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 PUTATIVE10 ) FATHER *__________________________________________ ) 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 putative father is waived. 17 Dated:_______________ _______________________________18 Circuit Court Judge19 _______________________________ Print, Type or Stamp Name20 21 Submitted by: * Certificate of Document Preparation * 22 ______________________________________ If this document was not completed by an Attorney/Petitioners Name Bar No. (if any) attorney, I hereby certify that the following 23 * statements are true: (check all boxes and ______________________________________ complete all blanks that apply)24 Address A. G I selected this document for myself and I * completed it without paid assistance25 ______________________________________ B G I paid or will pay money to ___________ City State Zip Phone No. For assistance in preparing this document.26 * * ______________________________________ ____________________________________27 Trial Attorney Bar No. Signature 28 ORDER WAIVING NOTICE TO PUTATIVE FATHER (Minor) - Page 1 of 1 FC(3/1/04)(Form 10M)