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appendix-page-21 — Appendix or form source excerpt — physical PDF page 21

Coos, Curry County Supplementary Local Rules (2026) · physical PDF page 21 · 2026

Page 21 of 22   
SLR Effective February 1, 2026  
15th Judicial District 
Coos/Curry County Circuit Courts 
 
____________________________________________________________ 
 
____________________________________________________________ 
 
 A restraining order, protective order, or no-contact order is currently in effect between  
 
the parties in (court)________________ under case number:_________________ 
 
 
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 
 
      ________________________________ 
      Name (printed) 
 
____________________________________________________________ 
Contact Address   City, Stay, ZIP           Contact Phone 
 
 
 
 
(Serve the other party and all adult children who have not filed a Waiver of Further Appearance)  
 
Certificate of Mailing  
 
I certify that on ( date):________________ I placed a true and complete copy of this 
Motion in the Unites States mail to (name): ____________________________       at 
(address):___________________________________________________ 
____________________________________________________________ 
 
_________________   ________________________________ 
Date      Signature 
 
      ________________________________ 
      Name (printed)

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Captured 2026-10-18T22:30:41.802948+00:00 · 2026 SLR publisher source, retrieved 2026-10-18; later amendments and case orders require separate verification

Stored circuit-court rule excerpt. Read the complete rule, exceptions, current publisher version and actual case orders; applicability and deadlines are not established.