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: *__________ ) 8 ___________________________________________ ) ORDER APPOINTING (Present Name(s) of Minor Child/ren) ) GUARDIA N AD LITEM 9 ) *__________________________________________ ) 10 ) ___________________________________________ ) 11 (Proposed Name(s) of Minor Child/ren) ) ) 12 *__________________________________________ ) (Petitioner/Guardian Ad Litem) ) 13 Based on the verified petition, 14 IT IS HEREBY ORDERED THAT: ________________________________ is appointed 15 as guardian ad litem to act on behalf of ______________________________________________16 _____________________________________________________ in this proceeding. 17 18 Dated:_______________ _______________________________19 Circuit Court Judge20 _______________________________ Print, Type or Stamp Name21 Submitted by: Certificate of Document Preparation22 If this document was not completed by an ______________________________________ attorney, I hereby certify that the following23 Attorney/Petitioners Name Bar No. (if any) statements are true: (check all boxes and complete all blanks that apply)24 ______________________________________ A. G I selected this document for myself, and I Address completed it without paid assistance.25 B. G I paid or will pay money to ___________ ______________________________________ for assistance in preparing this document.26 City State Zip Phone No. 27 ______________________________________ ______________________________________ Trial Attorney Bar No. Signature 28 ORDER APPOINTING GUARDIAN AD LITEM - Page 1 of 1 FC(3/1/04)(Form 2M)