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Petitioners Sworn Statement Of Eligibility - Oregon
| Petitioners Sworn Statement Of Eligibility Form. This is a Oregon form and can be used in Circuit Court Multnomah Local County . |
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PETITIONER'S SWORN STATEMENT OF ELIGIBILITY (This sworn statement must be filed with the DUII diversion petition and agreement) (To be filled in by petitioner, please print or type:) Circuit Court Court Name Multnomah County Court Location Court Case Number Being duly sworn to tell the truth, I, the undersigned, do hereby swear that I am eligible to participate in a Driving W hile Under the Influence of Intoxicants (DUII) Diversion Program in the case described above, and that: 1. On the date I file the attached petition for a DUII diversion agreement, there is no other charge for an offense of DUII or its statutory counterpart pending against me in this state or in any other place except the charge for the present DUII offense described in that petition; From the date I file the attached petition for a DUII diversion agreement going back to ten (10) years before the date of the alleged commission of the present offense of DUII, I have not been convicted of and have not forfeited bail or security on a charge for the offense of DUII or its statutory counterpart in this state or in any other place; On the date I file the attached petition for a DUII diversion agreement, I am not participating in a DUII diversion program or in any similar alcohol or drug rehabilitation program in this state or in any other place except a program I may have entered as a result of the charge for the present offense of DUII; From the date I file the attached petition for a DUII diversion agreement going back to ten (10) years before the date of the alleged commission of the present offense of DUII, I have not participated in a DUII diversion program or in any similar alcohol or drug rehabilitation program in this state or in any other place; On the date I file the attached petition for a DUII diversion agreement, there is no charge of an offense pending against me in this state or in any other place for any degree of murder, manslaughter, criminally negligent homicide, or assault that resulted from the operation of a motor vehicle; From the date I file the attached petition for a DUII diversion agreement going back to ten (10) years before the date of the alleged commission of the present offense of DUII, I have not been convicted, in this state or in any other place, on any charge of an offense in any degree for murder, manslaughter, criminally negligent homicide, or assault that resulted from the operation of a motor vehicle; and The DUII offense described in the attached petition for which I am charged did not involve any deaths or any physical injury to any other person ("physical injury" means impairment of physical condition or substantial pain--ORS 161.015). 2. 3. 4. 5. 6. 7. Petitioner's Signature Petitioner's Name (typed or printed) Today's Date Subscribed and sworn before me this _________ day of _____________________, 20______. ___________________________________________________ Clerk of the Court/Notary Public for Oregon My commission expires ______________________________. 08-20 (12/03) Distribution: OriginalCourt (See SLR 4.085 (4)) American LegalNet, Inc. www.USCourtForms.com
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