Declaration Of Noncompliance And Request For Judgment

IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF MULTNOMAH Small Claims Department ________________________________ ________________________________ Plaintiff(s), v. ________________________________ ________________________________ Defendant(s). Attach a completed Small Claims Judgment and Small Claims Agreement/Mediation Agreement I, ______________________________________, signed a (name) Small Claims Agreement Mediated Agreement CASE NO. ___________________ DECLARATION OF NONCOMPLIANCE AND REQUEST FOR JUDGMENT on______________________with__________________________________________. (other party's name) A copy of the agreement is attached. (Print other party's name) has not complied with (followed) the agreement. Explain I did not prevent the other party from complying with the agreement. I request judgment against ____ ______ for $ _ __ (name) 1. Money Award $ 2. Prejudgment Interest $ 3. Costs & Service Expenses $ 5. Prevailing Party Fee (listed at ORS 20.190) $ 4. Attorney Fees $ , which includes Plus Postjudgment interest on the amount in sections 1 and 2 at the rate set by ORS 82.010(2) (or ______% by agreement of the parties), and in sections 3, 4, and 5 at the rate set by ORS 82.010(2) Instead of or in addition to a money award, I request judgment for the following terms: _____ On (date) ________________, I mailed a copy of this request to the person I request judgment against at address)________________________________________________________________ I hereby declare that the above statements are true to the best of my knowledge and belief, and that I understand they are made for use as evidence in court and I am subject to penalty for perjury. Date Signature Print Name 05-87 (11/13) Request for Judgment, Noncompliance Declaration American LegalNet, Inc. www.FormsWorkFlow.com