IN THE CIRCUIT COURT OF THE STATE OF OREGON

FOR THE COUNTY OF

Case No: _________________

Plaintiff/Petitioner
v. ACCEPTANCE OF
SERVICE

Defendant/Respondent

I am the Plaintiff/Petitioner Defendant/Respondent in this matter.

On (date) I received a true copy of (check all that apply):
Petition Summons
Claim Information on mediation
Complaint Other:

And for Domestic Relations cases:

Notice of Statutory Restraining Order Preventing Dissipation of Assets

Notice of CIF (Confidential Information Form) Filing
Information on continuation of insurance coverage (COBRA)
Order to Show Cause re: Modification with Motion and Declaration
Statement of Assets and Liabilities
Uniform Support Declaration
Other forms:

I hereby declare that the above statements are true to the best of my knowledge
and belief. I understand they are made for use in court and I am subject to penalty
for perjury.

Date Signature

Name (printed)

Address City/State/Zip Telephone

Acceptance of Service OJD OFFICIAL

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