Dissolution Of Marriage Form – Fill Out and Use This PDF

IN TH E CIRCUIT COURT OF TH E STATE OF OREGON

FOR TH E COUNTY OF

In the Matter of th e Marr iage or Registered Dom estic Partn ership (RDP) of:

Ca s e N o : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Petition er	P ETITION FOR D IS S OLU TION
an d	OF MARRIAGE RD P
	Filin g fees at ORS 21.155 (m arriage) &
	21.135 (RDP)
Respon den t	Claim { is is n ot } subject to
	m an datory arbitration

an d

Un m arried childr en 18 , 19, or 20 years old (per ORS 10 7.10 8 ) (full n am es)

1.My spouse or partn er an d I h ave differen ces so great our m arriage/ RDP can n ot be repaired

2 . R e s i d e n c y

Marriage On ly: □ At least on e spouse curren tly lives in Oregon a n d th at sam e spouse h as lived in Oregon con tin uously for 6 m on th s prior to filin g th is Petition . At least on e spouse curren tly lives in th e coun ty wh ere th is Petition is bein g filed .

Registered Dom estic Partn ersh ip On ly:

□At least on e partn er curren tly lives in Oregon a n d th at sam e partn er h as lived in Oregon con tin uously for 6 m on th s prior to filin g th is Petition . At least on e partn er curren tly lives in th e coun ty wh ere this Petition is bein g filed

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□Neith er partn er curren tly lives in Oregon an d th is Petition is bein g filed in th e coun ty wh ere {□ Petition er □ Respon den t} last lived

3 . Ch ildren of Petition er an d Respon den t con ceived, born , or adopted during or prior to th e m arriage/ RDP an d an y ch ildren oth erwise legally recogn ized as ch ildren of both par ties:

Addition al children listed on page attached titled “Section 3 – Add ition al Children ”

Petition – Dissolution

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Nam e an d age of an y ch ild con ceived or born durin g th is m arriage/ RDP wh o is NOT th e ch ild of both parties

□Neith er party is now pregn an t

□Petition er □ Respon den t is pregn an t (an d) th e oth er party □ is □ is n ot th e paren t of th is ch ild. Th e expected date of th e ch ild’s birth is

4 . By filin g th is petition , I ackn owledge th at I am boun d by th e term s of th e S ta tu to ry Re s tra in in g Ord e r ( S RO) proh ibitin g eith er party from disposin g of m arital/ partn ersh ip assets. I un derstan d th at this restrain in g order is effective as soon as this Pet it ion an d th e S u m m on s are served on Respon den t .

5 . Oth e r Ca s e In fo rm a tio n 5 A. P e n d in g Ca s e s

List an y oth er dom estic relation s case th at h as been started but not yet fin ish ed in an y state between th e parties (in cludin g child or spousal/ partn er support, dissolution (div orce), an n ulm en t, separation , custody , patern ity , juv en ile court, or m odification s)

Nam e of Court or	Case No.		In volves:
			(check all that apply )
Agen cy
			Dissolution , an n ulm en t, or separation
			Spousal/ partn er support
			Ch ild Support
			Custody/ Paren tin g Tim e
			Restrain in g Order
			J uven ile Depen den cy/ Delin quen cy
			Dissolution , an n ulm en t, or separation
			Spousal/ partn er support
			Ch ild Support
			Custody/ Paren tin g Tim e
			Restrain in g Order
			J uven ile Depen den cy/ Delin quen cy
Addition al in form ation attach ed

5 B . Ex is tin g Ord e rs o r J u d gm e n ts

List an y existin g order or judgm en t in th is or an y oth er state between th e parties a n d attach a copy of th e sign ed order or judgm en t (in cludin g child support (w hether or n ot it is curren tly effectiv e), dissolution (div orce), an n ulm en t, separation , custody , patern ity , juv en ile court, m odification , or restrain in g/ protectiv e orders)

	Nam e of Court or	Case No.	Date		In volves:
	Agen cy		Sign ed		(check all that apply )
					Dissolution , an n ulm en t, or separation
					Spousal/ partn er support
					Ch ild Support
	*R esult (if custody / paren t in g tim e):
					Custody/ Paren tin g Tim e*
					Restrain in g Order
					J uven ile Depen den cy/ Delin quen cy

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6 C. List th e places wh ere th e m in o r ch ildren h ave lived in th e last five years, th e n am es of th e people th ey lived with at th at tim e, an d cu r r en t con tact addresses for those people

Cu rre n t:

Ch ild’s Nam e	Curren t Address	Lives with :
		Petition er	Respon den t
		Other: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
		Petition er	Respon den t
		Other: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Re s id e n ce s :

Dates

Coun ty, State

Nam e of

Con tact Address of

Wh ich

From / To

Paren t/ Caretaker

Paren t/ Caretaker

Ch ildren

□Addition al page attached titled “Section 6A-UCCJ EA”

Ad d itio n a l Ca re give rs :

Dates	Nam e of	Wh ere did th ey live	Con tact Address of	Wh ich
From / To	Paren t/ Caretaker	with this caretaker?	Paren t/ Caretaker	Ch ildren

6 D . □ Th e ch ildren listed in Section 3 h ave con tin uously lived in Oregon for th e six m onths before th e filin g of th is Pet it ion , except for th e children n am ed below

Th e followin g ch ildren have n o t live in Oregon con tin uously for six m on ths: (n am es)

Th ere is an oth er basis for Oregon to address th ese ch ildren . Explain :

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8 . S u p p o rt

A.Ch ild S u p p o rt

Th ere IS an existin g ch ild support order in th e m on th ly am oun t of $

from (county , state)

Th e court case # is			an d th e Ch ild
Support Program (CSP)# is

I do n ot wan t to ch an ge th is am ount (sk ip to section 8 D, below )

I do wan t to ch an ge th is am oun t because circum stan ces h ave ch an ged sign ifican tly sin ce th e order was issued . Explain the change

(fill in the section s below w ith the n ew am oun t y ou a re r equestin g)

( o r )

There IS NOT an existing child support order from any other court or agency

I am n ot requestin g ch ild support because

(sk ip to section 8 E, below )

I am requesting ch ild support (fill in the section s below )

A. 1. S u p p o rt (in cluding Cash M edical Support, see in struction s) is p re s u m e d to b e u n a va ila b le because th e paren t wh o would pay (check all that apply ):

receives cash paym en ts from a p u b lic a s s is ta n ce program in cludin g TANF or SSI

is (or is expected to be) in c a rce ra te d (in jail or prison for at least 6 m on th s) an d h as incom e less th an $ 20 0 per m onth

Support should be ordered despite th e presum ption (explain w hy an d com plete section 8 .A.2, below ):

A. 2 . S u p p o rt s h o u ld b e o rd e re d p a ya b le :
b y	Petition er		Respon den t
to	Petition er		Respon den t	Adult Ch ild Atten din g School (n am e):
o n th e first day of each m on th
b e gin n in g		th e m on th followin g en try of th is judgm en t or			th e date of service

of th is Petition

Th e total m on th ly am oun t should be:

Determ in ed un der th e Oregon ch ild support guidelin es prior to judgm en t

, wh ich is (check on e)

th e am ount presum ed correct as reflected on th e ch ild support guidelin e worksh eets attach ed to th is petition ( o r )

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□differen t from th e am oun t presum ed correct by th e ch ild support guidelin es because th e guidelin e am oun t would be un just or in appropriate (exp la in ):

B . Me d ic a l S u p p o rt

Medical support h as already been ordered in an oth er case as n oted in Section 4 above Th e existin g order should n ot be ch an ged . (sk ip to Section C below )

Th e existin g order should be ch an ged (fill out the section s below ). I h ave also requested a ch an ge of child support above.

If m edical support has n ot been ordered in an other case, com plete sections below

B . 1. H e a lth In s u ra n c e Co ve ra ge

Petition er Respon den t both paren ts should be ordered to provide h ealth in suran ce coverage th roughout th e period of th e ch ild support obligation

Ca s h Me d ic a l S u p p o rt

(If health in suran ce is n ot av ailable, then the paren t w ho is ordered to pa y child support w ill also be order ed to pay cash m edical support accordin g to the Child Support Guidelin es un less t he court fin ds reason n ot to)

Cash Medical Support should n o t be ordered because:

Support is presum ed to be un available for th e reason m arked in

Section 8 .A.1, above (N ote: if y ou ask ed that support be aw arded an y w ay , do n ot m ark this box)

th e paren t payin g ch ild support h as in com e at or below Oregon ’s m in im um wage for full-tim e em ploym en t, so cash m edical support should n ot be ordered

Th e children ’s m edical n eeds will be m et by th e Un in sured M edical

Expen ses provision below

Oth er (explain):
B . 2 . U n in s u re d Me d ic a l Exp e n s e s
Un in sured m edical expen ses should n ot be awarded
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Petition er should pay	% an d Respon den t should pay	% of th e

un reim bursed costs of the ch ildren ’s reason able m edical, den tal, an d vision care. Th is does n ot include ordin ary expen ses like n on prescription m edication , ban dages, vitam in s, an d copays for regular ch eckups, wh ich th e paren ts are presum ed to provide for th e ch ildren in proportion to th eir paren tin g tim e. Th is obligation is in addition to an y ch ild support a n d will be o ffs e t by an y cash m edical support ordered above.

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Th is obligation should be in a d d itio n to an y ch ild support an d cash m edical support ordered above

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C.P a ym e n t

How should payments be made?

Iun derstand th at paym en ts will be m ade by in com e withholdin g un less an exception applies

□ I request an exception to th e in com e with holdin g requirem en t of ORS 25.378 so th at paym en t can be m ade an oth er way because good cause exists

Petition er an d Respon den t h ave agreed in writin g to th e followin g altern ative paym en t m ethod (exp la in ):

Oth er exception un der ORS 25.396 (exp la in ):

Where should payments go?

All support paym en ts should be m ade to th e Departm en t of J ustice, Ch ild Support Accoun ting Un it, P.O. Box 1450 6, Salem , Oregon , 9730 9

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An exception to in com e with holdin g applies as noted above. All support paym en ts should be m ade to th e recipien t’s ch eckin g or savin gs accoun t . Th e receivin g paren t should be ordered to provide th e payin g paren t with curren t deposit slips or ban k n am e, account n am e, an d accoun t n um ber.

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Oth er (explain):

(on ly av ailable if y ou request an exception to in com e w ithholdin g, abov e)

A d u l t Ch i ld A t t e n d i n g S c h o o l

Th e Division of Ch ild Support (DCS)sh ould pay support for an adult ch ild atten din g school directly to th e ch ild un less good cause exists for paym en t to be m ade an oth er way

GOOD CAUSE exists for DCS n ot to pay support directly to a child atten din g school (explain ):

D . Le n gth o f c h ild s u p p o rt

Support should en d wh en th e last ch ild (check on e):

reach es age 18 , or if th e ch ild qualifies as a ch ild atten din g school un der ORS 10 7.10 8 , age 21

reach es age 18

or becom es self-supportin g, em an cipated, or m arried

E. Ta x D e p e n d e n ts

(N ot e that the judgm en t is n ot bin din g on the IR S an d w ill n ot prov ide a defen se if the parties fail to com ply w ith IR S r egulation s in an y giv en tax y ear . Sp eak to a law y er or tax profession al.)

Petition er

Respon den t should be permitted to claim th e followin g ch ildren

as depen den ts for tax purposes begin n in g with the ta x year th is judgm en t is

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en tered . Th e oth er parent m ust com plete an y IRS waivers or form s n ecessary to accom plish th is order in each tax year an d m ust not file contradictory tax return s. List n am es:

OR

Oth er (specify ):

F. Life In s u ra n c e Co ve ra ge fo r Ch ild re n

□Th e party payin g support should carry life in suran ce for th e ben efit of th e parties’ ch ildren throughout th e period of th e support obligation . Th e coverage should be in th e am ount of $

9 . Ad d itio n a l P ro vis io n s

□Addition al page attached titled “Section 9 - Addition al Provision s”

S P O U S A L / P A R TN ER S U P P O R T

10 . S p o u s a l/ P a rtn e r S u p p o rt a n d Life In s u ra n c e

A.S u p p o rt

No spousal/ partn er support is requested o r

Spousal/ partn er support should be paid by □ Petition er to Respon den t (or)

□Respon den t to Petition er

Ty pe of Support:	Pay m en t Term s:*			Based on these factors:
Tran sition al			m on thly paym en ts begin n in g the m on th
		followin g:
$ _ _ _ _ _ _ _ _ _
			en try of this judgm en t or
			the date of ser vice of this Petition
		 or _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
		En din g*:
		Or	lum p sum pa y able by
		(date): _ _ _ _ _ _ _ _ _ _ _ _ _
Com pen satory			m on thly paym en ts begin n in g the m on th
		followin g:
$ _ _ _ _ _ _ _ _ _
			en try of this judgm en t or
			the date of ser vice of this Petition
		 or _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
		En din g*:
		Or	lum p sum pa y able by
		(date): _ _ _ _ _ _ _ _ _ _ _ _ _
M ain ten an ce			m on thly paym en ts begin n in g the m on th
		followin g:
$ _ _ _ _ _ _ _ _ _
			en try of this judgm en t or
			the date of ser vice of this Petition
		 or _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

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En din g*:

Or lum p sum pa y able by (date): _ _ _ _ _ _ _ _ _ _ _ _ _

*All m on thly pay m en ts are due by the 1st of the m on th . All pay m en ts en d on the death of either party (un less an earlier ev en t is specified abov e)

Choose ONE option:

All support paym en ts sh ould be m ade directly in to recipien t’s ch eckin g or savin gs accoun t . Th e spouse or partn er receivin g support m ust provide th e payin g spouse or partn er with eith er curren t deposit slips or th eir ban k n am e, accoun t n am e, an d accoun t n um ber .

To th e Departm en t of J ustice, Ch ild Support Accoun tin g Un it, PO Box 1450 6, Salem , OR, 9730 9. Th e Departm en t of J ustice should provide all collection , accoun ting, disbursem en t, an d en forcem en t services.

C.Life In s u ra n c e

□Th e party payin g support should carry life in suran ce for th e ben efit of th e oth er party th roughout th e period of th e support obligation . Th e coverage should be in th e am ount of $

P R O P ER TY A N D D EB T S

11. Re a l P ro p e rty

□Neith er party h as an y in terest in an y real property in Oregon or an y oth er place

□Both parties h ave or {□ Petition er □ Respon den t h as} an in terest in real property at:

(address)

□Addition al page attached titled “Section 11 - Real Property”

□Th e legal description of th e real property is attach ed as Exh ibit _ _ _ an d in corporated in th is petition

12 . P e rs o n a l P ro p e rty

(R etirem en t ben efits can be div ided . See a law y er if y ou w an t to do that .)

□Th e Petition er an d Respon den t h ave divided between th em all person al property th at th ey own . Th is includes all person al effects, household goods, m otor veh icles, pets, an d oth er item s of property. Neith er party should claim item s n ow in th e possession of th e oth er.

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□Petition er an d Responden t should be awarded an equitable distribution of th e parties’ person al property. Th is in cludes retirem en t ben efits, pen sion plan s, profit -sh aring plan s, deferred -com pen sation plan s, an d stock option plan s h eld by th e parties.

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□Th e parties’ person al property sh ould be divided as follows, with equitable distribution of an y property n ot listed:

□Petition er should be awarded th e followin g person al property:

□Addition al page attached titled “Section 12 - Petition er’s Person al Property”

□Petition er sh ould be awarded all of Petition er’s retirem en t ben efits, pension plan s, profit -sh aring plan s, deferred -com pen sation plans, an d stock option plan s h eld by Petition er’s em ployer, free of an y in terest by Respon den t.

□Respon den t should be awarded th e followin g person al property:

□Addition al page attached titled “Section 12 – Respon den t’s Person al Property”

□Respon den t should be awarded all of Respon den t’s retirem en t ben efits, pen sion plan s, profit -sh aring plan s, deferred -com pen sation plans, an d stock option plan s h eld by Respon den t’s em ployer, free of an y in terest by Petition er .

13 . D is trib u tio n o f D e b ts		Debts sh ould be paid as follows:
	Nam e of Creditor	Wh at debt is for	Am oun t		Who sh ould pay (Petition er or
					Respon den t)
	(wh o debt is owed to)

□Addition al page attached titled “Section 13 - Distribu tion of Debts”

Each spouse or partn er sh ould be responsible for th e paym en t of all debts in curred individually sin ce th e date of th eir separation, all debts distributed to h im or h er by th e court, a n d all debts secured by property distributed to h im or h er

Debts should be divided as of (d a t e):

Tra n s fe r o f D e b ts a n d P ro p e rty

Each party sh ould be ordered to com plete all property tran sfers required by th e judgm en t with in

30days of th e date of judgm en t . Each should execute, ackn owledge, an d deliver wh atever docum en ts are n ecessary to accom plish th e distribution of debts an d property ordered by th e court . Th e judgm en t sh ould operate to con vey title if th e eith er party fails to com ply with th is requirem en t .

14 . Fo rm e r N a m e
□ My form er n am e of	should be restored

(w rite the FULL n am e – fir st, m iddle, an d last)

15 . In fo rm a tio n re q u ire d b y ORS 10 7. 0 8 5

Age of Petition er:			Age of Respon den t:
Respon den t’s contact address:

Petition – Dissolution

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