______________________________________________________________________________
IN THE CIRCUIT COURT
OF THE STATE OF OREGON
FOR ____________ COUNTY
In the Matter of )
) No.
) Petition No.
)
A Child. ) PETITION
TO THE ABOVE-ENTITLED COURT:
Petitioner, whose name appears below, respectfully represents to the Court as follows:
child are as follows: ________. The child's residence is provided in a sealed document because
providing that information would jeopardize the health, safety or liberty of the child or of
a party to the case. ORS 109.767.)
provided in a sealed document because providing that information would jeopardize the
health, safety or liberty of the child or of a party to the case. ORS 109.767.)
_______________
_______________
period:
_______________
_______________
capacity in any other proceeding concerning the custody of or parenting time or visitation
with the child. Court, case number and date of any child custody determination:
_______________
proceeding. Court, case number and date of the proceeding:
_______________
child(ren) or claims rights of legal custody, physical custody, parenting time or visitation
with the child(ren). Names and addresses of such persons:
_______________
_______________
WHEREFORE, petitioner prays this Court to have an investigation made of the circumstances concerning the above-named child and to make such order or orders as are appropriate in the circumstances.
DATED: ____________, 2___.
__________________
Petitioner
STATE OF OREGON )
) ss.
County of ______ )
I, ____________, being first duly sworn, on oath or upon affirmation, depose and say that I am the petitioner in the above-entitled proceeding, that I have read the foregoing petition, know the contents thereof, and the same is true as I am informed and believe.
__________________
Petitioner
SIGNED AND SWORN to before me on ____________, 2___.
_____________________
SEAL (Alternate Verification)
STATE OF OREGON )
) ss.
County of ______ )
I, ____________, being first duly sworn, on oath or upon affirmation, depose and say that I am the petitioner in the above-entitled proceeding, that I have read the foregoing petition, know the contents thereof, and the same is true based on my personal knowledge of this matter.
__________________
Petitioner
SIGNED AND SWORN to before me on ____________, 2___.
_____________________
SEAL
______________________________________________________________________________
ORS 419B.809