Free Form #6 - Oregon

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

In the Matter of the Change of Name of: __________________________________________ (Former Name) Petitioner to:_________________________________________ (New Name) STATE OF OREGON ) ) ss. )

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Case No: __________ PROOF OF POSTING NOTICE OF NAME CHANGE JUDGMENT

9 County of Marion 10 11

I, ___________________, being first duly sworn, do hereby declare and say: on ______________________________, I posted written notice the judgment changing my name, 12 dated ________________, on the bulletin board at the Marion County courthouse. 13 14 15 16 17 18 19 20 21 22 Certificate of Document Preparation 23 24 25 26 27 28 PROOF OF POSTING - Page 1 of 1 FC(3/1/04)(Form 6) 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 _____________________________________________________________________________ City State Zip Phone No. Trial Attorney (if other than above) Bar No. Submitted by: _____________________________________________________________________________ Attorney/Petitioner's Name Bar No. (if any) Address _______________________________ Petitioner (New name) SIGNED AND SWORN to before me on ________________________________. __________________________________________________________ Deputy Court Administrator/Notary Public for the State of ___________ My commission expires: ______________________________________