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Affidavit For Deferral Of Costs-Fees - Oregon
| Affidavit For Deferral Of Costs-Fees Form. This is a Oregon form and can be used in Fee Deferral Circuit Court Marion Local County . |
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IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE THIRD JUDICIAL DISTRICT ___________________________________,) Plaintiff/Petitioner,) AFFIDAVIT FOR DEFERRAL ) OF COSTS/FEES v. ) ) Case No. ___________________________________________________________,) Defendant/Respondent.) I swear/affirm that I am the Plaintiff/Petitioner Defendant/Respondent, that Iam unable to pay necessary fees, that I support ______ people, and that my assets, monthly income, and expenses are as follows: 1. Name, age and relationship of people I am supporting: __________________________________________________________________ __________________________________________________________________ 2. Date of Birth: _______________________________ Oregon Drivers License Number: _______________ 3. Employer Names: ___________________________________________________ Employer Address: __________________________________________________ __________________________________________________ Length of Employment: _______________________ Monthly Pay (Net): ___________________________ 4. All other income (including spouses income): Monthly Total: ______________________ Sources: __________________________________________________________ AFFIDAVIT FOR DEFERRAL OF COSTS/FEES - Page 1 of 2 FC(9/10/03)<<<<<<<<<********>>>>>>>>>>>>> 2 5. All other assets: What it is worth What you owe Real Property: _________ ________ Motor Vehicles: _________ ________ Other Property (guns, jewelry, stocks, bonds, etc.): ____________________________________________________________ ____________________________________________________________ 6. Bank Accounts and Cash: ____________________________________________ 7. Money owed to me or my spouse by others: ______________________________ __________________________________________________________________ 8. Expenses, Monthly: Housing $ _________ owed to ______________________________ Car Pmts $ _________ owed to ______________________________ Loan Pmts $ _________ owed to ______________________________ $ _________ owed to ______________________________ $ _________ owed to ______________________________ Other Living Expenses: $ _________ for __________________________________ $ _________ for __________________________________ $ _________ for __________________________________ $ _________ for __________________________________ DATED this _____ day of _________________________, _______. ____________________________________ Signature ____________________________________ Printed/Typed Name ____________________________________ Address ____________________________________ City/State/Zip ____________________________________ Telephone Number Subscribed and sworn to before me this _____ day of ____________________, _____. ____________________________________ Deputy Clerk of Court/Notary Public My Commission Expires: ______________AFFIDAVIT FOR DEFERRAL OF COSTS/FEES - Page 2 of 2 FC(9/10/03)
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