Petitioners Affidavit of Eligibilty

This affidavit must be executed by an accused individual seeking to declare any of the following statements: (1) has no prior conviction for any of the infractions enumerated in ORS 181.594(4); (2) has not been adjudicated for a conduct that can be considered as a violation listed in ORS 181.594(4); or (3) has not been convicted or adjudicated in another State for an offense that is stated in ORS 181.594(4).Download

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Petitioner’s Motion for Relief from Sex Offender Reporting Requirement Page 1 of 1 
OJIN Code: MORX (Motion Relief Sex Offender Rpt)  
 	
IN THE CIRCUIT COURT OF THE STATE OF OREGON 
FOR THE COUNTY OF _____________________ 
 
___________________________, )   
                       	
Petitioner,	 ) Case No. _________________   
v.     )  
   ) PETITIONER’S MOTION FOR RELIEF 
 )  FROM SEX OFFENDER REPORTING 
___________________________, District Attorney,  )  REQUIREMENT FROM AN IN STATE  
 	
Respondent.	 )  CONVICTION OR ADJUDICATION 
 
Pursuant to ORS 181.833, the petitioner in the above captioned case requests relief from the requirement to 
report as a sex offender as previously ordered in case number __________\
______ (enter the number of the 
case in which the petitioner was ordered to report as a sex offender).  As set out in the attached Petitioner’s 
Affidavit of Eligibility, the petitioner meets the elig ibility requirements for relief described in ORS 181.830. 
 
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. 
 
 
_______________   ______________________________________________________ 	
Date	     	Signature of Petitioner or Attorney for Petitioner	                 	Attorney’s Bar Number	 
       	
     ______________________________________________________ 
     	
Name of Petitioner or Attorney fo r Petitioner (printed or typed) 	
     ______________________________________________________ 
     	
Mailing Address                                  City                  State       Zip 	
     ______________________________________________________ 
     	
Phone Number                                    Fax Number 
______________________________________________________ 
Email 	
Note: Upon filing of the motion and affidavit, the COURT must schedule a hearing more than ninety (90) days from the date 
of filing and notify the defendant and district attorney of this hearing date.  The PETITIONER must serve the motion and 
affidavit on the district attorney and file an affidavit of se rvice with the court.  The DISTRICT ATTORNEY has ninety (90) 
days to contest the petitioner’s request for relief.

Petitioner’s Affidavit of Eligibility Page 1 of 2 
OJIN Code: AF (Affidavit) 
 	
IN THE CIRCUIT COURT OF THE STATE OF OREGON 
FOR THE COUNTY OF _____________________ 
 
___________________________, )   
                       	
Petitioner,	 ) Case No. _________________   
v.     )  
   )  
 )  PETITIONER’S AFFIDAVIT OF ELIGIBILITY 
___________________________, District Attorney,  )     
 	
Respondent.	 )   
 
 
I, the petitioner in this case, affirm that all of the following are true: 
1. I was  (check one from the following list)  
 	
 convicted of	 
 	
 found guilty except for insanity of 
 
 found to be within the jurisdiction of the juvenile court for having committed an act that if  
    committed by an adult constitutes 
  (check all that apply from the following list)  
 sodomy in the third degree   	 attempted sodomy in the third degree 	
 rape in the third degree    	 attempted rape in the third degree 	
 sexual abuse in the third degree 	 attempted sexual abuse in the third degree 	
 sexual misconduct     	 attempted sexual misconduct 	
 contributing to the sexual delinquency of a minor 
 attempted contributing to the sexual delinquency of a minor 
2.  I am less than five (5) years older than _________________________________________, the victim of  this crime; 
3.  The victim was fourteen (14) years of age or older at the time of the crime; 
4.  The victim’s lack of consent was based solely on the fact that the victim was under a specified age; and 
5.  At the time of the above offense or act, I had no prior conviction for an offense listed in ORS 181.594(4);  adjudication for an act that if committed by an adult would constitute an offense listed in ORS 
181.594(4); or no prior conviction or adjudication for conduct in another jurisdiction that if committed in 
Oregon by an adult would constitute an offense listed in ORS 181.594(4).

Petitioner’s Affidavit of Eligibility Page 2 of 2 
OJIN Code: AF (Affidavit) 
 
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. 
 
 
I hereby declare that the above statements in the Petitioner’s Affidavit of Eligibility and Certificate of 
Document Preparation are 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. 
 
 
_______________   ______________________________________________________ 	
Date	     	Signature of Petitioner	               	 	 	
 ______________________________________________________ 
     	
Name of Petitioner (printed or typed) 
______________________________________________________ 
     
Mailing Address                                  City                  State       Zip 	
     ______________________________________________________ 
     	
Phone Number                                     Fax Number 
______________________________________________________ 
Email

Petitioner’s Affidavit of Service Page 1 of 1 
OJIN Code: AFSR (Affidavit of Service) 
 	
IN THE CIRCUIT COURT OF THE STATE OF OREGON 
FOR THE COUNTY OF _____________________ 
 
___________________________, )   
                       	
Petitioner,	 )  Case No. _________________   
v.     )  
   ) PETITIONER’S AFFIDAVIT OF SERVICE 
___________________________, 	
District Attorney	, )     
 	
Respondent.	 )   
 	
I, _______________________________, state as fo llows (check one of the following): 
 	
  On _________________________, 20____, I mailed two  sets of true copies of the Petitioner’s 
Motion for Relief from Sex Offender Reporting Requirem ent and the Petitioner’s Affidavit of Eligibility 
to the respondent.  One set was sent by first clas s mail and the other by certified or registered mail 
with return receipt requested, or by express mail.  Both mailings we re sent to the following address: 
 
   ___________________________________________________________________ 
      (respondent’s mailing address) 
 
  On _________________________, 20____, I faxed a court certified copy of the Petitioner’s Motion 
for Relief from Sex Offender Reporting Requirement  and the Petitioner’s Affidavit of Eligibility to the 
respondent at the following fax number ______________________ and received an 
acknowledgment that the fax was successfully transmitted. 
 
Certificate of Document Preparation.   You are required to truthfully complete this certificate regarding the 
document you are fili ng 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. 
 
I hereby declare that the above statements in the Petitioner’s Affidavit of  Service and Certificate of Document 
Preparation are true to the best of my  knowledge and belief, and that I underst and it is made for use as evidence 
in court and is subject to penalty for perjury.	
 
 
_______________   ______________________________________________________ 	
Date	     	Signature of Petitioner or Attorney for Petitioner	                	Attorney’s Bar Number 	
      	______________________________________________________	 	
     	Name of Petitioner or Attorney fo r Petitioner (printed or typed)	    
   
______________________________________________________ 
     	
Mailing Address                                  City                  State       Zip 	
     ______________________________________________________ 
     	
Phone Number                                     Fax Number 
______________________________________________________ 
Email