1 2 3 IN THE CIRC UIT COURT OF THE STATE OF OREGON 4 FOR THE THIRD JUDICIAL DISTRICT 5 6 In the Matter of the Change of Name of: ) ) 7 __________________________________________ ) Case No: ___________ (Former Name) Petitioner ) 8 ) NOTICE OF NAME to:_________________________________________ ) CHANGE JUDGMENT 9 (New Name) ) 10 TO ALL INTERESTED PERSONS: 11 This notice is posted to advise all persons that a judgment was entered in this case 12 on__________________changing the name of _____________________________________ 13 to_________________________________________. 14 Dated_________________ _______________________________15 Petitioner (New name)16 Submitted by: 17 ______________________________________ Attorney/Petitioners Name Bar No. (if any) 18 ______________________________________ 19 Address 20 ______________________________________ City State Zip Phone No. 21 ______________________________________ 22 Trial Attorney if other than above Bar No. 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 NOTICE OF NAME CHANGE JUDGMENT - Page 1 of 1 FC(3/1/04)(Form 5)