1 2 3 4 5 IN THE CIRCUIT COURT OF THE STATE OF OREGON 6 FOR THE THIRD JUDICIAL DISTRICT 7 8 In the Matter of the Change of Name of: ) ) 9 __________________________________________ ) ) 10 __________________________________________ ) Case No: __________ (Former Name(s) of Minor Child/ren) ) 11 ) NOTICE OF NAME __________________________________________ ) CHANGE JUDGMENT12 ) __________________________________________ ) 13 (New Name(s) of Minor Child/ren) ) __________________________________________ ) 14 (Petitioner/Guardian Ad Litem) ) 15 TO ALL INTERESTED PERSONS: 16 This notice is posted to advise all persons that a judgment was entered in this case 17 on_____________________changing the name(s) of ___________________________________ 18 ___________________________________to_________________________________________ 19 ___________________________________. 20 21 Dated_______________ _______________________________22 Petitioner/Guardian Ad Litem23 24 25 26 27 28 NOTICE OF NAME CHANGE JUDGMENT - Page 1 of 2 FC(3/1/04)(Form 16M)>>>> 2 1 2 Submitted by: 3 ______________________________________ Attorney/Petitioners Name Bar No. (if any) 4 ______________________________________ 5 Address 6 ______________________________________ City State Zip Phone No. 7 ______________________________________ 8 Trial Attorney if other than above Bar No. 9 Certificate of Document Preparation10 If this document was not completed by an attorney, I hereby certify that the following statements11 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.12 B. G I paid or will pay money to _________________ for assistance in preparing this form/document 13 __________________________14 Signature15 16 17 18 19 20 21 22 23 24 25 26 27 28 NOTICE OF NAME CHANGE JUDGMENT - Page 2 of 2 FC(3/1/04)(Form 16M)