Supplemental Affidavit Form printable pdf download

Supplemental Affidavit Form

IN THE CIRCUIT COURT OF THE STATE OF OREGON

FOR THE THIRD JUDICIAL DISTRICT

_____________________________

Plaintiff, Petitioner or Moving Party,

SUPPLEMENTAL AFFIDAVIT

(Servicemembers Civil Relief Act)

vs.

Case No. ________________

_____________________________

Defendant, Respondent or Non-Moving Party.

I, _______________________________, hereby swear or affirm the following

information is true to the best of my knowledge: I am the Plaintiff/Petitioner/or Moving

Party, in this proceeding.

❑ The Defendant / Respondent / Non-Moving Party ❑ is ❑ is not in military

service. State supporting facts:

________________________________________________________________

❑ I am unable to determine whether Defendant / Respondent / Non-Moving Party is in

the military service. I have made the following efforts to make this determination:

________________________________________________________________

❑ The Defendant / Respondent / Non-Moving Party has waived his/her rights under the

Servicemembers Civil Relief Act, Pub.L. No. 108-189 (2003), as shown by the attached

affidavit, labeled as Exhibit ______.

For Eviction (FED) cases only:

❑ No one in the dwelling from which eviction is sought is dependent on anyone active

in the military. State supporting facts:

________________________________________________________________

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. (Sign in front of a notary or court clerk)

________________________________________________________________

Dated

Plaintiff /Petitioner/Moving Party (Signature)

(Print Name)

________________________________________________________________

Address

City

State

Zip

Telephone Number

SUBSCRIBED AND SWORN to before me this _______ day of _____________,

20____, by

____________________________________

Deputy Court Administrator/Notary Public

SUPPLEMENTAL AFFIDAVIT (Servicemembers Civil Relief Act) – Page 1 of 1

FC (11/19/12)

Supplemental Affidavit Form

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