Judgment 226 Fee Deferral or Waiver Page 1 of 2 (Aug 2019) IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF Case No: Plaintiff /Petitioner LIMITED SUPPLEMENTAL v. JUDGMENT AND MONEY AWARD RE: DEFERRED FEES Defendant /Respondent The court awards judgment for the State of Oregon and against the judgment debtor for the unpaid amount of: Filing Fees S heriff222s Service Fee Motion Fee Arbitration Fee Trial Fee Other (describe) : MONEY AWARD 1. Judgment Creditor: State of Oregon, (name and address of this court): a. Judgment Creditor222s lawyer (name, address, phone number) 2. Judgment Debtor Name Address Year of Birth SSN (last 4 digits) or Full Tax ID Driver License # (last 4) & State Lawyer ( name and bar #) 3. The total amount awarded by this judgment is $ . This amount does not include interest, attorney fees, or prevailing party fees. No interest will accrue post-judgment. Additional collection costs may be added without further notice to judgment debtor under ORS 1.202. Judge Signature: American LegalNet, Inc. www.FormsWorkFlow.com Judgment 226 Fee Deferral or Waiver Page 2 of 2 (Aug 2019) Certificate of Readiness This proposed judgment is ready for judicial signature because service is not required under UTCR 5.100 because this judgment is submitted ex parte as allowed by statute or rule Submitted by: plaintiff/petitioner defendant/respondent other: Signature Print Name I understand that I am subject to penalty for perjury for giving false information to the court. All factual information in this Judgment is true to the best of my knowledge and belief. I agree to the terms of this Judgment. I understand that this Judgment is enforceable by the court. Date Signature Name (printed) Contact Address City, State, ZIP Contact Phone American LegalNet, Inc. www.FormsWorkFlow.com