: ‘A copy of this Affidevt showing the date of filing will be delivered to each 2 || creditor who has not been paid in full or misiled to the ereditor atthe last known eddress shown 3 || above. 4 9. As far as known to afiant, there are no other persons who assert a claim against 5 || the estate nor are there any claims in dispute, 6 10, The address for the purposes of presenting a claim to the affiant is: 7 Theresa M. Wade Attorney at Law . P.O. Box 749 Salem OR 97308-0749 0 11. A copy of this Affidavit will be mailed or delivered to the following entities: nf] Department of Human Services ‘Oregon Health Authority Estate Administration Unit ‘500 Summer NE E-20 R P.O. Box 14021 Salem OR 97301 Salem OR 97309-9913 “4 12, The claims against the estate not listed in this Affidavit or in amounts larger than 15 || those listed in this Asidavit may be barred uniess: 16 & A clsim is presented to the affiant within four months of the filing of this 17 |] Affidavit he adres stated inthis Aidit for presentment of elais; ot a8 b. personal representative ofthe estate is appointed within the time allowed 19 || under ORS 114.555, 20 Aeathae2 “Poeypoa) —_ Heather Beyer ~ Ci — a ‘SUBSCRIBED AND SWORN to before me this_2Q¥W day of ||" ~The eae sho ma NOTARY PUBLIC FOR QREGON ss My Comission Expzesp ig" OM we ut 26 mu rams |] Aside OFCiining Sorte a tour ne ts ‘Enuteof David Lee Eeminds, Deceasal| Papen ‘Theresa M. Wade (OSB No. 993880) Garett Hemann Robertson P.C. 1011 Commercial Street NE. P.O, Box 749 Salem OR 97308 Phone No. 503-581-1501 Fax: 503-581-5891 Email: twade@ghrlawyers.com Affidavit OF Claiing Suesessor- Intestate Este: Estate of David Lee Ets, Deceased ender en adgags, SANTIAM MEMORIAL HOSPITAL Pave Statement Guarantor Account Status Inquiry Zeto Balances Inailed Last Three Paymonts Only For Account: 81488 EDMUNDS, HEATHER A rim Payment info MR Adm# Patient Namo FC. AcctAge Date ‘Amount i008 745309 EDMUNDS-BEVER, ROBE: 10 1680 1008/10, 1186.70, Adm Dato: 1008/10 Disch Date: 10/08/10 12/08V10 "77407 Fo: 10. 2138 DELETE 42/06/10 MEDICAID ADJ 1,001.60, PT: OPER. Dr: STRINGHAM, CHARLES 12I06'10 MPC ADJ 0.00 stmt: 0 Ins Date:11/11/10 42/06/10 MEDICAID ADJ 88.03, Cycle Records on File: 0001 Current Balance: 0.00 ‘ose 705863 -—«-EDMUNDS-BEYER,ROBE+ 10 1959 01/02/10 Original Balance: 923.28 ‘Adm Date: 1702/10 Disch Date:01/02/10 02/26/10 MPCHP 108.00 Fer 10. 2133 DELETE 0226/10 MEDICAID ADJ 317.28 PT: OPER. Dr: STRINGHAM, CHARLES stmt: 0 Ins Date:01/23/10 (Cycle Records on File: 0001 ‘Current Balance: 0.00 09% 702985 © EDMUNDS-BEYER, ROBE+ 10 1985 12107109 Original Balance: 18450 ‘Adm Date: 12107109 DischDate:12007/02 12/21/09 MPCHP “8950 For iO 2133 DELETE 1221/09 MEDICAID ADS “85.05, PT: OPOTHER Dr: BARNES, LAWRENCE 12/21/09 MPC ADJ 0.00 Sim: 0 Ins Date:12/11/08 12/21/09 MEDICAID ADJ 9:85 (Cycle Records on File: 0001 ‘Current Balance: 0.00 81486 934817 EDMUNDS, HEATHER A 12 605 09/17/13 Original Balance: 285.60 08/17/13 Disch Date:09/73 11/08/13 HNOPT “55.18 02 SELFPAY INS BAL. 11/08/13 ALLOWANCES “115.84 PT: OPER, Dr: VETS, STEVEN 11213 AUTO WRIOFF “060 stmt: 0. Ing Date:ionats Cycle Records on File: 0001 ‘Current Balance: 0.00 81486 984170 EDMUNDS, HEATHER A 12 607 GANS/3 Original Balance: 1,417.00 ‘Adm Date: 08/15/13 _Disch Date:o9/t5/3tavia/is HNOPT 2o1st FO: 90. 9000 BAD DEBT 1014713 ALLOWANCES ri33 PT: AMBULANCE Dr: NO FAMILY PHYS Stmt: 4 Oita Ins Date:09/23"13, 5 (Gyole Records on File: 0001 ‘Curront Balance: 243.76 81486 932087 EDMUNDS, HEATHERA 12 622 0831/13 Original Balance: 79240 ‘Adm Date: 08/31/13 Disch Date:oa/s1/13- 1022/13 HNOPT “108.85, Fo:i2. 6846 HEALTHNETOPTIONS PLUS _ 1022/13 ALLOWANCES 22084 PT: OPER, Dr: STRINGHAM, CHARLES y020/13 HNOPT "158.13, stmt: 0 Ins Dateri007/12 yaRe7'3 ALLOWANCES 308.77 (Cycle Records on File: 0001 ‘Current Batanc 0.00 e186 esz054 MUNDS, HEATHER A 2 622 08/31/13 Original Balance: 280.50 ‘Adm Date: 08/21/13 Disch Date:08/31/13. 00/90/13 HNOPT 18.48 Fc:'20. 9000 BAD DEBT. (9073 ALLOWANCES 94.52 PT: OPER, Dr: SPARKS, DANNY 19/07/13 HNOPT 0.00 Sim: 4 o1td Ins Date:09/11/13 1Q)07/'3 ALLOWANCES 11022 (Cycle Records on File: 0001 ‘Current Balance: 5628, 81486 981757 MUNDS, HEATHER A 12 624 08RaN3 Original Balance: 28050 ‘Adm Date: 0829/13 Disch Date:08/29/13. 09/30/13 HNOPT ‘ga Fo: 90.9000 BAD DEBT 092013 ALLOWANCES “110.22 PT: OPER, Dr: VETS, STEVEN, sopyia HN OPT 19.48 Sim: 4 O1tg Ins Date:09/12/'3 1024/12 ALLOWANCES 9452 AR poste. Sas iyoSa aS, ot te meres Lert mosgnt Hee SORE Fibers wayasias 2/28/44 = s1age /"easte = BEYER, HEATHER A oayiayi2 | HsPi000x PEAR ea/0n/2 ReDICRRE 02/12/12 | pRo:9003 O\e ER. 23/08/12 TeDCAne, + ese /"aant71 * BEYER, HEATHER & ozyzy12 | pRotg00% a\p e-. esa MEDICARE, | eames /Maauert's Bever, HEATHER & 02/13/12 | wsb:0001 0\p E- ear eC Oe o2/sa/12 | PRo:0001 BAP t8 5/08/42 MEDICARE BALANCE OU « arene /*sanees = BEYER, tisb:eee1"o\P e- ca BALANCE OU Thank you for using our hospital for your health care needs. {f you have questions ar need to set Up 2 payment pian please out Bod-7e9-8251 Santian Monorial Hospit# BALANCE SUE = 2/14/12 | pRo:0001 AP ER. 23/08/42 Rebicane 199.80 errs as 09/88/12 586.588 19 20 2 8 4 25 26 CERTIFIED A TRUE COPY 1 ‘GARRETT HEMAN ROBERTSON INTHE CIRCUIT COURT OF THE STATE OF OREGON ron TH COUNTY OF MARION Probate Department . intent eat ; 1 (20200 DAVID LEE EDMUNDS, ) AFFIDAVIT OF CLAIMING ) SUCCESSOR - INTESTATE ESTATE Deceased ) (SMALL ESTATE AFFIDAVIT) ) ) Fee Authority: ORS 21.145(4), ) ORS 114.515 STATE OF OREGON ) nu ‘County of Marion d 1, Heather Beyer, being frst duly sworn, depose and say that Iam decedent's daughter and a *climing sucosisor of the shovernamed decedent. "This Aflidevt is made pursuant to ons 114515 1. ‘The ollowing infomation is given with respect othe decedent: ‘Name: David Lee Edomunds i Age 30 © Domicile: Poeatello, Bannock County, daho d. Post Office Address: 151 Hiway Avent, Pocatello Idaho 83201 © Social Security Number: 518-60-5405 2. Devedent died September 2, 1981, at McCammon, Bannock County, 1dsho. A cartfied copy of decedent's Death Certificate is attached hereto. 3. A description of all ofthe decedent's property, inclndig its locaton, and its fair market value is as follows: mu thru Semen ate omens F ‘Exate of David Le Edmunds, Deceased ae16 W 18 19 a 2 2 4 25 26 PROPERTY: FAIR MARKET VALUE: ‘Merrill Lynch Acoount, Acct. No. XXX-XX-5405 (Stock option Account) 519,000.00 4. An application or petition for the appointment of a personal representative has not ‘been granted in Oregon. 5, Decedent died intestate, 6 The decedents heirs and the relationships to the decedent and the last address of cach as known to affiant are: NAME RELATIONSHIP ADDRESS (Cheryl Bdrmunds Spouse 51898 Gates Bridge Bast Gates, OR 97346 Reasonable efforts have been made to identify and locate all hers ofthe decedent. ‘A copy of this Affidavit showing the date of filing will be delivered to each heir or mailed to each heir at the Iast known address stated above. ‘The interest in decedent's property described in this Affidavit to which each hoir fs centited INTEREST. Cheryl Bdmnds Entire residuary estate 8 Reasonable efforts have been mado to ascertain creditors of the estte. The expenses of and claims agnns the esate remaining unpaid or on account of which the affant or any other person is entitle to reimbursement from the estate, including the known or estimated amounts thereof and the names and adéress of the creditors as known tothe affant are as follows: NAME AND ADDRESS AMOUNT Garrett Hemann Robertson P.C. $3500.00 (estimated) P.O, Box 749 Salem, Oregon 97308 Garrett Hemann Robertson P.C. {$115.00 (estimated court filing fee P.O. Box 749 & certified copy of affidavit) Salem, Oregon 97308 _Ailidavit OF Claiming Soccessor Intestate Fae: entesonntabe decease ‘Exate ofDavid Lee Edmunds, evesedee a! is STATE OF oF STATE OF OREGON ENTERED Maron County Great Sons By the Administrator (ORS 25.01 pee 17 DEC 1 6 ais ae 85 FILED CSP #: 047011351641 PARTIES TO THIS ACTION: State of Oregon and Heather A. Beyer CERTIFICATION TO CIRCUIT COURT FOR ENTERING/FILING ADMINISTRATIVE ORDER ‘The Administrator certifies the following documents are original or true copies of the originals ‘and requests the same be filed and entered in accordance with ORS 416.440. ‘The respondentVobligor in this action is Heather A. Beyer. ‘Notice & Finding of Financial Responsibility and Proposed/Final Order with return of service Money award including child support award ‘Administrative order(s) entered on 12/05/2008 December 5, 2008 { cuuaSeky Date Teresa Gosda Authorized Representative Division of Child Support 3200 Lancaster Drive NE Salem, Oregon 97305 ‘Telephone: (503) 373-7300 FAX: (503) 378-3335 ‘TDD: (503) 986-6244 gt |e CoenoATION TO CCU COURT FOR EATERACATLING ADMENSTRATIVG GRIER (SFeotos ites saoaum armingSOF UREGUN se Administrator (ORS 25.010) County: Marion Court ENTERED csPA 047011381641 gee. 7 2008 PARTIES TO THIS ACTION: Stat of Oregap and Heather A.B MONEY AWARD INCLUDING CHILD SUPPORT AWARD. 1. JUDGMENT CREDITOR/STATE OF OREGON: Division of Child Support (DCS) PO Box 14506, Salem OR 97309 In Salem: (503) 398-5567 Toll Free: 1-800-850-0228 Aitomey for State of Oregon Holly A.Fimore ‘Atiomey's address: 3200 Lancaster Drive NE. “Salem, Oregon 97305 Atiomey 's telephone no. 73-7300 2. JUDGMENT DEBTOR/OBLIGOR: ‘Obligor’s name: Heather A. Beyer ~ Obligor’s adress: PO Box 2 Gates, OR 97346-002) Obligor’s date of birth: “ouovis Obligor’s SSN: 518:94-684 —______ Obligor’s driver's license noJ/state:_6565753. OR Obligor’s attorney: NWA 3. AMOUNT OF CHILD SUPPORT AWARD '$365,00__ per month total child support beginning 1208/2008, Of the tote child support ‘amount, $0 per month is cash medieal support. ‘$2,190.00 lump sura past supporVarrears as of 11/30/2008. 4, PREIUDGMENT INTEREST: ‘None. ig 102 -eonay AvaRO LIBR SHLD ect te antec 33-00 Hci awn pirat ae cay sees sre tm O88 twee DE one Simona pi bfpacraaminr_{UDGMENT INTEREST INFORMATION: Oregon: Rate: 9% perannum ‘Type: Simple Interest accrues on the money award and on each unpaid installment of the child support award as ithecomes due. ‘The Child Support Program is able to provide our customers with information from forms and other notices in their own languages free of charge. ‘This also includes Braille, large print, and the use of interpreters. To find out more, please contact your child support office. ee) ai | | | | ap 24¢2- MONEY AWARD INCLUDOEMLD Dero ede “odes 72700 Sire aan ant i ape (Srente (en cozsoy rnp Sesame ete ‘i Oran 78—sstrator (ons 25.0207 ~ ines 27 08 oa7o13951661 es 88 TO THIS ACTION: State Of Oxegoa, HEATHER A BEYER #RT0N (1 axe NOTICE AND FINDING OF FHHANCIAL RESPONSIBILITY AND PROPOSHD/FINAL ORDER HEATHER A BEVER As the parent of: (CAXLD(REN) AND DATE(S) OF BIRTH, Davi aNDaESON, Dos 12718706 LAUREN BEYER, DOB 06/21/02 {J Mis action is being anended because Pursuant to ORS 416.400 to 416.465 and/or ORS 110.316, the Administrator FINDS and NOPIFTES you that Oregon has personal jurisdiction over the parties, The Adninistrator further FINDS and NOTTFIES you that this notice and finding will be entered as an order, unless a party's objection is received in writing by the office Listed on thie notice within 20 days after service of this paper. (ORS 416.415.) To object to the entry of this order, refer to the procedures listed on this notice, PENDING, FING_SUPEOR? OBLIGATIONS “There is no other support proceeding involving the child(ren) who te the subject of . this action pending in this or any other state, except as might be stated in the attached certificate ‘There is no other support oréer involving the child(ren) who Le the subject of thie action in this or any other state. ‘on-coma/cuRRENT CHILD SUPPORT Based upon the curvent financial circumstances of the parties and the application of (oan 137-050-0320 through 137-050-0490, HEATHER A BEYER Bball pay § 365.00 er month for the support of the child(ren) Listed above, Gut of this total noutbly child Support anount, § 0.00 is designated as cash medical dupport. The child(zen) {3 in the custody of Staea 6f Oregon + Payments shall begin the date the final order is Signed. _HEATHER A BEYER ‘shall pay by check or money order Eo Child Support Payments, Division of ChIid Suppore, FO Box 14506, Salem OR 97309, unless the payments are being withheld by HEATHER A BEYER" S ‘employer. bux] the guidetine anount of ¢ 265.00, as shown on the attached guideline computation worksheet, ig Just and appropriate Page 1 of 7 - NOTICE AND FINDING OF FINANCIAL RESPONSIBILITY AND PROPOS CSF 02 0802 (Rev. 08/29/07) TVG:a-£4‘PERN/LaMGTH oF RAYNENTS Support payments are due each month and nedica? chilé support must be provided untii alt | ta does not request cash support at this time, ra children are age 18, or age 21 if attending school ap defined in ORS 107.108, or bacone married or emancipated, or until further order of the administrator or a circuit court fudge. if a child is attending school as defined in ORS 107.108 and satisfies the Fequivenents of that law, support payments shall be distributed to the child, LE support ie ordered for nore than one child, the order will he a ‘class order’. This means. the court-ordered anount will stay the Sane until the LAST child is no longer eligible for support. (Goel support payments axe due each month nile the child(ren) is residing in a state Financed or supported residence, shelter or other faciliey or institution. support payments shall continue and medical child support mist be provided until the child(ren) ib age 18, or age 21 if attending school as defined in ORS 107.108, or until farther ‘order of the administrator or a circuit court judge. If the child(ren) is not residing in a state financed or supported residence, shelter or other facility or institution, support paynents shall be suspended TE support is ordered for more than one child, the order will be a ‘class order'. This fneans the court-ordered amount will stay the Game until the IAST child is no longer eligible for support. past surroRt (bec) Based upon the application of OAR 237-055-2220, HEATER A BEYER shall pay 8 1,095 representing past support due from 06/01/08 through the present. Past support will continue to accrue at the rate of § 365.00 per month until this proposed order ie signed as a final order. HEATHER A BEYER ‘shall pey by check Gr money order to Child Support Payments, Division of Child Suppoze, PO Box 14506, Salem OR 97309. Go] Pursuant to 42 USC § 608(a) (3), ORS 418.042 and OAR 461-220-0320, some or all of the past support requested may be assigned to the State of Oregon for public assistance expended for the ehilatrea). Page 2 of 7 - NOTICE AND FINDING OF FINANCIAL RESPONSIBILITY AND PROPOSED/FINAL, ORDER CSP 02 G01 (Rev. 08/28/07) TvG:a-f8‘PERN/LaMGTH oF RAYNENTS Support payments are due each month and nedica? chilé support must be provided untii alt | ta does not request cash support at this time, ra children are age 18, or age 21 if attending school ap defined in ORS 107.108, or bacone married or emancipated, or until further order of the administrator or a circuit court fudge. if a child is attending school as defined in ORS 107.108 and satisfies the Fequivenents of that law, support payments shall be distributed to the child, LE support ie ordered for nore than one child, the order will he a ‘class order’. This means. the court-ordered anount will stay the Sane until the LAST child is no longer eligible for support. (Goel support payments axe due each month nile the child(ren) is residing in a state Financed or supported residence, shelter or other faciliey or institution. support payments shall continue and medical child support mist be provided until the child(ren) ib age 18, or age 21 if attending school as defined in ORS 107.108, or until farther ‘order of the administrator or a circuit court judge. If the child(ren) is not residing in a state financed or supported residence, shelter or other facility or institution, support paynents shall be suspended TE support is ordered for more than one child, the order will be a ‘class order'. This fneans the court-ordered amount will stay the Game until the IAST child is no longer eligible for support. past surroRt (bec) Based upon the application of OAR 237-055-2220, HEATER A BEYER shall pay 8 1,095 representing past support due from 06/01/08 through the present. Past support will continue to accrue at the rate of § 365.00 per month until this proposed order ie signed as a final order. HEATHER A BEYER ‘shall pey by check Gr money order to Child Support Payments, Division of Child Suppoze, PO Box 14506, Salem OR 97309. Go] Pursuant to 42 USC § 608(a) (3), ORS 418.042 and OAR 461-220-0320, some or all of the past support requested may be assigned to the State of Oregon for public assistance expended for the ehilatrea). Page 2 of 7 - NOTICE AND FINDING OF FINANCIAL RESPONSIBILITY AND PROPOSED/FINAL, ORDER CSP 02 G01 (Rev. 08/28/07) TvG:a-f8oT ta does not request cash support at this tine, ‘Tenn/isNeTH oF PAYMENTS TE 1 Support payments are due each onth and medical child support must be provided until all children are age 18, or age 21 if attending school as defined in ORS 107.108, or bacone married or emancipated, or until further order of the administrator or a circuit court Judge. if a child is attending school as defined in ORS 107.108 and satisties the Fequivenents of that law, support payments shall be distributed to the child, IE support ie ordered for nore than one child, the order will be a ‘class crder'. This mmeans. the court-ordered anount will stay the Sane until the LAST child is no longer eligible for support. (Goel support payments axe due each month nile the child(ren) is residing in a state Financed or supported residence, shelter or other faciliey or institution. Support payments shall continue and medical child support mist be provided until the chila(ren) is age 18, or age 21 if attending school ap defined in ORS 107.108, or until farther ‘order of the administrator or a circuit court judge. If the child(ren) 1s not residing in a state financed or supported residence, shelter or other facility or institution, support paynents shall be suspended TE support is ordered for more than one child, the order will be a ‘class order'. This feans the court-ordered amount will stay the Game until the IAST child is no longer eligible for support. pas? surroRr bec) Based upon the application of OAR 237-055-2220, EEATWER A REYER shall pay 8 1,095 representing past support due from 06/01/08 through the present. Past support will continue to accrue at the rate of § 365.00 per month until this proposed order is signed as a final order. HEATHER A BEYER ‘shall pey by check Gr money order to Child Support Payments, Division of Child Suppor, PO Box 16506, Salem OR 97309. oe] Pursuant to 42 USC § 60B(a) (3), ORS 418.042 and OAR 461-120-0320, some or all of the past support requested may be assigned to the State of Oregon for public assistance expended for the euilatren). Page 2 of 7 - NOTICE AND FINDING OF FINANCIAL RESPONSIBILITY AND PROPOSED/FINAL, ORDER CSP 02 da01 (Rev. 08/29/07) TvG:a-ti* MEDICAL CHILD svProRE wAministrator finde that hhas access to appropriate site Health care coverage. fe administrator finde that and. have access to appropriate private health care coverage. or] The administrator finds that neither party has access to appropriate private health care coverage. al is ordered to provide appropriate private health care coverage ta As ordered to provide cash medical support in an amount ‘Getermined under the chilé support guidelines, ‘Cash medical support’ has the same meaning as ‘medical support’ in ORS 25.321(6). (oee] HETHER A BEYER is ordered to provide appropriate private health care coverage for the chiié(fen) whenever HEATHER A BEYER has acces to such coverage through an employer cr auy source, including @ apouse, domestic partner oF ether family menber. ca is ordexed to apply to enroll the ch{ld(zen) fn public health care coverage. ta 4s ordered to provide cash medical support in an anount determined under the chile support guidelines until appropriate private health care coverage becomes available and the order/judgnent is modified. "Cash medical support’ has the same meaning ap ‘medical support’ in ORS 25.221(6) HORDIATE INCOME WITHHOLDING ‘The support order is enforceable by incone withholding under ORS 25.372 to 25.978, and 25.387 to 25.427, Withholding on both current support and arrears will occur immediately on ali orders and modifications. If MEATHER A BEYER ‘has been granted an exenption from danediate withholding, the withholding will occur whenever there are arrears equal to at least the support payment for one month, whenever the obligated parent requests such withholding or a party requests withholding for good reason. ‘The district attorney or, a¢ appropriate, the Division of Child Support of the Department of Justice will help in starting such withholding. An exception to incore withholding may be allowed under ORS 25.396. COLLECTION OF SUPPORT ‘This order will be filed and entered ac a judgment with the county circuit court, Bven 4£ current cupport is being paid, the obligated parent's state and federal incone tax refunds can be taken to pay past die support. This means that the order will show as an unpaid lien against the obligated parent's property in any credit check. The obligated Parent's property will be subject to collection activity including garnishment or execution Of liens for any unpaid support enounts. ‘ADDRESS /ENPLOVER/EALTH CARE COVERAGE CHANGES As a party to this order, you must tell the court and the Child support Program (CSP) when there de a change in your address, phone number, @river's license number or current employer's nane and address. This information must be reported within 10 days of the Change, Tf you have been ordered to provide health care coverage, you must tell the CSP if health care coverage ig availeble through an enployer or any source, including a spouse, Page 3 of 7 - NOTICE AND FINDING OF FINANCIAL RESPONSIBILITY AND PROPOSED/PIMAL ORDER CSF 02 0301 (Rev. 08/28/07) TVGra-Fi* MEDICAL CHILD suProRT éministrator finde that has access to appropriate sate health care coverage. fe administrator finde that and. have access to appropriate private Health care coverage. ors] The administrator finds that neither party has access to appropriate private health care coverage. al is ordered to provide appropriate private health care coverage ta is ordered to provide cash medical support in an amount “ Geterained under the chilé support guideiines. "Cash medical support’ has the sane neaning as ‘medical support’ in ORS 25.321(6). (eel HENTHER_A BEYER is ordered to provide appropriate private health care coverage for the chiié(@en) whenever HEATHER A BEYER has access to such coverage through an employer cr auy source, including @ apouse, donestic partner oF other family menber. oa is ordexed to apply to enroll the ch{ld(zen) fn public health care coverage. ta 4s ordered to provide cach madical support in an anount determined under the chile support guidelines until appropriate private health care coverage becomes available and the order/judgnent is modified. "Cash medical support’ has the same meaning ag ‘medical support’ in ORS 25.221(6) {SHORDIATE INCOME WITHHOLDING ‘The support order is enforceable by incone withholding under ORS 25.372 to 25.978, and 25.387 to 25.427, Withholding on both current support and arrears will occur immediately on ali orders and modifications. If MEATHER A BEYER ‘has been granted an exenption from iamediate withholding, the withholding will occur whenever there are arrears equal to at least the support payment for one month, whenever the obligated parent requests such withholding or a party requests withholding for good reason. ‘The district attorney oF, a¢ appropriate, the Division of Child Support of the Department of Justice will help in starting such withholding. An exception to incore withholding may be allowed under ons 28.396. (COLLECTION OF SUPPORT ‘This order will be filed and entered as a judgment with the county circult court, Bven s£ curzent support is being paid, the obligated parent's state and federal incone tax refunds can be taken to pay past die support. This means that the order will show a> an unpaid lien against the obligated parent's property in any credit check. The obligated Parent's property will be subject to collection activity including garnishment or execution Of liens for any unpaid eupport amounts. ‘ADDRESS /BNPLOVER/EALTH CARE COVERAGE CHANGES As party to this order, you must tell the court and the Child Support Program (CSP) when there de a change in your address, phone number, @river's license number or current employer's nane and address. This information mist be reported within 10 days of the Change, Tf you have been ordered to provide health care coverage, you must tell the CSP if health care coverage ig available through an enployer or any source, including a spouse, Page 3 of 7 - NOTICE AND FINDING OF FINANCIAL RESPONSIBILITY AND PROPOSED/PINAL ORDER CSF 02 0801 (Rev. 08/25/07) TVGra-Fi‘ser or other famiiy menber. If health care coverage is available, you mst J the policy information. __ y JA, 2008 Terese conga, Authorized Reprosentative (ev1CR TO: HEATHER A BEVER and IE you agree with the proposed order, you do not have to do anything else. [REQUEST FOR HEARING IE you do not agree with the ancunt(s) show, you can talk to the office listed on the notice or motion. The CSP nay agree to issue an anended proposed order. You have the Hight to a hearing before an administrative law judge (ALJ), whether or not you decide to talk tous. If we cannot agree on the anount(s), or if you object to any part or all of this notice, you must ask for a hearing. At the hearing, an ALJ will decide how much support and’ past support should be paid. Any cali blocking or calier identigication Feature (s) on your telephone mst be turned off before the hearing. If you want a hearing, £111 cut the attached form called Request for Administrative Hearing.” YOUR REQUEST MOST BH RECHIVED TH WRUTING AT THE OFFICE LISTED ON THIS FORM HITED 20 DAYS after you get this paper. Fill in all. the information on the request for hearing. Mali or bring the request for hearing to the Office listed on thie fora. The ALI will apply tthe child support guidelines (aR 137-050-0320 to 137-050-0450) to any information given at the bearing. This means that the support and past support asounts HEATHER A BEYER should pay may be higher or lower than the anounts listed in thie notice and the medicat child support provisions may change. If your request for hearing (g not received in the office 1igted on this form within 20 days, you waive your right to an administrative hearing. ‘She dotice end finding will be entered ao an order ag shown, The CSP has designated ite fie * im Enis matter aa the record in this case “wnen one party vequeste a hearing, he or che may later withdraw the request. ven if another party hes already requested a hearing, if you also want a hearing to take place, you ust request a hearing within the tine limit stated in the notice or other docunent you received £0 ensure chat a hearing will be scheduled. ABPEAL RIGHTS This order may be appealed in the circuit court of the county where the order was entered. The appeal mist be filed within 60 days after the order was entered (ors 416.427) (QTWBR ORDERS OR FENDING LEGAL ACTIONS IE you have an existing order or pending legal action in any state ordering payment of ehiia support for the ohiid(zen) listed, contact the office listed on this notice. PRIVACY ACT NOFrCE You are xequired to provide your sootal security number to the C32, this is nandatory under federal taw [42 USC §405(0) (2)C and 42 USC §665(a) (13)]. Your soctal Becurity miner will be Used by the CoP a9 one of the 1dentisiers co find you and your Fecords for purposes of estebliching paternity and establishing, modifying end enforcing Support obligations, You may be asked for your case inher Or your soclal security number then you vali the CSP go that we ere able to commectly identity your case, We ney aloo ask Tor your social security muber on forms that you need to complete in order for the CSP to ely Page 4 of 7 ~ WOTTCE AND FINDING OF PRUNCIAL RESPONSIBILITY AND PROBOSHD/PIRL ORDER CSF 02 0801 (Rev. 08/29/07) Wore fEASSTOMUNT OF MEDTCRE nrGHES «vou receive public assistance or have a medical card, your nedicel rights are sped to the State of Oregon. This neans that the state will oxder medical child sort be provided for the child(ren). The total child support obligation may be J. ised or lowered by part of that cost: DISCLOSURE OF PERSONAL INFORMATION Sone documents the CSP is required to complete have personal infomation about you, Such as your addzess, phone number, driver's license nunber aud employer sane, acdress and phone number. Tf you believe the health, safety or Liberty of you or your child would be put at unreasonable risk by releasing your personal information to other parties, you cen make a clain that the information should aot be released. To make this claim, complete and return the enclosed form called '20 NOT RELEASE INFORMATION haved on CLA OF RISK’. You must also give the CEP an ‘address of record! which you consider safe to release and to which we will send 11 documents for you. If you do not give vs an adiress of record, Einding of risk will not be made and your information may be released to the other pasties. DISCLOSURE OF YOUR ADDRESS lie mist seve you at the addcess vere you receive public assistance, the address given by you on your application for child support services, or at any other adérese you have given us. This {s called your ‘service address.' Your secvice adiress may be zeleased to other parties. We mist send copies of what you send to us to the other party(ies). We wil also send you copies of anything the other partylies) sends to us. Any documents we send to you vill be sent to your service address. If yeu want to chaage your service address, you can contact us. If you change your service address, all fueuse ocunents will be sent eo the address you give us. NOTICE TO: HEATHER A BEYER The address where you received this notize ie now your ‘address of record.' this adazess ay be released to the other party(ies). We must send the other party(tes) of what you send to us, We will also send you anything the other party(ies) sends TE you want your address of record changed, you can contact ae and let us knew what your address of record should be. The adéreas Of secord mist be in che same sace a8 your hone address. If you change your adress of record, all future documents will be sent to the address you give us. if you do not give us an address of record, al? future Gocurents will be sent to the address where you received this notice DISCLOSURE OF FINANCIAL RECORDS The Child Support Program mst notify you that 1f you owe past due child support, ve witt aok for information fron financial institutions, including detailed account information. We may also ask for account information from financial institutions if you are a party to an action to establish, modify or enforce your child support obligation These laws can be found at ORS 25.640, 25.643, and 25.646. EXSORCHMENT RINEDIES THE STATE MAY USE ‘Even if current support is being paid, your state and federal income tax refunds can be taken to pay past due support. Your order will be filed and entered ae a judgnent with the county circuit court. This means that the order will show ae an unpaid iien againet your property in any credit check. Garnishnent or execution can be used againet your property to help collect any unpalé support anounte Page 5 of 7 = NOTICE AND FINDING OF FINANCIAL RESPONSIBILITY AND PROPOGED/PINAL ORDER CSF 02 0802 (Rev. 08/29/07) TvGra-£iY MBCEIPT OF PUBLIC ASSISTANCE saan you owt noey tess TRDpSEaly assistance for weedy Panties = Sees gps 1 ofagotlsuprienese acene reopens 2 eherSeledPsceuley aaniaGSS7Sancer te suppleeatal secutey tone tosrse - You are rebuttably presumed unable to pay chilé support. ‘This means you night be allowed a credit and satiafaction for months when you receive thege benefits, Call the office listed fon this form if you get any of these benefite 2f che cash benefits you get are fron another state or a tribe, you must give the CSP written proof of the cash Henefits before the CSP can suspend child support. Every chree (3) ‘months you mist to show written proof of the cash benefits received to keep having child ‘Support suspended. ‘SAWERUETCY Xf you are currently going through bankruptey, you should immediately notify the office Listed on tnis fom. ‘FEAL OareR (A) So request for hearing having been received in the tine allowed, {1 the request for hearing having been dismissed or withdrawn, thie onder fe EITERED as a final order, (1 -except that no ongoing 11 caan eniia support [1] medics! onshd soppore As ordered because [ ] the parties nave reconciled. [ ] the Obligee has asked for no child support services. |} a judgnene of dissolution has been entered with the court since the deouance of this proposed order, and the isaue of current pupport is waived ap it is addzessed in the judgnent of dissolution. This order is subject to review for compliance with the child support guidelines three years froa the date the order took effect, or at the request of a party anytine, based upon a substantial change of circunstances. 121085 )08 Trsedleide, Tate Rutherizea nepesentacive STARTSTECAL INFORNATTON In addition to the statistical information contained in the money award, the following is provided as requized by ORS 25.020: Page § of 7 - NOTECE AND FINDING OF FINANCIAL RESPONSIBILITY AND PROPOSED/FINAL. ORDER CSF 02 0801 (Rev. 08/29/07) TVG:a-#4fis adaxess: 120 Boy a5 |x pproyer's phone mab Sf opuzane_mironmszoN: maployer: na Baployer's addres snployer's phone nunber {1 mis document se an exact and conplete copy oe | [ aaa orrice morons GERVIGES ON BEEALP OF THE Suave OF OREGON. WE | season REPRESENT YOU O% GIVE YOU LEGAL ADVICE. YOU MAY CONTACT YOUR mn CARYER AT ANT TIME i eee i Division Of Child Support ! ! |, 22velonmess privet 1 | i Hl Salen, OR 37305 . ‘Telephone: (503) 373-7300 i Exe (503) 378-2225 | | | epp: (503) 986-6248 the child support Program is able to provide cur custoners with information from fonse ad anaes core Eneiz ow languages free of charge, This algo fncludes, Brattie, Tors and other the ane of interpreters, To find oit more, please contact your obiid suppors cefice. age 1 of 7 = WOYTCR AND FINDING OF FINRNCIA RABFOSIRTLITY 21D FROFOSED/PIIAL ORDAR | GSte2 Stor ‘eev. 06/29/07) swes2-£8Ww ‘CHILD SUPPORT CODUEASTON RORESHEET (COCH) pecermine Parent A and Parent B. (See Tastructions) pavent A __pus/ora Parent 8 SEATHER 3 BEYER ‘of Joint Winor chindren 2 F, of Children Attending school (ORS 207.108) 2 Of adule children 0 (eee instructions fo: catoutattons) parent A parent B Combined Encore {Gross Monthy Tneome goo] 2,450.08) /////10111 Ja. Rebuttal anount applied, #f any | as {ase worksheet S-4) | 0.00] 0.00 | //// (11/117 |e pi oeeesceeeee ces eer ralTITT| 3. spousal support recesved 0.00 0.00] ////11 1111 3. Spousal support and/or mandatory | Vins | union dues paid 4.00} 0.00} ALTE | | coeagenmemnee | | YH nea: add or subtract line 18, \ [ins 2; gubtrace dine 3)7 emcees | | VAT | reaule \ o.oo] 1,484.88) //7 HH | | %, Social Security benefite oF | MINT Goterane’ benefits received for Joint} HUNT Wiivgiren) tencer in column of parent] \ MI : She chose disability or retizenent | MME aajunemonve _boae{ts are paid, esesdiens of, | | Pa Shieh parent actually receives the Ga. Mumber of nonjoint children for | ATTY each parent ° 0 THT Gb. Credit for nonjoint ehazéren | | TIAA (reference the scale for each | | parencte incone fron line 4, using | HAND i Pamper of nonjoine. children for each TATTLE parent, as appropriate) 0.00) 0.00/11 ja | 7, najustea Gross Monthly Income (add | [ince send 5 and suberact Line by Yor each parent) Combine amounts for! | i Forent A and Parent B an enter \ Peoult in 'Conined’ coluna 0.00} 2,454.88 2,454.88] ! @. Bercentage ebere of income, (cack | Veasaiiyiiaiy i Sietnera income fom ine 7 divided | \ MAILE i Ey the combined incon) ot aos TIT: | “Beate eaita 9, Basic child support Ohhigatce TAME {| support 2 ears eee For commined ancone (20MIN IAL \ fron Line 7 snd munber of Joint WMT | cntldzen) HTL ATLL 368.00 || nage 1 of 5 ~ CHILD SUPEOR? COMPUTATION WORKSHEEE (SCH) Cee 02 O809A (Rev. 09/19/07)Ba, Basic ChiId Support Obligation T/////T/IN/AIIITII IL for Joine Minor Chilatzen) (ancune onl//////// 10 /|[//1U/(11011| | Line 9 divided by total number of (//////10010/|L0/1I/II/11| 1 joint children, then muleipiied by | /////I/I IMME | unber of Joint minor ehiléren) WHMITHNHIUTIN| 365.00} |————4 Bb, Basie chi2a support obtagation (///////7//1I\IT/HIIIIII i For Child(zen) attending Sehook N/MM III) (Subtract Line 9a fron Line 8; enter [/////0///1I\IIINIIHI| zesule} A 0.00 JOrNE wrwoR 10. Each parent's pro rata basic | Tan) carto (RE) chi1a support obligation (Line § WUD Eines Iine 9a for each parent) a.00] 258.00 | /////00/111 Do parties have a current written agreenent or court order for parenting — | +r tine equal to or greater than 25% and equel to and lees than 508 for both | parenta? Or do che parents have split custody? if yes, complete worksheet 5:2 and enter result ia Line 20e; 1£ no, ignore Line ida ané continue. 10a. Zach parent's pro rata basic Wain eniia support obligation after Wnt parenting tine credit from worksheet i We 5:2, Line 10 (1 any) | nn) Yow incon «22. Each parent's single incone | IIE Adjustment _— obligation (reference the scale for | IT Sach parent's nods fied gross monthly | IY Sneoue from Line < and aumber of | MN Joint children); divide this mnber | TL by toral number of joint ehildreny | MII maitiply result by mnber of Joint | MUM Minor ehilaren 0.00) 368.00) ////11111117 32, Nonthiy chia support obligation | i | before costs and edjusenents | VT TE no parenting tine credit is MUM Theluded, enter zero for Fazent MUM Ay enter the lesser of Line 10 a aid Line 11 for Parent 3; Wain on WMI If parenting tine oredit is MILA included, enter the lesser of I ine 10a’ and line 11 for Parent WY Band zero for Parent A \ a.00] __368-00////// 1/1/11 Child Caze 3a, Child care costs for joint minor] MUI conte & entiaren (use workeheet §-3) 0.00] 0.00] //I aajustnente ~ Somer MINOR +13, Rebuttal anount applied, if any | | Wantitiit cern (RE) (anoune by whieh costs for joint | i Vy) Toter costs minor chiié(zen) should be Increased | MUM in column of or decreased for parent) (use WED paren who. worksheet 5-4) 0.00] 0.00 Tncurs come Tie. Total Costs (Line 13a and aaa | aii oF subtract 1ine 130) | 0.00} @.00|//11//111111\ age 2 of 5 - CHILD SUPPORT CONPUTATZON WORKSHEET (CSCH) CSF 02 0808R (Rev. 09/39/07)26, ot ore ro Mart 8 ine &] Parent A tines line 13e Parent B. Z€ no Parent A, enter ancunt from Line je Parent 3) Vn ae OAL VIII TEET 0.00) MITT ae ees je. Costs owed to Parent A (ine 8 |///////7////| AUT Parent B tines Line 130 Parent A) ee ee ABE. Net Coste owed (line 134 subtracted from line 13e. Enter amount in Parent B, if negative number place @ minus sign in front ‘the anount in parenthesis, enter sero in Parent By enter zero in Parent A) IE there ip @ chil: fen) attending Vain 0.00/11 Seana teen 1 UAT | Winn | WT | A | | | | 0.00 WMT 0.0 ool im this calculation, proceed to | Line 14; if not, skip to line 18. 14. Bach parent's pro rata basic | | Vveuiiaiis) child support obligation for | | een ta\ Child(ren) Attending Sohool (Line @ | | LITT Eines line sb for each | 0.00] O.0011//11111) parent) i | ELL Low Income 15. Bach parent's single income | T Vyetsitiyy ty) Adjustment obligation (reference scale for each | I ALI parent's noJified gross monthly | | WITTE incone fron line ¢ and aumber of | CE joint children; divide this nosber | TIN by total nusber of joint children; 1 VitiTH1| multiply result by aunber of joint iin, Child(zen) Attending Schoo!) 0.00] 2.00) /////10/111 46. Monthly child support obligation | | before costs and a | | the lesser of line i¢ and line 15. | | for each parent) i 0.00 2.00) /7//0/110111| costs & | | Adjustment - I I | (carp (RIE) attending school should be § | | ATTENDING ox decreased for parent) (pee | VITA SCHOOL worksheet S-4) I 0.00) o.00)//////10111| in column of incurs cost «IE no azent A, enter amount from | | i | Line 27a Parent 8) i I Costs owed to Parent A (line € Parent B tines Lin MITTIN CE I {ee | | TLE 9-00) MUN ss A 0.00) MIA Page 3 of 5 - CHILD SUPPORT COMPUTATION WORKSHEET (CSC) CSF 02 G30sR (Rev. 03/19/07)376, wet costa oned (Line 27D T T We subtracted from tine Le. meer | | ML snout in Parent 8, af segative | | UNE Sumber place a minis sian | | UI GF enctose the anount | | a, 22 no conte enter zero | MN enter sero in areat 3) 0.00] v.00) 11111111 ee _ euaiy We, Noathly ohiia support obligation] i TT after cote (ine 1€ Parent A plas | | | Hise ant peeat sy Lise ie rerene 9 | | Wanna pis or minus ine 370 parent By 3 | | Bay) | 0.09] 0.00 |//771001111) 18. Total net child support | | obligation after conte (aad or | UMN Subtract, as appropriate, dines 12, | | HT Ge ans ive for each parent, af | | WIN Regetive numer place's mins sion | | UN infront or enclose the enoart is | | Wu parenthesis) | 00) 36s.00/ MMIII) veaioal Guid 39. Davenim ap waavia tum cane | i Wri Support Costs COVERAGE IS REASONABLE IN CDOT (woe | Winn worksheet 6-5) | | Hee child support obligation wich | NN private health care coverage costo | | for chstdren, 2 any | UIT Ze proces bales ese covesae | NN 1s not reasonable in cost fren | WI worksheet Sef, or no private beatth | | HIT Gate coverage ip available, ener | | WI Bike 30 for each parent and go co | | WU Line 20 0.00] 368.001 /////11//111| 20, even cAen REDTCAL suProRT | | Auouwe, (ue workoneet 6), if any. | i WHT Het oniid support ebligation wish | | | Gash medical support. (nedica? | | WAHT cseensce oe pile betch care | | VMI coverage cost) | HTM Te none, enter snounte from tine 39 | | MTN for each parent | 9.00} __365.00////7/1/101111 Benetive Tf S6B or WB is received by TAHITI Vaitiiiiai\ stnent —-«Pavent A-as reprecentacive payee for |/MU/HI///141 Wenn Joine chiia(ren) aaa zeswle of |//7//////10/| TT Pazent Bia dlaabslity or vettrement |///1/////// HH nter anoint in Parent B WT 0.001 771101711001 22, Total Child Suppore Obtigation | | | Patent A enter figure from tine 20 | | WITT) Parent A | | WT) Parent 8 - Line Z0 minus Line 21; if | | Wn) negative value, enter zero] 23a. Enter modified gross monthly | income (line 4) for each parent. | 368.00 //////111111| VIHHIILN 4,484.88|//////111111| Page 4 Of § - CHILD SUPPORT COMPUTATION WORKSHEET (CSCW) C5? 02 O803A (Rev, 09/19/07)SSS Ed 23b. Self Support Resexve 353.00] 983.001/7///11IN, cone avadiabie | j Va ine 236; WU 23e. Bach parent: for support. (Line 23a mim if negative value enter 2 9.00 01.88 | //71111111 24, wonehly Chita support Obligation | Vit Geaver the lesser of Line 22 of Tine | nnn 23e) 0.00) _368-00////0///1/111| 24a. Rebuttal anount applied, if any i Va (use worksheer 5-4) | 0.00) 9.00 ///// 0111110) —- +————+- Goal child 25. Total Moathly Child Support | | Verity Support Obiigation (add or subtract lines | | WUVIT 24a from 24 for each parent. Round | | WATT tovwhole number; if negative maber | ULL enver zezo) { 0.00 365.001/// 1/11/11] suppor? TION Parent B's income figure derived from: LAST EVPLOVWENT VERT Reagon(s) for applying rebuttal(s) (if any) Name(s) of nonjoint child(ren) of Parent a: Name(s) of nonjoint child(ren) of Paxent 8: Page § of § - CHILD SUPPORT COMPUTATION MORKEHEET (CSCK) CSF 02 0809 (Rev. 09/19/07)y ee ee ee Aarowan BEvER ose #: 047021351642, duideline Past, aAnount Support hire at _0 onthe tines ¢, 307 equals 6, Daves: 2 children at __3 months times §. 368 equals ¢, 1,085 bates: 6/08-8/08 3 children ar __0 months eines § 368 equals § ate 4 children et __0 months tines § 373 emails §, © ates: 5 chilézen et __0 months tines § 37 equais & o pate: 6 children at __0 months times ¢, ae equals §, Daves: 7 enitaven at __o months times. 5. 385 equais § nates: 8 chitéren at __0 months vines § 389 emals ¢____ ates: [.} Based on ORS 25.265, this calculation does not Include months during which the obligor received cash benefits. Dates: ‘TOTAL FAST SUPPORT 5, 1,095 |] Based on OAR 137-055-3220, credit should be given in the anount of §. for cash or in-kind payments paid during the months in question (see explanation Below] [1 the amount of past cupport is unjust or unreasonable and will therefore be reduced by the amount of § . " (geagon and method for dollar amount of credit must be stated below) coments: {TOTAL ADJUSTED PAST SUPPORT § Page 1 of 1 - PAST SUPPORT COMPUTATION WORKSHEET cSF 02 0110 (Rev. 03/07/07)y ee ee ee Aarowan BEvER ose #: 047021351642, duideline Past, aAnount Support hire at _0 onthe tines ¢, 307 equals 6, Daves: 2 children at __3 months times §. 368 equals ¢, 1,085 bates: 6/08-8/08 3 children ar __0 months eines § 368 equals § ate 4 children et __0 months tines § 373 emails §, © ates: 5 chilézen et __0 months tines § 37 equais & o pate: 6 children at __0 months times ¢, ae equals §, Daves: 7 enitaven at __o months times. 5. 385 equais § nates: 8 chitéren at __0 months vines § 389 emals ¢____ ates: [.} Based on ORS 25.265, this calculation does not Include months during which the obligor received cash benefits. Dates: ‘TOTAL FAST SUPPORT 5, 1,095 |] Based on OAR 137-055-3220, credit should be given in the anount of §. for cash or in-kind payments paid during the months in question (see explanation Below] [1 the amount of past cupport is unjust or unreasonable and will therefore be reduced by the amount of § . " (geagon and method for dollar amount of credit must be stated below) coments: {TOTAL ADJUSTED PAST SUPPORT § Page 1 of 1 - PAST SUPPORT COMPUTATION WORKSHEET cSF 02 0110 (Rev. 03/07/07)| 7 sumer BY the Administrator (ORS 25.010) Count Court #: CSP ‘STATE OF OREGON Marion County Circuit Courts} JUL 16 2009 Marion 047011351641 CERTIFICATE, i ‘The child(ren) listed below is/are no longer residing in a state financed or supported residence, shelter ar other facility or institution. Your support order for the child(ren), including any medical child support, is suspended as of 07/08/2009, Jf you owe past due support for the child(ten), you are still required to pay back that amount, If the child(ren) listed below return(s) to a state financed or supported residence, shelter oF ‘other facility or institution, your full support order, including medical child support, will be reinstated effective the date of the ehild(ren)'s return to state care. oo CHILD(REN) DATEOFBIRTH RESIDENTIAL CARE, partes a ee ; 14 lO9 (utedaada Date! Teresa Gosda Division of Child Support 4800 25th Ave NE Ste 180 Salem, Oregon 97305 ‘Telephone: (503) 986-6033 “TDD: (503) 986-6244 ‘The Child Support Program is able o provide our customers with information from forms and other notices in their own languages free of charge. This also includes Braille lage print, and the use of - interpreters. To find out more, please contact your child support offiee. (C8 OA or 008CERTIFICATE OF SERVICE, Court case #: 08C34107 Thereby certify that: [1A certified true copy { ] An original [X] A copy of Certificate Suspending Support (ettached) was served upon Heather A. Beyer on 07/17/2009, [Thy substitute serviee on at [Thy sending the document(s) by cestfied mail, certified mail number return receipt requested, addressed as follows: [XT by sending the document(s) by first-class mail, addressed as follows: Heather A. Bever PO Box 21. Gates, OR 97346-0021 ‘mailed on 7/14/2009, ‘The person on whom the document(s) was served is: [Attorney of record for [X1_ The identical one named in the document served, L ] The public child support agency of the State of i [ J The public child support agency of the State of. ‘on behalf ofthe obligee per ORS 25.085. ul ‘Teen Gosda Authorized Representative Division of Child Support 44600 25th Ave NE Ste 180 Salem, Oregon 97305 ‘Telephone: (503) 986-6033 FAX: (503) 986-6289 ‘TDD: (503) 986-6244 -CSFen tee uz STEN Ae1 A chit support judgnent(s) or order(s) exiet(s) as follows: Name/County of Court or Agency that issued judgnent ‘cage aunbs [1 Pursuant to ORS 110.333(2), the tribunal(s) issuing the support Juaeene a) oe onaeziat an sedate’ janteaiceton auquse QR , 2008 hada Bate. Teresa Gosda Authorized Representative ge 2 08 2 ~ cumemercas o7 rowers sauna oF cusrice erapnenes (603) 272-7309 (rtons socestina a BuGeINE Diviaion of cite sapere ex: (ss) Steass OPPO GRNRRS O26 25.287, C2685, $26828 2200 taarecter Drive Emr (ean) sresenae (sr on ome (tev. o4/sel0n) ‘sien, oF 008 attsSTATE OF OREGON, Child Support Program (CSP), by he Administrator (ORS 25.010) County: Marion Court #: 08634107 csp i: O47011351641 CChiléren: Lauren Boyer, David Andresen and Robert Edmundebeyer Obligor: Heather A Beyer Obliges: State of Oregon STATE OF OREGON Marion County Cireyit Courts JAN 18 2012 | comfy that a copy of State's Motion for Modification and Proposed Order fi i ‘ABayer by persona service at Address of Serco Maintained in GSP Records, the DCS offen, on ‘10/06/2011 served by Kathy Folds at 02:45 pm. SIMEGE Meron Coy Sean Ny JAN 23 202 CERTIFICATE OF SERVICE ‘The person served with the document(s) was: ‘The identical one named in the document: + | 22-1 I Bate DIVISION OF CHILD SUPPORT 4600 25TH AVE NE #180, SALEM OR 97301- TELEPHONE: (608) 986-6083 FAX: (603) 986-6289 TTY: (800) 736-2900 Page tof -CERMICATE OF SERVICE (CS etna fe, oa Dans OFT T2618 Contam Copy7 Application Form Oregon NDHS netaiovernarnasasne HEAL Oregon Department printed information in an alternate format such as uth cfFaman Sees Braille, large print, audio tape or computer dise. (See form DHS 1005.) AGING AND Glient information ee, qe Sgting| PEOPLE WITH Lastname EDMUNDS First HEATHER MIA SDS 539 a Address 3125 SANTIAM HWY SE RM 75 City ALBANY Client 7 State OR Zip Code 97322___‘Telephone ($03) 509-1703 (H) EDMUNDS, Mailing address 313 1ST AVE W HEATHER A. CiyALBANY __Stale OR_Zip Code 97321_Daate sent Date of birth OV/OW/I9T6 ‘Social See. No. #2906881 50/2015 _ Marital status O single © maried _O divorced Ovwidowed separated Case number Citizenship © U.S. citizen © Non-citizen Gender OM @F_ 1064867 _ Disabled? Oyes Ono Blind?” Oyes_ Ono _—‘Prime number Tlivein Ohouse © roomand board © adultfosterhome —~—~=~S*S* How about an auto loan at 0} APR? . : We aze offering auto loans at rates LEATHER ANN BEYER ‘as low a 5.009 APA. CHERYL ARN EDMONDS And one lucky member will win the PO 30K 575. chance to have an interest’ sree args OR 97346-0575, gute lean! We will also be giving away a $100 and §50 gas card every week! Visit nycreditunion. com I way, Your balance at the beginning of the period... est SHARE ‘OLNUG Depostt -ACH-A-TRYS03 802.54 Suffix 0 Us TREASURY 303 (RR BET) o1ae nkendrawal a2.s4 Your new balance On 31AVODB. 0s. cceeceeeeeee a2sa Dividends Paid To You Tn 2008 Oa Suttix’ 9” ‘yr Tax” YEAR-TO-DATE INFORMATION FOR TAX PURPOSES: Sumaary Total non-IRA dividends earned (hay be reported to IRS as interest for this calendar year)..§ 0.24Page 1 of 1 ———— (Sbank. Requested by: Meliss Vinson ‘This check mage contains confdental Information, Ifyou print his img, please store tina secre place to avolé Unguthorzad urage of thi Informatan. Increased secuty anareness when diserding or destroying tis doce [sem 2 <— -|ASeet no. 3080002 Sequence no. 00979070546 Sunt a0 000050 peta rr eRe sevmmaenaen ALBANY COMMUNITY * 530000305 i ‘CASH BOX ID 0002 camera . ~ Boe ee ee | CASK OUT Ow ! Zosessas70z0 msa000030s" 31080092" #200.00 ese on | 2 ‘tpsfimage.s bandas comvimagelJSP/ReportXI jap?ImageNo=1 sys2013ee —_— (bank. Transaction History Star Savers Club Date Printed: 09/06/13. Account ending n 9020 Printed By: NGARAUL Page tof ACCOUNT BALANCE AVAILABLE BALANCE _—_ERB ean Doin caer [Oa aman) _ =r ad ar 89 TREE eve CSRS aT | Thists informational ony. itdoos not constiute your oficial statement. \ Allof serving your Pogo oft Tan customer Confident: he 39 Ub Bakrenent. Si Tey Medial Need Wh, Kansas why Phe813 INTHE CIRCUIT COURT OF THE STATE OF OREGON FOR THE THIRD JUDICIAL DISTRICT Sevenle Deparmest Tn the Matter of: 2 ) Noo FIP <29 > Aasescasn >) WDOMENT TRRMENATING. awa”) WaRDSHIP Tue ato for te Cory tie of te Dentin ot Ramin Seve (DS) thal ho wripeihed en sexo JOR bere ‘The Court has roviewel th evidens presented and mates the lowing findings: A tte yard has been safely romited witha parent, or a safe sltemstive to reunification ‘ha ben implemented forth ward. 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