Free Form #1M - Oregon

1 2 3 4 5 6 7 8 9 __________________________________________ 10 11 12 13 1. 14 I, petitioner, am the ____________________ (describe relationship) of the child/ren 15 named in this petition. The date(s) of birth of the child/ren is/are: ________________________ 16 _____________________________________________________________________________ 17 (fill in name and date of birth of each child). 18 2. 19 I request a judgment changing the name(s) of the child/ren as set forth in the title of this 20 petition. 21 3. 22 I am 18 years old or older. The child/ren reside(s) in Marion County. 23 24 4. 25 I am requesting this name change because: _____________________________________ 26 _____________________________________________________________________________ 27 _____________________________________________________________________________ 28 PETITION FOR CHANGE OF NAME - Page 1 of 2 FC (1/1/08)(Form 1M) __________________________________________ (Proposed Name(s) of Minor Child/ren) __________________________________________ (Petitioner/Guardian Ad Litem) In the Matter of the Change of Name of: __________________________________________ __________________________________________ (Present Name(s) of Minor Child/ren) ) ) ) ) ) ) ) ) ) ) ) ) ) ) IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE THIRD JUDICIAL DISTRICT

Case No: __________ PETITION FOR CHANGE OF NAME

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 Submitted by: 20 21 22 23 24 25 26 27 28 G (Check the box that applies): G (Check the box that applies): G G

5.

Both parents of the child/ren are living. OR The____________________ (mother, father, or parents) of _______________________ (name(s) of child/ren) is/are deceased. 6.

The child/ren does/do not have any legal guardian other than his/her/their parents. OR The legal guardian(s) of ___________________________ (name(s) of child/ren) is/are ___________________________ (name(s) of guardian(s)). 7.

G I am not one of the parents of the child/ren. I request that I be appointed Guardian Ad Litem for the child/ren in this proceeding.

I hereby declare that the above statement is true to the best of my knowledge and belief, and that I understand it is made for use as evidence in court and is subject to penalty for perjury. _______________________________ Petitioner/Guardian Ad Litem

____________________________________________________________________________ Attorney/Petitioner's Name Address ____________________________________________________________________________ City State Zip Phone No. If Attorney: Bar No. E-mail Fax Certificate of Document Preparation If this document was not completed by an attorney, I hereby certify that the following statements are true: (check all boxes and complete all blanks that apply) A. G I selected this document for myself, and I completed it without paid assistance. B. G I paid or will pay money to _________________ for assistance in preparing this form/document __________________________ Signature PETITION FOR CHANGE OF NAME - Page 2 of 2 FC (1/1/08)(Form 1M)