Transcript
IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF In the Matter of □ the Marriage of: , Petitioner, and
, Respondent.
) ) ) ) ) ) ) ) ) )
Case No.
ACCEPTANCE OF SERVICE
) )ss. )
STATE OF County of I,
, being first duly sworn, say: I am the Respondent in this matter I received a true copy of the Petition and Summons, with attached notices of and on statutory restraining order preventing dissipation of assets, continuation of health coverage, Notice of CIF Filing, mediation and other information provided by the court clerk in the County of , State . of 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. for assistance in preparing this form. □ I paid or will pay money to
Signature of Respondent Address or Contact Address
Print Name City, State, Zip
SIGNED AND SWORN to before me this by
Telephone or Contact Telephone
day of
, 20 .
Notary Public for My Commission Expires:
ACCEPTANCE OF SERVICE - Page 1 of 1 Disso-1BC: AccServ1BCVer03.doc (9/10)
/Court Clerk
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