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Response And Counterclaim To Petition For Annulment (With Children) (17D) Form. This is a Oregon form and can be use in Circuit Court Statewide.
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Tags: Response And Counterclaim To Petition For Annulment (With Children) (17D), Oregon Statewide, Circuit Court
IN THE CIRCUIT COURT OF THE STATE OF OREGON
FOR THE COUNTY OF __________________
In the Matter of the Marriage of:
________________________________,
Petitioner,
and
________________________________,
Respondent.
1.
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Case No. ____________________
RESPONSE AND COUNTERCLAIM
TO PETITION FOR ANNULMENT
[WITH CHILD/REN]
Respondent appears and agrees with the petition for annulment filed in this case, except paragraph(s):
Additional page attached labeled “Paragraph 1, continued.”
2.
Respondent makes the following counterclaim(s):
(a)
(b)
Additional page attached labeled “Counterclaims, continued”.
3.
Child Support:
Social Security or apportioned Veterans benefits are paid to or on behalf of the child/ren in the
amounts listed below as a result of my disability or retirement, and I request that child support be reduced dollar
for dollar.
Child’s Name:
Amount of Benefit received by child: $
Child’s Name:
Amount of Benefit received by child: $
Child’s Name:
Amount of Benefit received by child: $
Survivors’ and Dependents’ Educational Assistance under 38 USC chapter 35 is paid to or on behalf
of the child/ren in the amounts listed below as a result of my disability or retirement, and child support must be
reduced dollar for dollar.
Child’s Name:
Amount of monthly assistance received: $
Child’s Name:
Amount of monthly assistance received: $
Child’s Name:
Amount of monthly assistance received: $
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RESPONSE AND COUNTERCLAIM TO PETITION FOR ANNULMENT [WITH CHILD/REN] - PAGE 1 OF 3
Annul-17D: Response17DVer01.doc (3/08)
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4.
(Optional) Exception to Income Withholding of Child Support: Respondent requests an exception to
the income withholding requirement of ORS 25.378 as follows:
Allowing payment to be made by electronic funds transfer (EFT) to the Department of Justice (this
option is the only one permitted if support enforcement services are being provided to either party).
Allowing payment to be made directly to Husband’s Wife’s checking or savings account (this
option is allowed only if support enforcement services are not being provided to either party). A receipt of
deposit should be kept by the parent paying support as proof of payment. The parent receiving support should
provide the paying parent with current deposit slips and/or bank name, account name, and account number.
State facts in support of your request for an exception to income withholding:
5.
Information Required by the Uniform Child Custody Jurisdiction and Enforcement Act.
List the places where the minor child/ren of the parties have lived in the last five years and the names of
the people they lived with at that time.
Dates
County, State
Parent(s)/Caretaker
Current Address or Contact
Address of Parent/Caretaker
Which Child/ren
Additional page attached; see section labeled “UCCJEA Information Continued”.
I have have not participated in any litigation concerning the custody, visitation, parenting time or
placement of the child/ren in this or any other state. I have participated in the following litigation:
Name of Court
State
Case No.
Date
Result
I do not know of any other domestic violence, custody, visitation, parenting time or placement
proceeding involving the child/ren, or of any other court case which could affect this case, pending in this or
any other state except for:
(identify court, case number and kind of proceeding)
I do not know any person other than my spouse who has physical custody of the child/ren or who claims
to have custody, visitation or parenting time rights except for:
(list name and address)
RESPONSE AND COUNTERCLAIM TO PETITION FOR ANNULMENT [WITH CHILDREN] - PAGE 2 OF 3
Annul-17D: Response17DVer01.doc (3/08)
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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.
STATE OF OREGON
)
) ss.
County of _____________________ )
I, _______________________________, being duly sworn, say that I am the Respondent in this matter,
and that the statements in this Response are true and correct to the best of my knowledge.
Signature
Address or Contact Address
Print Name
City, State, Zip
Telephone or Contact Telephone
SIGNED AND SWORN to before me this _________ day of ______________, 20_____,
by _________________________________________________.
Notary Public for ____________/Court Clerk
My Commission Expires:
I certify that this is a true copy:
Respondent, Signature
RESPONSE AND COUNTERCLAIM TO PETITION FOR ANNULMENT [WITH CHILD/REN] - PAGE 3 OF 3
Annul-17D: Response17DVer01.doc (3/08)
American LegalNet, Inc.
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