parent has not previously been granted an exemption from withholding, and:
□ The parents, and the State, if support rights are assigned, have agreed in writing to an alternative
arrangement; or
□ Good cause not to require withholding is found because there is proof of timely payment of
previously-ordered support and income withholding would not be in the best interests of the child.
All payments of child support shall be made (check either (a) or (b) below):
(a)
□ To the Oregon Department of Justice, Child Support Accounting Unit, P.O. Box 14506,
Salem, Oregon, 97309 or □ by electronic payment withdrawal (EPW) or electronic funds
transfer (EFT).
(b)
□ Pursuant to the above exception, directly to □ Petitioner’s □ Respondent’s checking or
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savings account. A receipt of deposit shall be kept by the parent paying support as proof of
payment. A canceled check is also prima facie evidence that payment has been made. The
person receiving support shall provide the paying parent with current deposit slips and/or bank
name, account name and account number.
NOTICE OF INCOME WITHHOLDING
This child support order is enforceable by income withholding under ORS 25.378 to 25.390, 25.414 to
25.372 and 25.375. Withholding shall occur immediately, whenever there is an arrearage at least equal to
the support payment for one month, whenever the obligated parent requests such withholding, or whenever
the obligee requests withholding for good cause. The District Attorney or, as appropriate, the Division of
Child Support of the Department of Justice, will assist in securing such withholding. Exceptions may apply
in some circumstances.
6. Dependents for Tax Purposes.
□ Petitioner □ Respondent shall be entitled to claim the following child(ren) as dependent(s) for tax
purposes beginning the year this judgment is entered (list names):
,
OR
□ Other (specify):
7. Life Insurance Coverage for Child/ren.
□ Petitioner □ Respondent shall obtain and maintain life insurance for the benefit of the parties’
child/ren throughout the period of the support obligation if he/she is insurable. The coverage shall be in the
amount of $
.
NOTICE ABOUT PARENTING TIME AND CHILD SUPPORT
The terms of child support and parenting time (visitation) are designed for the child’s benefit and not the
parents’ benefit. You must pay support even if you are not receiving parenting time. You must comply with
parenting time and visitation orders even if you are not receiving child support.
Violation of child support orders and visitation or parenting time orders is punishable by fine, imprisonment or
other penalties.
Publicly funded help is available to establish, enforce, and modify child support orders. Paternity establishment
services are also available. Contact your local district attorney, the domestic relations court clerk, or the
Department of Justice at 1-800-850-0228 or 503-378-5567 for information.
Publicly funded help may be available to establish, enforce, and modify parenting time or visitation orders.
Forms are available to enforce parenting time or visitation orders. Contact the domestic relations, civil court
clerk or courthouse facilitator for information.
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8. Spousal Support and Life Insurance.
□ No spousal support or spousal life insurance is ordered in this case.
□ The terms indicated on the inserted Supplement to Judgment shall be in effect.
9. 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 9 - 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.
10. 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 10 - 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 10 - Respondent’s Personal Property Distribution continued” attached.
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11. 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 11 - Distribution of Debts continued”.
Each party shall be responsible for the payment of all debts incurred by him/her individually since the
date of the separation; all debts which are distributed to him/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 s/he does so, the spouse/domestic partner responsible for that debt shall
reimburse the other spouse/domestic partner for any monies s/he paid to the creditor after the date this judgment
was entered.
.
The date of separation (when you began living apart) was:
12. 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.
13. Former Name.
□ Petitioner’s □ Respondent’s former name of
is restored.
14. Additional Provisions:
□ Additional page attached labeled “Paragraph 14 - Additional Provisions continued”.
15. 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:
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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.
16. 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.
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 below 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, the Department of Justice or the District Attorney shall not disclose the
information in the following section to the other parent.
□ Otherwise:
Petitioner
Respondent
Full Name
Former Legal Name(s) Do not list here. List the information
on the UTCR 2.130 Confidential
Information Form (CIF).
Do not list here. List the information on
the UTCR 2.130 Confidential Information
Form (CIF).
Age
Address or Contact
Address
Telephone Number
Social Security
Number
Do not list here. List the information
on the UTCR 2.130 Confidential
Information Form (CIF).
Do not list here. List the information on
the UTCR 2.130 Confidential Information
Form (CIF).
Driver License
Number
Do not list here. List the information
on the UTCR 2.130 Confidential
Information Form (CIF).
Do not list here. List the information on
the UTCR 2.130 Confidential Information
Form (CIF).
Employer Name
Do not list here. List the information
on the UTCR 2.130 Confidential
Information Form (CIF).
Do not list here. List the information
on the UTCR 2.130 Confidential
Information Form (CIF).
Do not list here. List the information on
the UTCR 2.130 Confidential Information
Form (CIF).
Employer Address
Do not list here. List the information on
the UTCR 2.130 Confidential Information
Form (CIF).
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Employer Telephone
Do not list here. List the information
on the UTCR 2.130 Confidential
Information Form (CIF).
Do not list here. List the information on
the UTCR 2.130 Confidential Information
Form (CIF).
□ Additional page labeled “Paragraph 16 - Required Information continued” attached.
.
.
Date of marriage/domestic partnership:
Place of marriage/domestic partnership:
17. 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 □
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Type of Judgment
Child Support
Award
Amount of Judgment
WHO PAYS
□ Petitioner
□ Respondent
WHO RECEIVES
□ Petitioner
□ Respondent
Spousal Support
Award
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
1. $
per month starting on □ the first day
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.)
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
///
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Postjudgment
Interest
(Note: ORS
21.607(1)
disallows interest
on fees that have
been deferred.)
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
WHO PAYS
□ Petitioner
□ Respondent
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.
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 $
(date).
to be paid by:
$
WHO RECEIVES
□ Petitioner
□ Respondent
WHO PAYS
□ Petitioner
□ Respondent
$
WHO RECEIVES
□ Petitioner
□ Respondent
DATED this ________ day of ________________________________, 20______.
_______________________________________________
Circuit Court Judge
_______________________________________________
Print Name
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APPLICATION FOR FULL CHILD SUPPORT PROGRAM SERVICES: By signing below, I apply for
child support services, including enforcement, from the Child Support Program(CSP). Check the box in
Paragraph 4(a) if you are requesting accounting and disbursement services only. (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
□ 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
, 20
, (date)
by
(name of person(s)).
Notary Public for
My Commission Expires:
/Court Clerk
□Respondent, Signature
State of
County of
)
)
This instrument was acknowledged before me on
, 20
by
(name of person(s)).
Notary Public for
My Commission Expires:
, (date)
/Court Clerk
□If applicable, child who is at least 18 and under 21 years of age, has agreed (stipulated to the terms of this judgment):
□Child, Signature
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State of
County of
)
)
This instrument was acknowledged before me on
, 20
, (date)
by
(name of person(s)).
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.
for assistance in preparing this form.
□ I paid or will pay money to
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
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