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RESPONSE WITH UCCJEA INFORMATION DOMESTIC RELATIONS CASE SUBJECT TO FEE UNDER ORS 21. 111 Response Respondent appears and agrees with the petition for dissolution filed in this case except as specifically stated below Response with UCCJEA Information III Information Required by the Uniform Child Custody Jurisdiction and Enforcement Act. IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF In the Matter of the Marriage of Case No* Petitioner and Respondent. Please fill in the following...blanks a* The parties minor child/ren are b. The child/rens present residence mailing or contact address is c* The places where the minor child/ren of the parties have lived in the last five years and the names of the person with whom the child/ren have resided are Dates County/State With Whom Which Children From to Additional page attached see section labeled paragraph C continued* d. lived are The current addresses of the persons listed above with whom the minor child/ren have Name Address e....I have not participated in any litigation concerning the custody visitation parenting time or placement of the child/ren in this or any other state or I have participated in the following litigation concerning the custody visitation parenting time or placement Name of Court State Result f* Except as stated below I do not have any knowledge of any other domestic violence custody visitation parenting time or placement proceeding involving the child/ren of this marriage pending in this or another...state Identify court case number and the nature of the proceeding g. custody of the child/ren or who claims to have custody visitation or parenting time rights list name and address Certificate of Document Preparation I certify that check all that apply I selected this document for myself* I was provided this document by an attorney. I completed this document without paid assistance. I paid or will pay money to for assistance in preparing this document/form* STATE OF OREGON County of Marion...print name respondent in this matter and that the statements in this Response are true and correct to the best of my knowledge. Signature Print Name City State Zip Code Telephone SUBSCRIBED AND SWORN TO before me this day Notary Public for /Court Clerk My Commission Expires Respondent Pro Se Signature of. Please fill in the following blanks a* The parties minor child/ren are b. The child/rens present residence mailing or contact address is c* The places where the minor child/ren of the parties...have lived in the last five years and the names of the person with whom the child/ren have resided are Dates County/State With Whom Which Children From to Additional page attached see section labeled paragraph C continued* d. lived are The current addresses of the persons listed above with whom the minor child/ren have Name Address e. lived are The current addresses of the persons listed above with whom the minor child/ren have Name Address e. I have not participated in any litigation...concerning the custody visitation parenting time or placement of the child/ren in this or any other state or I have participated in the following litigation concerning the custody visitation parenting time or placement Name of Court State Result f* Except as stated below I do not have any knowledge of any other domestic violence custody visitation parenting time or placement proceeding involving the child/ren of this marriage pending in this or another state Identify court case number and the...nature of the proceeding g.