IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF In the Matter of the Marriage of: , Petitioner, and , Respondent. ) ) ) ) ) ) ) ) Case No. PETITIONER'S CERTIFICATE OF MAILING TO THE DIVISION OF CHILD SUPPORT I certify that on , 20 , I mailed a true copy of the Ex Parte Motion for Order to Show Cause re: Modification of Judgment in the above case to the local branch office of the Department of Justice, Division of Child Support (list address): 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 . Petitioner, Signature Print Name Address or Contact Address City, State, Zip Code Telephone or Contact Telephone PETITIONER'S CERTIFICATE OF MAILING TO THE DIVISION OF CHILD SUPPORT - PAGE 1 OF 1 Modification-4A: CertMail4AVer01.doc (1/08) American LegalNet, Inc. www.FormsWorkFlow.com