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Oregon Acceptance of Service Form

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Oregon Acceptance of Service Form
Oregon Acceptance of Service Form
ACCEPTANCE OF SERVICE - Page 1 of 1
Disso-1BC: AccServ1BCVer03.doc (9/10)
IN THE CIRCUIT COURT OF THE STATE OF OREGON
FOR THE COUNTY OF
In the Matter of the Marriage of: )
)
, ) Case No.
Petitioner, )
and )
)
) ACCEPTANCE OF SERVICE
)
, )
Respondent. )
STATE OF )
)ss.
County of )
I, , being first duly sworn, say: I am the Respondent in this matter
and on I received a true copy of the Petition and Summons, with attached notices of
statutory restraining order preventing dissipation of assets, continuation of health coverage, Notice of CIF
Filing, mediation and other information provided by the court clerk in the County of , State
of .
Certificate of Document Preparation. You are required to truthfully complete this certificate
regarding the document you are filing with the court. Check all boxes and complete all blanks that apply:
I selected this document for myself and I completed it without paid assistance.
I paid or will pay money to
for assistance in preparing this form.
Signature of Respondent Print Name
Address or Contact Address City, State, Zip Telephone or Contact Telephone
SIGNED AND SWORN to before me this
day of , 20 ,
by
.
Notary Public for /Court Clerk
My Commission Expires:
Oregon Acceptance of Service Form