IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF DOUGLAS In the Matter of: Case No. APPLICATION and DECLARATION for Last First Middle Minor222s Current Name APPOINTMENT OF GUARDIAN ad LITEM for IDENTITY CHANGE OF MINOR Last First Middle Full Name of proposed Guardian ad Litem APPLICATION The proposed Guardian ad Litem (or a minor child at least 14 years of age) asks the Court to appoint a Guardian ad Litem for the Minor in this matter. This motion is supported by ORCP 27 and the declaration below. DECLARATION 1. I am: Check either 223a224 or 223b224 and fill out that section. a. A Minor, age 14-17 years of age. I am years old. I am asking the court to appoint (print name of person you want to be your Guardian ad Litem) to be my Guardian ad Litem in this case. b. The person asking to be appointed as the Guardian ad Litemfor the Minor in this case. The minor is years old. 2. The proposed Guardian ad Litem: Check either 223a224 or 223b224 and fill out where appropriate. a. is a parent of the Minor. b. is not a parent of the minor. The proposed Guardian ad Litem knows (or is related to) the Minor in this way: . 3. The proposed Guardian ad Litem is a suitable person to be appointed. The proposed Guardian ad Litem is also willing to serve and has signed his/her agreement below. 4. The proposed Guardian ad Litem is at least 18 years of age. American LegalNet, Inc. www.FormsWorkFlow.com Declaration re Truth of Statement: 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. Signature of Proposed Guardian ad Litem Date Signature of Minor (if age 14, 15, 16, or 17 years) Date Certificate of Document Preparation . You are required to truthfully complete this certificate about the document you are filing with the court. Check all boxes that apply. I selected this document for myself and I completed it without paid assistance. I paid or will pay money to for assistance in preparing this form. Signature and Contact Information for Guardian ad Litem Proposed Guardian Ad Litem, Print Name Telephone or Contact Telephone Address or Contact Address City / State / Zip American LegalNet, Inc. www.FormsWorkFlow.com IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF DOUGLAS In the Matter of: Case No. ORDER re APPLICATION Last First Middle Minor222s Current Name of GUARDIAN ad LITEM for IDENTITY CHANGE OF MINOR Last First Middle Full Name of proposed Guardian ad Litem ORDER Based on the application and declaration for appointment of a Guardian ad Litem for the Minor named above, the Court orders that the application is: Allowed. Denied. Other: Submitted by: Submitting Party, Print Name Telephone or Contact Telephone Address or Contact Address City / State / Zip American LegalNet, Inc. www.FormsWorkFlow.com