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: ) ) 8 *__________________________________________ ) Case No: * ____________ ) 9 ___________________________________________ ) ORDER WAIVING (Present Name(s) of Minor Child/ren) ) NOTICE TO OTHER10 ) PARENT *__________________________________________ ) 11 ) ___________________________________________ ) 12 (Proposed Name(s) of Minor Child/ren) ) ) 13 *__________________________________________ ) (Petitioner/Guardian Ad Litem) ) 14 Based on the motion of petitioner and the supporting affidavit, 15 IT IS HEREBY ORDERED THAT: service of notice of the petition for name change on16 the other parent is waived. 17 Dated:_________________ _______________________________18 Circuit Court Judge 19 _______________________________ Print, Type or Stamp Name of Judge20 Submitted by: * Certificate of Document Preparation21 * ______________________________________ If this document was not completed by an22 Attorney/Petitioners Name Bar No. (if any) attorney, I hereby certify that the following * statements are true: (check all boxes and 23 ______________________________________ complete all blanks that apply) Address A. G I selected this document for myself and I24 * completed it without paid assistance ______________________________________ B G I paid or will pay money to ___________25 City State Zip Phone No. For assistance in preparing this document. * * 26 ______________________________________ ____________________________________ Trial Attorney Bar No. Signature 27 ORDER WAIVING NOTICE TO OTHER PARENT - Page 1 of 1 FC(3/1/04)(Form 10M/1) 28