Small Claims Judgment-Money Award Form. This is a Oregon form and can be use in Uniform Trial Court Statewide.
Tags: Small Claims Judgment-Money Award, 15.010.1d, Oregon Statewide, Uniform Trial Court
IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR COUNTY Small Claims Division - _____________________________________________________ (court’s address and phone number) Plaintiff v. Defendant(s) ) ) ) ) ) ) ) ) CASE No. _________________ REQUEST FOR JUDGMENT; NONCOMPLIANCE DECLARATION (NOTE: Complete this and attach a completed Judgment you propose) I, request judgment against Name Other Party’s Name for the following : A total judgment award of $ , which total includes: 1. Money awarded in the amount of $ , 2. Prejudgment interest of $ , 3. Accrued arrearages of $ , if any, , 4. Costs and service expenses of $ 5. A prevailing party fee under ORS 20.190 of $ . I request judgment include postjudgment interest at a rate of % per based on (authority for interest) And, I request the following terms in addition to or in lieu of a money award: G NONE, or I have attached a completed proposed small claims judgment for purposes of this request. I, ___________________________________, hereby swear or affirm that on ____________________________ (date agreement signed) ____________________________________ and I signed a Mediation Agreement which has been entered (Print other party’s name) in this case and which contained the following terms. ________________________________________________ __________________________________________________________________________________________ _____________________________________ has not complied with the agreement by failing to do the following: (print other party’s name) __________________________________________________________________________________________ __________________________________________________________________________________________ I did not keep the other party from following the agreement. I certify that on I mailed a copy (date) of this request to the party against whom I request judgment at (address) I hereby declare that the above statement is true to the best of my knowledge and belief, and that I understand it is made for use as evidence in court and is subject to penalty for perjury. Plaintiff’s Name (print) Dated: _______________________________ _____________________________________________ Authorized Signature Form 15.010.1d – REQUEST FOR JUDGMENT; NONCOMPLIANCE DECLARATION – UTCR 15.010(1)(d) (Revised 8-1-11) American LegalNet, Inc. www.FormsWorkFlow.com