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Stipulation To Modify Parenting Time Order And Supplemental Judgment Form. This is a Oregon form and can be use in Circuit Court Statewide.
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Tags: Stipulation To Modify Parenting Time Order And Supplemental Judgment, 4C, Oregon Statewide, Circuit Court
IN THE CIRCUIT COURT OF THE STATE OF OREGON
FOR THE COUNTY OF __________________
In the Matter of:
)
)
)
)
)
)
)
)
________________________________,
Petitioner,
and
________________________________,
Respondent.
Case No. ______________________
STIPULATION TO MODIFY
PARENTING TIME ORDER; AND
SUPPLEMENTAL JUDGMENT [ORS 107.174]
Based upon the request and stipulation of the parties as shown by the notarized signatures below, and it
appearing to the Court that a judgment of annulment, dissolution of marriage, separation, or establishing
paternity, custody and parenting time, was granted in this case on
case number
, in the
, 20
, in
County Circuit Court, and the parties
jointly request a modification of the parenting time provisions of this judgment; Now, therefore,
IT IS HEREBY ORDERED that:
‘ Father ‘ Mother shall have parenting time with the child/ren in accordance with ‘ the attached
parenting plan, labeled “Exhibit
”, or as follows:
Page 1 of 2, STIPULATION TO MODIFY PARENTING TIME ORDER; AND SUPPLEMENTAL
JUDGMENT [ORS 107.174]
American LegalNet, Inc.
Modification-4C: ModStipJudg4CVer06.wpd (2/04)
www.USCourtForms.com
All other provisions of the decree or judgment shall remain in effect as stated including, but not limited to, all
provisions for custody and support of the minor children of the parties.
‘ Neither parent shall move to a residence more than 60 miles further distant from the other parent
without giving the other parent reasonable notice of the change of residence and providing a copy of such notice
to the court, or ‘ the requirement of ORS 107.159 regarding notice of move is suspended for good cause found.
DATED this ____ day of _____________________, 20_____.
______________________________________
Circuit Court Judge
______________________________________
Print Name
Both parties have agreed to the terms of this Judgment.
Petitioner, Signature
State of
County of
Respondent, Signature
)
)
This instrument was acknowledged before me on
by
, 20
, (date)
(name of person(s)).
____________________________________
Notary Public for ____________/Court Clerk
My Commission Expires: _______________
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.
Submitted by:
___________________________________________________________________________________________
‘ Petitioner ‘ Respondent, Signature
Print Name
___________________________________________________________________________________________
Address or Contact Address
City, State, Zip
Telephone or Contact Telephone
Page 2 of 2, STIPULATION TO MODIFY PARENTING TIME ORDER; AND SUPPLEMENTAL
JUDGMENT [ORS 107.174]
American LegalNet, Inc.
Modification-4C: ModStipJudg4CVer06.wpd (2/04)
www.USCourtForms.com
