[Attach to Summons per ORS 109.103(5)] NOTICE OF STATUTORY RESTRAINING ORDER PREVENTING THE DISSIPATION OF ASSETS IN DOMESTIC RELATIONS ACTIONS BETWEEN UNMARRIED PARENTS TO THE PETITIONER AND RESPONDENT: Under ORS 109.103(5) and UTCR 8.080, neither Petitioner nor Respondent may: Insurance Policies (1) Cancel, modify, terminate, or allow to lapse for nonpayment of premiums, any policy of health insurance that one party maintains to provide coverage for the other party or a minor child of the parties, or any life insurance policy that names either of the parties or a minor child of the parties as a beneficiary. Insurance Beneficiaries (2) Change beneficiaries or covered parties under any policy of health insurance that one party maintains to provide coverage for a minor child of the parties, or any life insurance policy. EFFECTIVE DATE: The above provisions are in effect immediately upon service of the Petition and Summons on the respondent. They remain in effect until a final judgment is issued, until the petition is dismissed, or until further order of the court. RIGHT TO REQUEST A HEARING Either Petitioner or Respondent may request a hearing to modify or revoke one or more terms of this restraining order by filing with the court the Request for Hearing re: Statutory Restraining Order form specified in Form 8.080.3 in the UTCR Appendix of Forms. Page 1 - Form 8.080.2 NOTICE OF STATUTORY RESTRAINING ORDER PREVENTING THE DISSIPATION OF ASSETS IN DOMESTIC RELATIONS ACTIONS BETWEEN UNMARRIED PARENTS (8-1-14) REVIEW THIS NOTICE CAREFULLY. BOTH PARTIES MUST OBEY EACH PROVISION OF THIS ORDER TO AVOID VIOLATI NG THE LAW. SEE INFORMATION ON YOUR RIGHT TO A HEARING BELOW. American LegalNet, Inc. www.FormsWorkFlow.com