Declaration Of Noncompliance

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IN THE CIRCUIT COURT OF THE STATE OF OREGON
FOR THE THIRD JUDICIAL DISTRICT
________________________________
)
Plaintiff,
)
FED DECLARATION OF
vs.
)
NONCOMPLIANCE
)
)
Case No. _____________________
________________________________
)
Defendant.
)
I, _________________________, hereby swear or affirm that
_____________________________
(Print other party’s name)
(Print your name)
(
signed a Mediation Agreement
agreed to a Stipulated Order in front of the Judge
Choose one)
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 hereby declare that the above
I did not keep the other party from following the agreement.
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)

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