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. □ PETITIONER’S □ RESPONDENT’S EX PARTE MOTION FOR ORDER TO SHOW CAUSE REGARDING MODIFICATION OF JUDGMENT RE: □ CUSTODY □ PARENTING TIME □ CHILD SUPPORT Motion I, □ Petitioner □ Respondent, request that the court issue an Order to Show Cause requiring □ Petitioner □ Respondent to appear in Circuit Court in the County Courthouse in , Oregon, to show cause why this court should not grant the following relief concerning the parties’ child/ren: (Name/s and date/s of birth) 1. Change custody of the minor child/ren as follows: a. □ Petitioner □ Respondent to be awarded sole custody of the child/ren (list names and dates of birth): b. □ The parties have agreed to joint custody of the following child/ren (list names and dates of birth): 2. Change the current court-ordered parenting time as follows: a. □ Petitioner □ Respondent should have parenting time with the child/ren □ as set forth in the attached Parenting Plan, labeled Exhibit ____, or □ Other: /// /// □ PETITIONER’S □ RESPONDENT’S EX PARTE MOTION FOR ORDER TO SHOW CAUSE REGARDING American LegalNet, Inc. MODIFICATION OF JUDGMENT - Page 1 of 4 www.FormsWorkFlow.com Modification-4A: MoShowCaus4AVer07.doc (1/08) b. □ Petitioner □ Respondent should not be granted parenting time because this would endanger the health and safety of the child/ren. Supporting facts are as follows: c. □ Parenting time shall be supervised by: □ Any cost of the supervision shall be paid by □ Petitioner □ Respondent □ Other: d. □ Petitioner and Respondent should each provide contact addresses and contact telephone numbers to the other and notify each other of any emergency circumstances or substantial changes in the child/ren’s health. e. □ Petitioner □ Respondent should be allowed to move more than 60 miles further distant from the other parent without advance notice because good cause exists. 3. □ Terminate □ Petitioner’s □ Respondent’s child support obligation due to the requested change in custody. 4. □ Require □ Petitioner □ Respondent to pay child support in the amount of $ per month beginning , 20 , for (list names of children): until the child/ren is/are 18 years of age or otherwise emancipated, or until age 21, so long as the child/ren is/are student(s) attending school as defined in ORS 107.108. The support amount was calculated pursuant to the support guidelines set out in Oregon’s Administrative Rules. The support amount □ does not deviate from the presumed correct amount under the guidelines OR □ Does deviate, and I am requesting the deviation because application of the formula would be unjust or inappropriate in this case because of (check one or more that apply) □ Recurring medical expenses (describe):: □ Other: □ All payments of child support shall be made (check either (a) or (b) below): (a) □ To the Oregon Department of Justice, Child Support Accounting Unit, P.O. Box 14506, Salem, Oregon, 97309 or □ by electronic payment withdrawal (EPW) or electronic funds transfer (EFT). (b) □ An exception to Income withholding is requested because there is no support arrearage, the paying parent has not previously been granted an exemption from withholding, and: (i) □ The parents, and the State, if support rights are assigned, have agreed in writing to an alternative arrangement; or (ii) □ Good cause not to require withholding is found because there is proof of timely payment of previously-ordered support and income withholding would not be in the best interests of the child. Pursuant to the above exception, payment is requested to be made directly to □ Petitioner’s □ Respondent’s checking or savings account. A receipt of deposit shall be kept by the parent paying support as proof of payment. A canceled check is also prima facie evidence that payment has been made. The person receiving support shall provide the paying parent with current deposit slips and/or bank name, account name and account number. /// /// □ PETITIONER’S □ RESPONDENT’S EX PARTE MOTION FOR ORDER TO SHOW CAUSE REGARDING American LegalNet, Inc. MODIFICATION OF JUDGMENT - Page 2 of 4 www.FormsWorkFlow.com Modification-4A: MoShowCaus4AVer07.doc (1/08) 5. Cash Medical Support □ The amount of child support requested above includes cash medical support □ for out of pocket medical expenses exceeding $250 per year per child in the amount of $ and/or □ to reimburse for public health care costs in the amount of $ . (Check if applicable): □ Petitioner □ Respondent and/or □ Child/ren are eligible for public medical assistance and should not be ordered to pay cash medical support. 6. Health Care Coverage 1.) PRIVATE INSURANCE IS AVAILABLE A.) THROUGH ONE PARENT □ Petitioner or □ Respondent has/have appropriate private health care coverage available for the parties’ child/ren either through an employer, union, or other source, or through a domestic partner, spouse or other family member residing with them (describe type of coverage): I request that □ Petitioner □ Respondent be ordered to maintain this coverage throughout the period of the support obligation for the benefit of the parties’ child/ren. B.) THROUGH BOTH PARENTS □ Both Petitioner and Respondent have appropriate private health care coverage available for the parties’ child/ren. I select the following health care coverage to be maintained throughout the period of the support obligation: □ Petitioner’s □ Respondent’s □ Both Petitioner’s and Respondent’s (describe type/s of coverage): 2.) NO PRIVATE INSURANCE IS AVAILABLE NOW □ Neither Petitioner nor Respondent has appropriate private health care coverage available for the parties’ child/ren A.) □ Petitioner □ Respondent □ Both Petitioner and Respondent should be ordered to apply for and enroll the child/ren in public health care coverage. B.) □ Petitioner □ Respondent has already applied to enroll the child/ren in public health care coverage. This coverage should be maintained if the child/ren are accepted for enrollment. C.) □ The child/ren are currently enrolled in public health care coverage. This coverage should be maintained. D.) □ Both Petitioner and Respondent should be ordered to provide appropriate private health care coverage when such coverage becomes available to them through any source. 3.) RESPONSIBILITY FOR UNINSURED HEALTH EXPENSES □ Petitioner should pay % □ and Respondent should pay % of the uninsured HEALTH, ACCIDENT, DENTAL, ORTHODONTIC, AND OPTICAL HEALTH costs incurred by the child/ren. This obligation is in addition to any cash medical support requested in paragraph 5 as part of the child support award. 7. □ Petitioner □ Respondent shall be entitled to claim the following child/ren as dependent/s for tax purposes beginning the year this judgment is entered (list names): , OR □ Other (specify): □ PETITIONER’S □ RESPONDENT’S EX PARTE MOTION FOR ORDER TO SHOW CAUSE REGARDING American LegalNet, Inc. MODIFICATION OF JUDGMENT - Page 3 of 4 www.FormsWorkFlow.com Modification-4A: MoShowCaus4AVer07.doc (1/08) 8. Life Insurance Coverage for Child/ren □ Petitioner □ Respondent should obtain and maintain life insurance for the benefit of the parties’ child/ren throughout the period of the support obligation. The coverage should be in the amount of $ . 9. Court Costs and Fees. (Choose “a” or “b”) Judgment should be entered according to the cost and fee allocation indicated below. a. Deferred Costs and Fees. Any court costs and service fees (if service 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. i. Each party should be responsible for paying his/her own court costs and service fees for this case. ii. □ To be paid by both parties equally iii. □ Petitioner □ Respondent should reimburse the other party for his/her court costs and service fees for this case. iv. □ Other: 10. Preservation of General Judgment Terms. Any terms in the original Judgment not amended by this Supplemental Judgment should remain in effect. Points and Authorities ORS 107.135(1)(a) allows the court to modify custody, parenting time and support terms in a judgment of dissolution. ORS 109.103 extends the provisions of ORS 107.135 to custody and parenting time cases involving the children of unmarried parents. DATED: , 20 . 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. □ Petitioner □ Respondent, Signature Print Name Address or Contact Address Telephone or Contact Telephone City, State, Zip I certify that this is a true copy: □ Petitioner □ Respondent, Signature □ PETITIONER’S □ RESPONDENT’S EX PARTE MOTION FOR ORDER TO SHOW CAUSE REGARDING American LegalNet, Inc. MODIFICATION OF JUDGMENT - Page 4 of 4 www.FormsWorkFlow.com Modification-4A: MoShowCaus4AVer07.doc (1/08)