IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF _____________________ ______________________________________,
Petitioner/Plaintiff,
v. ______________________________________,
Respondent/Defendant.
) ) ) ) ) ) )
Case No. _________________ LIMITED JUDGMENT SUPPLEMENTAL JUDGMENT FOR DEFERRED FEES WITH MONEY AWARD
_______________________________________ (applicant name) has filed an application for deferral of fees. The court has reviewed the application and deferred all or part of the fees. As of the date of this judgment, the amount shown below is unpaid and the applicant is obligated to the State of Oregon for that amount.
MONEY AWARD
Judgment Creditor: State of Oregon ___________________________________________________________________
Address City State Zip
Judgment Debtor: ___________________________________________________________________
Full Name Social Security Number Driver License # / State
___________________________________________________________________
Address City State Zip
___________________________________________________________________
Name of Attorney (if represented by counsel) Bar Number Attorney Phone Number
___________________________________________________________________
Attorney Address City State Zip
Filing Fee(s) $__________ Hearing Fee(s) $________ Motion Fee(s) $_________ TOTAL DUE $_________
Trial Fee(s) $_______________ Other Fee(s) $______________
Interest Rate __0__%
To be paid in full by (date) _____________. To be paid according to a collection agreement. To be paid according to a payment schedule of $_______ today and $_______ on the same day of each month until paid. _______________________________
Date
__________________________________________
Signature of Judge/Court Administrator
__________________________________________
Name of Judge/Court Administrator (printed or typed)
Limited or Supplemental Judgment for Deferred Fees with Money Award OJIN Code: JGLN (Judgment Limited Creates Lien) or JGSK (Judgment Supplemental Creates Lien)
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NOTICE
When you are granted a partial or full deferral of fees, the deferred fees are an obligation owed by you to the State of Oregon. This obligation is payable according to the terms set out above. Failure to pay the amount shown within 30 days of entry of the judgment or failure to comply with the payment schedule may result in 1) additional amounts for administrative and collection costs to be added automatically to the judgment, and 2) your account being referred to the Department of Revenue for collection, without further notice to you from the court. When payment is received in full, the court will make a notation in the court records. Checks or money orders are to be made payable to the State of Oregon and may be mailed to the following address: _____________________________________
Court Name
_____________________________________
Mailing Address
_____________________________________
City State Zip
Cash or credit/debit card payment must be brought to the address below: _____________________________________
Court Name
_____________________________________
Street Address
_____________________________________
City State Zip
Limited or Supplemental Judgment for Deferred Fees with Money Award OJIN Code: JGLN (Judgment Limited Creates Lien) or JGSK (Judgment Supplemental Creates Lien)
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