Oregon > Statewide > Circuit Court > Family Law > Modification Of Judgment
Stipulation To Modify (4C) - Oregon
| Stipulation To Modify (4C) Form. This is a Oregon form and can be used in Modification Of Judgment Family Law Circuit Court Statewide . |
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IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF __________________ In the Matter of: ________________________________, Petitioner, and ________________________________, Respondent, and ________________________________, Child who is at least 18 and under 21 years of age, unmarried and unemancipated. (ORS 107.108) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) Case No. ______________________ STIPULATION TO MODIFY CUSTODY PARENTING TIME CHILD SUPPORT; AND SUPPLEMENTAL JUDGMENT [ORS 107.135; 107.174] Based upon the request and stipulation of the parties, as shown by the notarized signatures below, and it appearing to the Court that a judgment of annulment, dissolution of marriage, separation, or establishing paternity, custody and parenting time was granted in this case on , 20 , in case number , in the County Circuit Court, that the parties jointly request a modification of the custody, parenting time and/or child support provisions of this judgment; Now, therefore, IT IS HEREBY ORDERED that: 1. Custody: a. The judgment with respect to custody remains in effect and unchanged. b. Petitioner Respondent is awarded sole custody of the child/ren: (Names and dates of birth), c. The parties have agreed to joint custody of the following child/ren: (Names and dates of birth), as described in the attached parenting plan, labeled "Exhibit 1." 2. Father Mother shall have parenting time with the child/ren in accordance with the attached parenting plan, labeled "Exhibit 1", or as follows: Neither parent shall move to a residence more than 60 miles further distant from the other parent without giving the other parent reasonable notice of the change of residence and providing a copy of such notice to the court, or the requirement of ORS 107.159 regarding notice of move is suspended for good cause found. /// STIPULATION TO MODIFY CUSTODY PARENTING TIME CHILD SUPPORT, AND American LegalNet, Inc. SUPPLEMENTAL JUDGMENT [ORS 107.135; 107.174] - Page 1 of 8 www.FormsWorkFlow.com Modification-4C: ModStipJudgWithSupport4CVer12.doc (3/08) 3. Child Support, including Cash Medical Support. a. Child support as previously ordered remains in effect and unchanged. b. The Judgment is modified to terminate Petitioner's Respondent's support obligation effective for the child/ren: (name(s) and date(s) of birth) Check either A or B below: (A) No child support shall be ordered at this time because: An order for child support in the amount of $ monthly, including health care coverage, has already been ordered and docketed with the County Circuit Court, case number . Other reason: (B) Child support shall be paid by Petitioner to Respondent (or) Respondent to Petitioner beginning on the first or of the month following the date of the judgment and continuing on the same day of each month thereafter. The support for each child shall continue until the child reaches eighteen (18) years of age, or is otherwise emancipated, unless the child is a student attending school as defined by Oregon law, in which case support shall continue until the child reaches 21 years of age. Until further order, the total payment per month shall be $ for children. Cash Medical Support: Of the amount ordered above in paragraph 2B, $ is cash medical. The cash medical support amount ordered is in addition to any percentage of uninsured costs either of the parties is ordered to pay below in paragraph 4(C). (Check if applicable) Neither Petitioner or Respondent have appropriate private or public health care coverage available for the parties' child/ren (see 4(3) below). Cash medical support is is not ordered and the court's findings in this regard are as follows: Petitioner Respondent and/or Child/ren are eligible for public medical assistance and cannot be ordered to pay cash medical support. (Check if applicable) This order shall modify and replace the following existing order: (List court/agency and case no.) because the court finds that the existing order was issued by an Oregon court or agency, one of the parents or the child/ren receiving support under the order still resides in Oregon and circumstances have changed since this order was entered. 4. Child Support Calculation (Check any that apply). The child support worksheet on which the support amount was calculated is labeled "Exhibit "and attached to and incorporated in this judgment. The support award does not deviate from the amount presumed correct under the guidelines set outin the Oregon Administrative Rules. STIPULATION TO MODIFY CUSTODY PARENTING TIME CHILD SUPPORT, AND American LegalNet, Inc. SUPPLEMENTAL JUDGMENT [ORS 107.135; 107.174] - Page 2 of 8 www.FormsWorkFlow.com Modification-4C: ModStipJudgWithSupport4CVer12.doc (3/08) The support amount presumed correct under the guidelines set out in Oregon Administrative Rules is $ . The support award deviates from this amount because this Court finds that application of the formula would be unjust or inappropriate in this case because of (check one or more that apply): Recurring medical expenses of Other 5. Health Care Coverage. (DO NOT FILL THIS SECTION OUT if the boxes in Paragraph 3(A) above have been checked stating that there is an existing child support order that includes health care coverage currently in effect.) A.) PRIVATE INSURANCE IS AVAILABLE Petitioner Respondent shall name the child/ren as beneficiaries of the following appropriate private health care coverage for the duration of the support obligation (describe type/s of coverage): B.) NO PRIVATE INSURANCE IS AVAILABLE NOW Neither Petitioner nor Respondent has appropriate private health care coverage available for the parties' child/ren. 1.) Petitioner Respondent is ordered to apply to enroll the child/ren in public health care coverage. If the child/ren is/are accepted for enrollment, this coverage shall be maintained. 2.) Petitioner Respondent has already applied to enroll the child/ren in public health care coverage. If the child/ren is/are accepted for enrollment, this coverage shall be maintained. 3.) The child/ren are currently enrolled in public health care coverage. This coverage shall be maintained. 4.) Petitioner, Respondent Both Petitioner and Respondent are ordered to provide appropriate private health care coverage when such coverage becomes available to them through any source. C.) RESPONSIBILITY FOR UNINSURED HEALTH EXPENSES Petitioner should pay % and Respondent should pay % of the uninsured health, accidental, dental, orthodontic, and optical costs incu
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