1 IN THE CIRC UIT COURT OF THE STATE OF OREGON 2 FOR THE THIRD JUDICIAL DISTRICT 3 4 In the Matter of the Change of Name of: ) ) 5 *__________________________________________ ) Case No: *_____________ (Present Name) Petitioner ) 6 ) CHANGE OF NAME to: *_______________________________________ ) GENERAL JUDGMENT 7 (Proposed New Name) ) 8 Based on the petition, and the court finding that proper notice to interested parties has 9 been made and no person has shown cause why the requested judgment should not be granted;10 now, therefore: 11 IT IS HEREBY ADJUDGED: 12 The name of *_________________________________ is changed to 13 *__________________________________, and notice of the change of name shall be posted at14 a public place in this county. 15 Dated:__________________ __________________________________16 Circuit Court Judge 17 __________________________________ Print, Type or Stamp Name of Judge18 Submitted by: 19 * _____________________________________________________________________________ 20 Attorney/Petitioners Name Bar No. (if any) Address * 21 _____________________________________________________________________________ City State Zip Phone No. Trial Attorney (if other than above) Bar No.22 23 *Certificate of Document Preparation 24 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) 25 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 this26 form/document * _______________________________27 Signature 28 CHANGE OF NAME GENERAL JUDGMENT - Page 1 of 1 FC(3/1/04)(Form 4)