Affidavit Of Noncompliance (After Mediation Agreement)

IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE THIRD JUDICIAL DISTRICT ________________________________ Plaintiff, vs. ) ) ) ) ) ) ) FED DECLARATION OF NONCOMPLIANCE Case No. _____________________ ________________________________ Defendant. I, _________________________, hereby swear or affirm that _____________________________ (Print your name) (Print other party's name) (Choose one) 9signed a Mediation Agreement 9 agreed to a Stipulated Order in front of the Judge with me on ____________________, which contained the following terms (write out or attach (Date of Agreement) copy): ________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ___________________________ has not complied with the agreement by failing to do the (Print other party's name) following:_____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ I did not keep the other party from following the agreement. I hereby declare that the above statement is true to the best of my knowledge and belief, and that I understand it is made for use as evidence in court and is subject to penalty for perjury. DATED: ______________________, 20______ ____________________________________ (Sign your name) FED DECLARATION OF NONCOMPLIANCE - PAGE 1 OF 1 FC (1/1/08)