Free Form #9M - Oregon

1 2 3 4 5 6 7 8 9 10 __________________________________________ 11 12 13 14 STATE OF OREGON 15 County of Marion 16 I, __________________________, being first duly sworn, do hereby declare and say: 17 To the best of my knowledge and belief, the father of this child is: _______________________. 18 Paternity of the child has not been established because the mother was not married to the father 19 at the time of conception of the child, birth of the child, or after the birth of the child; the father 20 has not voluntarily acknowledged paternity by signing the birth certificate or filing an 21 acknowledgment of paternity with the State Registrar of the Center for Vital Statistics; and no 22 other legal proceeding has declared this person to be the father of this child. 23 The child has not lived with the father at any time during the 60 days immediately before 24 the filing of this petition for name change, or at any time since the child's birth if the child was 25 less than 60 days old when the petition was filed. The father has not tried to contribute to the 26 child's support in the year before the filing of the petition for this name change, or at any time 27 28
AFFID AV IT FOR MO TION TO W AIV E NO TICE TO P UTA TIVE FAT HER - Page 1 of 2 FC(3/1/04)(Form 9M)

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) ) ) ss. )

) ) ) ) ) ) ) ) ) ) ) ) ) )

Case No: __________ AFFIDAVIT FOR MOTION TO WAIVE NOTICE TO PUTATIVE FATHER

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since the child's birth if the child was less than one year old when the petition was filed.

_______________________________ Petitioner/Guardian Ad Litem SIGNED AND SWORN to before me on _____________________________.

______________________________________________________ Deputy Court Administrator/Notary Public for the State of ______ My commission expires:__________________________________ Submitted by:

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AFFID AV IT FOR MO TION TO W AIV E NO TICE TO P UTA TIVE FAT HER - Page 2 of 2 FC(3/1/04)(Form 9M)

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