______________________________________________________________________________
In the Justice Court for ______ District, ______ County, Oregon.
____________
Plaintiff,
vs.
____________
Defendant.
In the Small Claims Department
This is to certify that in a certain action before me, the undersigned, had on this, the _____ day of _____, 2__, wherein ______ was plaintiff and _________ was defendant, jurisdiction of the defendant having been had by personal service (or otherwise), as provided by law, I then and there entered judgment against the (defendant or plaintiff) in the sum of ___ dollars, which judgment has not been paid.
Witness my hand this ___ day of ______, 2__.
__________________
Justice of the Peace
Sitting in the Small
Claims Department.
______________________________________________________________________________
ORS 55.130