1 2 3 4 IN THE CIRCUIT COURT OF THE STATE OF OREGON 5 FOR THE THIRD JUDICIAL DISTRICT 6 7 In the Matter of the Change of Name of a Minor Child:) ) 8 __________________________________________ ) Case No:__________ ) 9 __________________________________________ ) AFFIDAVIT IN SUPPORT (Present Name(s) of Minor Child/ren) ) OF MOTION FOR10 ) ALTERNATIVE FORM __________________________________________ ) OF SERVICE11 ) __________________________________________ ) 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 This affidavit concerns the ______________________ (mother or father) of ________________18 ___________________(these children/this child/or name of specific child). The name of the19 other parent is: _________________. The other parent has willfully deserted this child/these20 children or neglected without just and sufficient cause to provide proper care and maintenance21 for the child/ren for one year before the filing of the petition for name change. The facts which22 demonstrate this are: ____________________________________________________________ 23 _____________________________________________________________________________ 24 _____________________________________________________________________________ 25 _____________________________________________________________________________. 26 I cannot find out the current address of the other parent by making reasonable efforts. 27 AFFIDAVIT IN SUPPORT OF MOTION FOR ALTERNATIVE FORM OF SERVIC E - Page 1 of 3 28 FC (3/1/04)(Form 12M) >>>> 2 1 This is a description of the efforts I have made to find out the other parents address and what has 2 happened as a result of those efforts:________________________________________________ 3 _____________________________________________________________________________ 4 _____________________________________________________________________________ 5 _____________________________________________________________________________. 6 The last known address I have for the other parent is: ____________________________ 7 ____________________________________________________________________. This is no 8 longer a good address because:_____________________________________________________ 9 _____________________________________________________________________________.10 The last time I or the child/ren had contact with the other parent was: 11 ______________________________________________________________________________12 _____________________________________________________________________________.13 The last time the other parent provided any financial support for the child/ren14 was:__________________________________________________________________________15 _____________________________________________________________________________.16 17 _______________________________ Petitioner/Guardian Ad Litem18 19 SIGNED AND SWORN to before me on _____________________________________.20 _________________________________________________________21 Deputy Court Administrator/Notary Public for the State of __________ My commission expires:______________________________________ 22 23 24 25 26 27 AFFIDAVIT IN SUPPORT OF MOTION FOR ALTERNATIVE FORM OF SERVIC E - Page 2 of 328 FC (3/1/04)(Form 12M) >>>> 3 1 Submitted by: 2 ______________________________________ 3 Attorney/Petitioners Name Bar No. (if any) 4 ____________________________________ Address 5 ______________________________________ 6 City State Zip Phone No. 7 ______________________________________ Trial Attorney if other than above Bar No. 8 9 10 Certificate of Document Preparation11 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)12 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 this13 form/document 14 __________________________ Signature15 16 17 18 19 20 21 22 23 24 25 26 27 AFFIDAVIT IN SUPPORT OF MOTION FOR ALTERNATIVE FORM OF SERVIC E - Page 3 of 328 FC (3/1/04)(Form 12M)