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Uniform Support Affidavit (6D) - Oregon
| Uniform Support Affidavit (6D) Form. This is a Oregon form and can be used in Miscellaneous Family Law Circuit Court Statewide . |
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Uniform Support Affidavit Instructions for Form 6F The Uniform Support Affidavit must be completed when the payment of child support is an issue. It provides basic information about expenses and ability to pay. CAUTION: Please read the instructions for and use UTCR Form 2.100 for all forms which may contain Social Security Numbers. There may be attachments submitted with the Uniform Support Affidavit that have Social Security Numbers in them. It is your responsibility to redact (black out) any Social Security Numbers on the attachments or copies. UNIFORM SUPPORT AFFIDAVIT of Petitioner Respondent Co-Petitioner - Page 1 of 10 6D-Z.MiscForms: 6F-UniformSupportAffidavit.Ver07.doc (2/08) American LegalNet, Inc. www.FormsWorkflow.com IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF _____________ In the Matter of: ) ) ) ________________________________________, ) Petitioner, ) ) ) AND ) ) ________________________________________, ) Respondent Co-petitioner. ) Circuit Court No._____________________ Uniform Support Affidavit of: Petitioner Respondent Co-petitioner (Child Support or Spousal Support Case) This form is a SWORN AFFIDAVIT (under oath) required for support determinations. It must be signed before a notary public, filed with the court, and served upon the other party (or their attorney). If no party seeks spousal support or a deviation (change) from the uniform child support guidelines, you need only complete the Affidavit (pages 1 through 6) and any attachments requested on those pages. If any party seeks either spousal support or any deviation (change) from the uniform child support guidelines, you must complete not only the Affidavit (pages 1 through 6) and any attachments requested on those pages, but also the attached "Schedule 1 Monthly Expenses and Rebutting Factors Required." In addition, note that certain documentation MUST be attached to this Affidavit (e.g., see pages 2 and 3). STATE OF OREGON ) ) ss. County of ________________________ ) I, _______________________, being first duly sworn under oath, depose and say that I am the_________________in the above-entitled matter and that the following are true to the best of my knowledge and belief: Petitioner/Respondent 1. 2. 3. 4. 5. 6. Your Age: Date of Birth: under UTCR 2.100 Residence Address: Name of Employer &Address: Occupation: Length of Employment: Children born of or adopted during this relationship: Social Security Number: File Title: UNIFORM SUPPORT AFFIDAVIT of Petitioner Respondent Co-Petitioner - Page 2 of 10 6D-Z.MiscForms: 6F-UniformSupportAffidavit.Ver07.doc (2/08) American LegalNet, Inc. www.FormsWorkflow.com Child living with: Name of Child Age Me Other Parent Other 7. List all people living in your household (other than children named in item 6 above): Name Age Relationship to You Monthly Income 8. List your other dependents or children not listed in items 6 or 7 above: Name Age Relationship to You Monthly Income 9. ENTER THE FOLLOWING INFORMATION FROM SCHEDULES INDICATED: A. TOTAL GROSS INCOME (From page 5, item 16.D.) : B. TOTAL EXPENSES OF CHILDREN (From Schedule 1, item 1.): C. TOTAL MONTHLY EXPENSES (From Schedule 1, item 6.) : (a) Are you or your present spouse entitled to receive court-ordered child support for any children now living with you? YES NO If "YES," complete the following and ATTACH A COPY OF ALL SUCH CHILD SUPPORT ORDERS. 10. Name of Child Age Relation to You Support Amount __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ (b) Are those support payments being made? YES NO UNIFORM SUPPORT AFFIDAVIT of Petitioner Respondent Co-Petitioner - Page 3 of 10 6D-Z.MiscForms: 6F-UniformSupportAffidavit.Ver07.doc (2/08) American LegalNet, Inc. www.FormsWorkflow.com 11. Are you required to pay a court-ordered child support obligation for a child of yours who is not listed in item 6 above? YES NO If "YES," complete the following and ATTACH A COPY OF ALL CHILD SUPPORT ORDERS. Name of Child Age Name of Recipient Monthly Support Amount __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 12. Are you ordered to pay or entitled to receive court-ordered spousal support? YES NO If "YES," complete the following and ATTACH A COPY OF ALL SUCH SPOUSAL SUPPORT ORDERS. Owed To Paid By Monthly Support Amount __________________________________________________________________________________________ Owed Until:______________________________(Date or Event):_____________________________________ 13. Are you incurring child care costs on behalf of the children listed in item 6 above? YES NO If "YES," complete the following and attach documentation verifying the information provided below: Name of Day-care Provider Monthly (gross amount before application child and Address cost of any tax credit or subsidy) __________________________________________________________________________________________ __________________________________________________________________________________________ 14. 15. Do you receive any subsidy for such care? If so, amount $_________________per month. MEDICAL AND DENTAL ELECTIONS The child support recipient may elect to require the support payor to name the child(ren) as the beneficiary on a health/dental insurance plan. If so elected, the child support may be adjusted by an amount equal to all or a portion of the cost to parent who provides the child/ren's portion of the health/dental insurance premium. Please choose: I wish to require health/dental insurance coverage by the other party and understand that a portion of the premium may be deducted from support. I do not wish to require health/dental insurance coverage by the other party. I provide health/dental insurance through my employer; see page 6, item 18, of this schedule, for information. ATTACHMENTS REQUIRED Last four (4) payroll stubs. Most recent federal and state income tax return. Copies of any and all relevant child/spousal support orders. UNIFORM SUPPORT AFFIDAVIT of Petitioner Respondent Co-Petitioner - Page 4 of 10 6D-Z.MiscForms: 6F-UniformSupportAffidavit.Ver07.doc (2
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