IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF __________________ In the Matter of the Marriage of: ) ) ) ) ) ) ) ) ________________________________, Petitioner, and ________________________________, Respondent. 1. Case No. ____________________ GOVERNING CHILD SUPPORT JUDGMENT (SUPPLEMENTAL JUDGMENT) This matter came before the court: a. On the Petition of Petitioner Respondent the State of Oregon; b. On the court’s own motion; c. At a hearing held on __________________ (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 Evidence presented Other: , and found that: a. There exist two or more child support judgments involving the same obligor and child/ren and the same time period, copies of which are attached hereto and incorporated herein by reference, as follows: Exhibi t# Agency Case # Court Case # County Entry/ Effective Date Amount of Child Support Ordered Payment Start Date Additional Information about Judgment 1 2 3 4 Additional sheets attached as “Attachment #2(a)-Multiple Judgments.” GOVERNING CHILD SUPPORT JUDGMENT (SUPPLEMENTAL JUDGMENT) - Page 1 of 7 GovernCSJudg-14: GovJudgment14Ver06.doc (9/10) American LegalNet, Inc. www.FormsWorkFlow.com b. The presumption that the terms of the last-issued child support judgment are the controlling terms and supersede contrary terms of each earlier-issued child support judgment has been rebutted as follows: i. The last-issued child support judgment should be set aside under the provisions of ORCP 71 for the following reason(s): 1. The mistake, inadvertence, surprise, or excusable neglect of Petitioner Respondent; 2. There is newly discovered evidence which by due diligence could not have been discovered in time to move for a new trial under Rule 64F; 3. The fraud, misrepresentation or other misconduct of Petitioner Respondent; 4. The judgment is void; 5. The judgment has been satisfied, released or discharged, or a prior judgment upon which it is based has been reversed or otherwise vacated, or it is not longer equitable that the judgment should have prospective application. ii. The last-issued child support judgment was issued without prior notice to the issuing court, administrator or hearing officer that: child/ren, or there was a pending support proceeding involving the there existed another child support judgment involving the child/ren, in this state or any other jurisdiction. iii. The last-issued child support judgment was issued after an earlier child support judgment and did not enforce, modify or set aside the earlier child support judgment in accordance with ORS 25.089. c. Notice has been provided to all affected parties as required by law. IT IS HEREBY ORDERED AND ADJUDGED that: 1. CONTROLLING TERMS. (Choose one.) a. The terms of the last-issued child support judgment dealing with cash child support and medical support (including health insurance and cash medical support) are the controlling terms and supersede contrary terms of each earlier-issued child support judgment (See Exhibit # b. ). The terms of the last-issued child support judgment are the controlling terms and supersede contrary terms of each earlier-issued child support judgment, except that: the last-issued child support judgment is silent about cash child support, and thus the monetary support terms of the preceding judgment issued most recently continue (See Exhibit # ). the last-issued child support judgment is silent about medical support, and thus the medical support terms of the preceding judgment issued most recently continue (See Exhibit # ). GOVERNING CHILD SUPPORT JUDGMENT (SUPPLEMENTAL JUDGMENT) - Page 2 of 7 GovernCSJudg-14: GovJudgment14Ver06.doc (9/10) American LegalNet, Inc. www.FormsWorkFlow.com c. The presumption that the terms of the last-issued child support judgment are the controlling terms having been rebutted, or a substantial change in circumstance having been established by Petitioner Respondent, the controlling terms with respect to cash child support and medical support shall be as follows: i. As contained in the earlier-issued judgment dated (See Exhibit # ii. ). Modified as follows: The effect of this modification on all preceding judgments identified in Paragraph 2(a) above is that all terms contained therein regarding cash child support and medical support are hereby terminated as of the date this judgment is entered, and all other terms that do not relate to cash child support and/or medical support are hereby affirmed, except as follows: 2. EFFECTIVE DATE of CONTROLLING TERMS. The effective date of each controlling term in each of the child support judgments identified in Paragraph 2(a) above is as follows: Exhibit # 1 Controlling Term Effective Date Other Cash Child Support Medical Support 2 Cash Child Support Medical Support 3 Cash Child Support Medical Support 4 Cash Child Support Medical Support Additional sheet attached as “Attachment #2-Effective Dates.” GOVERNING CHILD SUPPORT JUDGMENT (SUPPLEMENTAL JUDGMENT) - Page 3 of 7 GovernCSJudg-14: GovJudgment14Ver06.doc (9/10) American LegalNet, Inc. www.FormsWorkFlow.com 3. ARREARS and/or CREDITS. Check one. The court having determined the validity and effective dates of the judgments identified in Paragraph 2(a) above, monetary support arrears and/or credits for overpayments is reconciled as follows: Exhibit # Effective Dates for Accrual of Child Support (Mo/Yr) Amount of Child Support Arrearage Credits for Overpayments Per Annum Interest Not Already Included Additional sheets attached as “Attachment #3 - Arrears/Credits.” OR The court having determined that one or more of the judgments identified in Paragraph 2(a) above are Agency orders and/or that the Administrator possesses the necessary record of support payments to determine arrears, the establishment of arrears is deferred to the Administrator in a separate proceeding to be commenced by: Petitioner Respondent State of Oregon Other 4. FILING CERTIFIED COPIES WITH THE COURT OR THE CHILD SUPPORT PROGRAM ADMINISTRATOR. Petitioner Respondent Other: shall file a certified copy of this Governing Child Support Judgment with each court and/or the agency that issued an earlier child support judgment. A party who fails to file a certified copy as required by this judgment is subject to monetary sanctions, including but not limited to attorney fees, costs and disbursements. GOVERNING CHILD SUPPORT JUDGMENT (SUPPLEMENTAL JUDGMENT) - Page 4 of 7 GovernCSJudg-14: GovJudgment14Ver06.doc (9/10) American LegalNet, Inc. www.FormsWorkFlow.com 5. Money Award. Child Support Obligation □ included □ not included. 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 GOVERNING CHILD SUPPORT JUDGMENT (SUPPLEMENTAL JUDGMENT) - Page 5 of 7 GovernCSJudg-14: GovJudgment14Ver06.doc (9/10) American LegalNet, Inc. www.FormsWorkFlow.com 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.) 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 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 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 GOVERNING CHILD SUPPORT JUDGMENT (SUPPLEMENTAL JUDGMENT) - Page 6 of 7 GovernCSJudg-14: GovJudgment14Ver06.doc (9/10) American LegalNet, Inc. www.FormsWorkFlow.com 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 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 State of Oregon, 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 State of Oregon, Signature Print Name I certify that this is a true copy: Petitioner Respondent State of Oregon, Signature GOVERNING CHILD SUPPORT JUDGMENT (SUPPLEMENTAL JUDGMENT) - Page 7 of 7 GovernCSJudg-14: GovJudgment14Ver06.doc (9/10) American LegalNet, Inc. www.FormsWorkFlow.com