Free Form #2M - Oregon

1 2 3 4 5 6 7 8 9 *__________________________________________ 10 11 12 13 Based on the verified petition, 14 IT IS HEREBY ORDERED THAT: ________________________________ is appointed 15 as guardian ad litem to act on behalf of ______________________________________________ 16 _____________________________________________________ in this proceeding. 17 18 Dated:_______________ 19 20 21
Submitted by:

IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE THIRD JUDICIAL DISTRICT

In the Matter of the Change of Name of: *__________________________________________ ___________________________________________ (Present Name(s) of Minor Child/ren)

___________________________________________ (Proposed Name(s) of Minor Child/ren) *__________________________________________ (Petitioner/Guardian Ad Litem)

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Case No: *__________ ORDER APPOINTING GUARDIAN AD LITEM

_______________________________ Circuit Court Judge _______________________________ Print, Type or Stamp Name
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 p reparing this do cum ent.

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______________________________________ City State Zip Phone No. ______________________________________ Trial Attorney Bar No. ______________________________________ Attorney/Petitioner's Name Bar No. (if any) ______________________________________ Address

______________________________________ Signature

ORDER APPOINTING GUARDIAN AD LITEM - Page 1 of 1

FC (3/1/04)(Form 2M)