IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF In the Matter of □ the Marriage of: ________________________________, Petitioner, and ________________________________, Respondent. STATE OF County of ) ) ) ) ) ) ) ) Case No. PETITIONER’S AFFIDAVIT SUPPORTING GENERAL JUDGMENT OF SEPARATION ) ) ss. ) I, , being first duly sworn, say: I am the petitioner in this proceeding. The parties were married/registered on (date): , in the County of , State of . □ Irreconcilable differences between us have caused a temporary or unlimited breakdown of our 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. 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. □ No domestic relations suits involving this marriage/domestic partnership of Petitioner and Respondent are pending in any other court.  There are no unemancipated child/ren under the age of 18 to this marriage/domestic partnership, and no child of this marriage/domestic partnership is age 18 to 21 and a “child attending school” as defined in ORS 107.108. □ Neither party is now pregnant. /// PETITIONER’S AFFIDAVIT SUPPORTING JUDGMENT OF SEPARATION - PAGE 1 OF 2 Separation-2B: AffJudgment2BVer02.doc (3/08) American LegalNet, Inc. www.FormsWorkflow.com □ Respondent has not appeared in this matter and an Order of Default has been entered. □ Respondent filed a response and later □ signed and filed a Waiver of Further Appearance and Consent to Entry of Judgment, (or) □ has waived further hearing by stipulating to the terms of the Judgment. This case is now ready for a hearing on the merits. I make this affidavit in support of a Supplemental Judgment of Separation without a hearing. The allegations in my Petition are true and it is just and reasonable that the relief requested be granted in the proposed judgment. □ The request for spousal support is supported by the following facts: □ I request that personal information, such as telephone number, address and employment information, not be disclosed in the court’s judgment as otherwise required by ORS 25.020 and ORS 107.085 because my health, safety or liberty, or that of my child/ren would unreasonably be put at risk by such disclosure. State supporting facts: 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 form myself, and I completed it without paid assistance. □I paid or will pay money to for assistance in preparing this form. Dated: , 20 . Petitioner’s Signature Address or Contact Address Print Name City, State, Zip SIGNED AND SWORN to before me this Telephone or Contact Telephone day of , 20 , by Notary Public for My Commission Expires: /Court Clerk I certify that this is a true copy: Petitioner Signature PETITIONER’S AFFIDAVIT SUPPORTING JUDGMENT OF SEPARATION - PAGE 2 OF 2 Separation-2B: AffJudgment2BVer02.doc (3/08) American LegalNet, Inc. www.FormsWorkflow.com