1 IN THE CIRC UIT COURT OF THE STATE OF OREGON 2 FOR THE THIRD JUDICIAL DISTRICT 3 4 In the Matter of the Change of Name of: ) ) 5 __________________________________________ ) Case No: __________ (Former Name) Petitioner ) 6 ) PROOF OF POSTING to:_________________________________________ ) NOTICE OF NAME 7 (New Name) ) CHANGE JUDGMENT 8 STATE OF OREGON ) 9 ) ss. County of Marion ) 10 I, ___________________, being first duly sworn, do hereby declare and say: on 11 ______________________________, I posted written notice the judgment changing my name, 12 dated ________________, on the bulletin board at the Marion County courthouse. 13 _______________________________14 Petitioner (New name) 15 SIGNED AND SWORN to before me on ________________________________. 16 __________________________________________________________ Deputy Court Administrator/Notary Public for the State of ___________17 My commission expires: ______________________________________ 18 Submitted by: 19 _____________________________________________________________________________ Attorney/Petitioners Name Bar No. (if any) Address 20 _____________________________________________________________________________ 21 City State Zip Phone No. Trial Attorney (if other than above) Bar No.22 Certificate of Document Preparation 23 If this document was not completed by an attorney, I hereby certify that the following statements24 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.25 B. G I paid or will pay money to _________________ for assistance in preparing this form/document 26 _______________________________ Signature 27 28 PROOF OF POSTING - Page 1 of 1 FC(3/1/04)(Form 6)