SLR 17-16.061: Trial by Declaration Under Penalty of Perjury ................................ ................................ .. 34 APPENDIX OF FORMS

Testimony by affidavit or by declaration under penalty of perjury shall be allowed in violation cases only upon receiving a signed statement from the defendant waiving the right to have the testimony presented orally in court. The declaration and statement may be filed in the form set forth in the appendix of forms, form number 16.061. At the commencement of any violation trial, any and all affidavits which have been filed by that time with the Trial Court Administrator shall be deemed offered by the party who tendered them to the court or on whose behalf they were tendered to the court, and such affidavits shall then be received and considered by the court as substantive evidence in that case. 17th Judicial District, Lincoln County Circuit Court Supplementary Local Rules for 2026 - Page 35 APPENDIX OF FORMS Form 3.181 – Public Access Certificate IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF LINCOLN In re Public Access Coverage: CERTIFICATE I, _________________________________________, represent _____________________________________ and I desire to provide public access coverage in the following case: Case Name: Case Number: I make the following representations: 1. I have read and will comply with UTCR 3.180. 2. I have read and will comply with Lincoln County Circuit Court’s SLR 3.181. 3. I understand my permission to provide public access coverage can be immediately withdrawn if: a. I violate the above described rules; b. I violate any limitations imposed by the Court under the rules; or c. The Court orders termination of the coverage. ____ Date Signature Printed Name 17th Judicial District, Lincoln County Circuit Court Supplementary Local Rules for 2026 - Page 36 Form 8.075 – STANDARDIZED PARENTING PLAN (1) Subject to the parenting time guidelines as set forth in subsection 13 of this plan which modify parenting time until the child reaches the age of six, the non-custodial parent shall have the following PARENTING TIME SCHEDULE: (a) ALTERNATE WEEKENDS, a weekend being defined as beginning at 6:00 p.m. on Friday and ending at 6:00 p.m. on the following Sunday; and (b) ALTERNATE WEDNESDAYS, commencing at 9:00 A.M. and ending at 6:00 P.M., providing the child is not in school; and (c) WINTER BREAK: Regardless of whether the child is attending school, parenting time shall be during the period of winter vacation of the district in which the custodial parent resides (measured from the day school adjourns through the day before school resumes). Parenting time for the non- custodial parent shall commence at 6:00 P.M. on the day school adjourns through 8:00 A.M. on December 25 in odd-numbered years, and from 9:00 A.M. on December 25 until 9:00 A.M. on the last day of the break in even- numbered years; and (d) THANKSGIVING BREAK: In even numbered years, commencing on Wednesday at 6:00 P.M. and ending on Sunday at 6:00 P.M.; and (e) SPRING BREAK: In odd numbered years, spring vacation of the school district of the custodial parent’s residence from 6:00 P.M. on the day that school adjourns until 9:00 A.M. on Sunday prior to the commencement of school; and (f) SUMMER BREAK: Regardless of whether the child is in school, for a period of five weeks during summer school vacation commencing at the beginning of the break in even numbered years and the last five weeks of the summer in odd numbered years (except that the child shall be returned to the custodial parent at least thirty-six hours prior to the commencement of school in the fall). 1. When the non-custodial parent exercises their right to a parenting time period of more than twenty days, the custodial parent shall have the right to a weekend parenting time. At the option of the non- custodial parent, the weekend parenting time for this summer break shall occur on the third or fourth weekend and shall be preceded by 17th Judicial District, Lincoln County Circuit Court Supplementary Local Rules for 2026 - Page 37 notice to the custodial parent at the commencement of the summer parenting time period. Further, this parenting time shall not extend beyond the summer parenting time period of the non-custodial parent. 2. In the period of time not assigned to the non -custodial parent, the custodial parent shall be entitled to an uninterrupted two -week block during which the alternate weekend and alternate Wednesday of the non-custodial parent shall be suspended. Notice of the dates of the two-week block shall be given to the non -custodial parent at the commencement of the summer break. (g) HOLIDAYS: The non-custodial parent shall be entitled to alternate legal holidays as set forth in ORS 187.010 et seq, excluding Sundays and those holidays previously mentioned or explicitly covered, commencing with Martin Luther King, Jr.'s Birthday on the third Monday in January in even numbered years, and in odd numbered years with Presidents Day on the third Monday in February. 1. Any holiday not falling on Friday, Saturday, Sunday or Monday, the period of parenting time shall be from 9:00 A.M. through 6:00 P.M., unless the holiday falls on a school day in which case there will be no parenting time. Any holiday falling on a Friday or a Monday, will entitle the party to the holiday, to have the child for the entire weekend, including the holiday. If the holiday falls on Friday, parenting time will be from 6:00 P.M. on Thursday to 6:00 P.M. on Sunday. If the holiday falls on Monday, parenting time is from 6:00 P.M. on Friday, through 6:00 P.M. on Monday. 2. Fourth of July shall be included in the non-custodial parent’s summer parenting time during even numbered years, regardless to which the holiday belongs. 3. Halloween shall be included in the non-custodial parent’s odd- numbered parenting time. (h) PERSONAL HOLIDAYS: The non-custodial parent shall be entitled to have parenting time on the day of his or her birthday from 9:00 A.M. to 6:00 P.M., if occurring on a non-school day. If the custodial parent's birthday falls during a period of parenting time, the custodial parent shall be entitled to 17th Judicial District, Lincoln County Circuit Court Supplementary Local Rules for 2026 - Page 38 parenting time with the child for that day from 9:00 A.M. to 6:00 P.M., unless it causes a substantial interference with the scheduled parenting time of the non-custodial parent. Further, each parent is entitled to parenting time on their respective Mother's or Father's Day, from 9:00 A.M. until 6:00 P.M.; and either parent may include this day in a whole weekend and trade the upcoming parenting time weekend for Mother's or Father's Day weekend. A parent may not exercise parenting time on that parent’s birthday if the birthday falls on a holiday designated as the other parent’s parenting time. (i) CHILD'S BIRTHDAY: The non-custodial parent shall be entitled to parenting time with the child on the child’s birthday in even numbered years. The parenting time will be from 9:00 A.M. if the birthday falls on a non-school day until 6:00 P.M., and if the birthday falls on a school day, from 5:00 P.M. until 8:00 P.M. (2) All parenting time periods shall be exercised in a prompt manner so that both parties can make their plans accordingly. The non-custodial parent shall pick the child up from the front steps of the custodial parent's residence no earlier than 15 minutes before and not later than 15 minutes after the parenting time period commences. Return of the child to the front steps of the custodial parent's residence shall also be subject to the 15-minute rule. The non-custodial parent shall notify the custodial parent by telephone at least 24 hours in advance if he or she is going to be unable to exercise parenting time rights as scheduled. (3) The custodial parent shall have the child fed and ready on time for parenting time with sufficient and proper clothing packed and ready for the parenting time period. (4) The non-custodial parent shall feed the child the evening meal before returning from the parenting time period, and return the child with the same clothes as when they arrived, laundered and ready to wear. (5) In the event the child is ill and unable to visit, a makeup parenting time will be allowed to the non-custodial parent on the next succeeding weekend. However, if the non-custodial parent fails to exercise their parenting time, for reasons of health or for any other reason, there will be no makeup parenting time period. The child will not be permitted to determine whether they wish to visit with the non-custodial parent. (6) Personal plans of the custodial parent or child, school activities, church activities and other considerations will not be reasons for failing to adhere to the parenting time schedule set forth in the court's order. Only substantial medical reasons will be 17th Judicial District, Lincoln County Circuit Court Supplementary Local Rules for 2026 - Page 39 considered sufficient for postponement of parenting time. (7) Both parties will provide addresses and contact telephone numbers to the other party and will immediately notify the other party of any emergency circumstances or substantial changes in the health of the child. Both parents shall be entitled to complete access to all medical, dental, and other records concerning the health of the child. (8) The non-custodial parent shall, in addition to the parenting time, have the unlimited right to correspond with the child, and to telephone the child during reasonable hours without interference or monitoring by the custodial parent or anyone else in any way. Unless otherwise agreed upon between the parties, telephone conferences between the non-custodial parent and child shall be limited to no more than 3 per week and each call shall be of 10 minutes or less in duration. The custodial parent shall have the same rights as set forth above during the period that the child is with the non-custodial parent. (9) Both parties shall be restrained and enjoined from making derogatory comments about the other party or in any way diminishing the love, respect and affection that the child has for the other party. (10) In addition to the parenting time specified above, the non-custodial parent shall have the right to visit with the child at school, attend the child's school activities, and have full access to school teachers and administrators for complete information about the child in school. The non-custodial parent does not have the right to take the child out of school without the written authorization of the custodial parent. (11) No modification or acquiescence in changes of these specific parenting time conditions will be allowed or recognized, unless such modifications are in the form of a written stipulation signed by the parties, or a court order. (12) As is state law, unless otherwise set forth in the judgment of dissolution, no modification or abatement of support shall occur during the periods of parenting time, including the summer. (13) The following are PARENTING TIME GUIDELINES in reference to the age of the child: (a) INFANTS THROUGH 12 MONTHS: The parenting time in section 1 shall be modified as follows: 17th Judicial District, Lincoln County Circuit Court Supplementary Local Rules for 2026 - Page 40 1. The alternate weekend in Section 1 (a) shall be reduced to a 24-hour period beginning at 6:00 pm on Friday and ending at 6:00 p.m. on Saturday. 2. Sections 1(b) through 1(h) do not apply. 3. The non-custodial parent shall be allowed a 3-hour period beginning at 6:00 pm and ending at 9:00 p.m. each Monday and Wednesday. 4. The parents are encouraged to add additional days during the summer break. (b) CHILDREN AGE ONE THROUGH THREE: 1. The alternate weekend in Section 1 (a) shall be reduced to a 24-hour period beginning at 6:00 pm on Friday and ending at 6:00 p.m. on Saturday. 2. The non-custodial parent shall be allowed a 3-hour period beginning at 6:00 pm and ending at 9:00 p.m. each Monday and Wednesday; 3. Winter break in Section 1(c) shall be reduced to 6:00 pm on December 23 to 8:00 p.m. on December 24 in even numbered years, and 8:00 p.m. on December 24 to 6:00 pm on December 25 in odd numbered years. 4. Thanksgiving break in Section 1(d) shall be reduced to Thursday at 9:00 a.m. to Friday at 9:00 a.m. in even numbered years. 5. The summer break in section 1(f) shall be reduced to 5 three-day blocks, each block being separated by at least three days. The blocks may not be used to extend any period of parenting time to four days or more. The non-custodial parent shall notify the custodial parent in writing by May 1 of each year setting out the schedule for the summer break. 6. Sections 1 (b) and (e) do not apply. 7. If the holiday listed in section 1(g) falls on a Monday, parenting time will be from 6:00 pm on Sunday until 9:00 p.m. on Monday. Parenting time on Veterans Day and Independence Day shall be from 9:00 a.m. 17th Judicial District, Lincoln County Circuit Court Supplementary Local Rules for 2026 - Page 41 until 6:00 p.m. (c) CHILDREN FOUR THROUGH FIVE The summer break listed in section 1(f) shall be 2 two-week blocks with at least a 2 week block in between. The non-custodial parent shall notify the custodial parent in writing by May 1 of each year setting out the schedule for the summer break. (d) CHILDREN AGE SIX TO TWELVE: The parenting time schedule should be flexible enough to insure the child's participation in ongoing or special activities. During the summer, residence with the non-custodial parent is suggested with the custodial parent having weekly or bi-weekly access. (e) ADOLESCENTS AND YOUNG ADULTS, OVER TWELVE: Flexible parenting time is the basic principle, with the child having some input to avoid scheduling conflicts. At this age, it seems the quality of time is more important than the quantity. During the summer, consideration should be given to the child's employment, organized athletics and other activities. (f) LONG DISTANCE PARENTING TIME: Unless otherwise specified by court order, the non-custodial parent shall make appropriate arrangements for travel, taking into account the age of the child. 17th Judicial District, Lincoln County Circuit Court Supplementary Local Rules for 2026 - Page 42 FORM 16.061 – TRIAL BY DECLARATION IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF LINCOLN State of Oregon Case No: ________________ v. DEFENDANT’S DECLARATION Defendant (Trial by Declaration) I waive my right to appear personally at trial and submit my evidence by this Declaration to the court. I understand that I will be notified by mail of the court’s decision. Additional page attached Certificate of Document Preparation. Check all that apply: I chose this form for myself and completed it without paid help A legal help organization helped me choose or complete this form, but I did not pay money to anyone I paid (or will pay) __________________________ for help choosing, completing, or reviewing this form I hereby declare that the above statements are true to the best of my knowledge and belief. I understand they are made for use as evidence in court and I am subject to penalty for perjury. Date (signature) Print Name Contact Address City, State, Zip Contact Phone 17th Judicial District, Lincoln County Circuit Court Supplementary Local Rules for 2026 - Page 43 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF LINCOLN State of Oregon Case No: ________________ v. Citation No: ________________ REPORTING OFFICER’S DECLARATION Defendant (Trial by Declaration) The Defendant has entered a plea of Not Guilty and requested a Trial by Declaration. Please submit your Declaration of the facts to the Court before ________________. I am the Reporting Officer in this case and I submit the following facts to the court: Additional page attached I hereby declare that the above statements are true to the best of my knowledge and belief. I understand they are made for use as evidence in court and I am subject to penalty for perjury. Date , Officer (signature) Contact Address City, State, Zip Contact Phone