1 2 3 4 IN THE CIRC UIT COURT OF THE STATE OF OREGON 5 FOR THE THIRD JUDICIAL DISTRICT 6 7 In the Matter of the Change of Name of: ) ) 8 __________________________________________ ) Case No: __________ ) 9 __________________________________________ ) AFFIDAV IT FOR (Present Name(s) of Minor Child/ren) ) MOTION TO WAIVE10 ) NOTICE TO PUTATIVE __________________________________________ ) FATHER 11 ) __________________________________________ ) 12 (Proposed Name(s) of Minor Child/ren) ) ) 13 __________________________________________ ) (Petitioner/Guardian Ad Litem) ) 14 STATE OF OREGON ) 15 ) ss. 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 father19 at the time of conception of the child, birth of the child, or after the birth of the child; the father20 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 no22 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 before24 the filing of this petition for name change, or at any time since the childs birth if the child was25 less than 60 days old when the petition was filed. The father has not tried to contribute to the26 childs support in the year before the filing of the petition for this name change, or at any time27 28 AFFID AV IT FOR MOTION TO WAIV E NOTICE TO PUTA TIVE FAT HER - Page 1 of 2 FC(3/1/04)(Form 9M)>>>> 2 1 since the childs birth if the child was less than one year old when the petition was filed. 2 3 _______________________________ Petitioner/Guardian Ad Litem 4 5 SIGNED AND SWORN to before me on _____________________________. 6 7 ______________________________________________________ Deputy Court Administrator/Notary Public for the State of ______ 8 My commission expires:__________________________________ 9 Submitted by: 10 ______________________________________ 11 Attorney/Petitioners Name Bar No. (if any) 12 _____________________________________ Address 13 ______________________________________ 14 City State Zip Phone No. 15 ______________________________________ Trial Attorney if other than above Bar No. 16 17 Certificate of Document Preparation 18 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) 19 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 this20 form/document 21 __________________________ Signature 22 23 24 25 26 27 28 AFFID AV IT FOR MOTION TO WAIV E NOTICE TO PUTA TIVE FAT HER - Page 2 of 2 FC(3/1/04)(Form 9M)