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) ) Case No. PETITION FOR SEPARATION DOMESTIC RELATIONS CASE SUBJECT TO FEE UNDER ORS 21.111 CLAIM □ SUBJECT □ NOT SUBJECT TO MANDATORY ARBITRATION 1. Date of marriage/domestic partnership: . (County, State) . Place of marriage/domestic partnership: 2. (Check the box/es that apply) □ Irreconcilable differences between the Petitioner and Respondent have caused a temporary or unlimited breakdown of the marriage/domestic partnership. □ The parties have entered into an agreement that will be filed with the court suspending for a period of not less than one year our obligation to live together as husband and wife/domestic partners. □ Irreconcilable differences exist between the parties and the continuation of the marriage/domestic partnership preserves or protects their legal, financial, social or religious interests. 3. Certificate of Residency. Marriage Only: □ I certify that one or both of the parties to this case currently live in the county in which this petition is being filed. Domestic Partnership Only: □ I certify that one or both of the parties to this case currently live in the county in which this petition is being filed, or □ neither party currently resides in Oregon but I certify that this petition is filed in the county where □ Petitioner or □ Respondent last resided. 4. No other domestic relations suit or support proceeding involving this marriage is pending in this or any other state PETITION FOR SEPARATION – DOMESTIC RELATIONS CASE SUBJECT TO FEE UNDER ORS 21.111 American LegalNet, Inc. PAGE 1 OF 5 Separation-2B: Petition2BVer07.doc (3/08) www.FormsWorkflow.com 5. By filing this petition, I acknowledge that I am bound by the terms of the statutory restraining order prohibiting either party from disposing of marital/partnership assets, a copy of which I have received and read, and understand that this restraining order is effective immediately upon service of this petition and the summons upon the Respondent. 6. There are no children under the age of 18 to this marriage, OR no child of this marriage is age 18 to 21 and a “child attending school” as defined in ORS 107.108. 7. Spousal Support and Life Insurance. Spousal Support. Support should 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 □ maintenance based on consideration of the following factors (list): Spousal support payments are taxable to the obligee spouse and deductible to the obligor spouse. All payments terminate upon the death of either party. Payments. Payments should 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 should be made: (check (a) or (b)) (a) □ To the Department of Justice, Child Support Accounting Unit, P.O. Box 14506, Salem, Oregon, 97309. Petitioner requests that collection, accounting, disbursement, and enforcement services be provided through the Department of Justice. (Required if child support is paid through the state.) (b) □ Directly into ’s checking or savings account. A receipt of deposit should be kept by the paying spouse/domestic partner as proof of payment. The spouse/partner receiving support should provide the paying spouse/partner with current deposit slips and/or bank name, account name, and account number. Withholding. □ If child support is also ordered in this case and if enforcement services are provided through the State of Oregon’s Department of Justice, the spousal support order should be enforceable by income withholding under ORS 25.378. Life Insurance. □ Petitioner □ Respondent should buy and maintain life insurance for the benefit of □ Petitioner □ Respondent throughout the period of the spousal support obligation, in the amount of $ . PETITION FOR SEPARATION – DOMESTIC RELATIONS CASE SUBJECT TO FEE UNDER ORS 21.111 American LegalNet, Inc. PAGE 2 OF 5 Separation-2B: Petition2BVer07.doc (3/08) www.FormsWorkflow.com 8. Real Property. □ Neither Petitioner nor Respondent has any interest in any real property located in this or any other state. □ Petitioner □ Respondent has/have an interest in real property located at the address of: This property should be distributed: □ equitably, or □ as follows: □ Additional page labeled “Paragraph 8 - Real Property continued” attached. □ The legal description of the real property is attached as Exhibit ___ and incorporated in this petition. □ Distribution of this property is not within the jurisdiction of this court. 9. Personal Property (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 neither should claim those items now in possession of the other. The Petitioner should be awarded: □ an equitable distribution of the parties’ personal property, or □ the following personal property: □ Additional page labeled “Paragraph 9 - Petitioner’s Personal Property Distribution continued” attached. □ The Petitioner should be awarded his/her retirement benefits, pension plan, profit-sharing plan, deferred-compensation plan, and /or stock option plan held by Petitioner’s employer, free of any interest in the Respondent. The Respondent should be awarded: □ an equitable distribution of the parties’ personal property, or □ the following personal property: □ Additional page labeled “Paragraph 9 - Respondent’s Personal Property Distribution continued” attached. □ The Respondent should be awarded his/her retirement benefits, pension plan, profit-sharing plan, deferred-compensation plan, and/or stock option plan held by Respondent’s employer, free of any interest in the Petitioner. □ Additional page attached; see section labeled “paragraph 9 continued.” 10. Distribution of Debts. □ There are no outstanding debts of this marriage/domestic partnership. □ The debts should be paid as follows: Name of Creditor (who debt is owed to) What debt is for Amount Who should pay (Petitioner or Respondent) PETITION FOR SEPARATION – DOMESTIC RELATIONS CASE SUBJECT TO FEE UNDER ORS 21.111 American LegalNet, Inc. PAGE 3 OF 5 Separation-2B: Petition2BVer07.doc (3/08) www.FormsWorkflow.com Name of Creditor (who debt is owed to) What debt is for Amount Who should pay (Petitioner or Respondent) □ Additional page attached, labeled, “Paragraph 10 continued”. Each spouse/partner should be responsible for the payment of all debts incurred by him/her individually since the date of their separation; all debts which are distributed to him/her by the court; and all debts which are secured by property distributed to that spouse/partner. Also, if any creditor asks the spouse/partner not responsible for a debt to pay all or a portion of it, and he/she does so, the spouse/partner responsible for that debt should reimburse the other spouse/partner for any monies he/she paid to the creditor after the date of the judgment. 11. Transfer of Debts and Property. Within 30 days of the date of judgment, each party should execute, acknowledge, and deliver whatever documents are necessary to accomplish the distribution of debts and property ordered by the court. The judgment should operate to convey title to the spouse/partner awarded the property if the other spouse/partner fails to comply with this requirement. 12. 13. Former Name. □ ’s former name of should be restored. Duration. □ The separation should be □ unlimited □ for a period of (fill in amount of time) 14. Information Required by ORS 25.020 and ORS 107.085. □ Disclosure of the following information would unreasonably put to risk the health, safety, or liberty of □ Petitioner □ Respondent or a child for the following reasons: □ Otherwise: (Fill out the information in the table below) Petitioner Respondent Full Name Former Legal Name(s) Age Address or Contact Address Telephone Number Social Security Number Do not list. Provide by UTCR 2.100 Affidavit. Do not list. Provide by UTCR 2.100 Affidavit. Drivers License Number PETITION FOR SEPARATION – DOMESTIC RELATIONS CASE SUBJECT TO FEE UNDER ORS 21.111 American LegalNet, Inc. PAGE 4 OF 5 Separation-2B: Petition2BVer07.doc (3/08) www.FormsWorkflow.com Petitioner Respondent Employer Name Employer Address Employer Telephone □ Additional page labeled “Paragraph 14 continued” attached. 15. Court Costs and Fees. A. Deferred Costs and Fees Any court costs and service fees (if service is completed by the Sheriff) that are deferred (required to be paid at a later date) by the court should be paid by: □ Petitioner □ Respondent □ Both parties equally □ Other: B. Costs and Fees Paid by the Parties □ Each party should be responsible for paying his or her own court costs and service fees for this case. □ To be paid by both parties equally □ Petitioner □ Respondent should reimburse the other party for his/her court costs and service fees for this case. □ Other: Judgment should be entered according to the cost and fee allocation listed above. 16. 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. WHEREFORE, Petitioner requests a Judgment granting the relief asked for above, and other equitable relief that the Court thinks is just. STATE OF County of ) ) ss. ) I, , being duly sworn, say that I am the petitioner in this matter and that the foregoing petition is true and correct to the best of my knowledge. Petitioner (signature) Print Name Address or Contact Address City, State, Zip Code Telephone or Contact Telephone SIGNED AND SWORN to before me this day of , 20 by Notary Public for My Commission Expires: I certify that this is a true copy: /Court Clerk , Petitioner (signature) PETITION FOR SEPARATION – DOMESTIC RELATIONS CASE SUBJECT TO FEE UNDER ORS 21.111 American LegalNet, Inc. PAGE 5 OF 5 Separation-2B: Petition2BVer07.doc (3/08) www.FormsWorkflow.com