1 2 IN THE CIRC UIT COURT OF THE STATE OF OREGON 3 FOR THE THIRD JUDICIAL DISTRICT 4 5 In the Matter of the Change of Name of: ) ) 6 __________________________________________ ) Case No: ______________ (Present Name) Petitioner ) 7 ) PROOF OF POSTING to:_________________________________________ ) NOTICE OF PETITION 8 (Proposed New Name) ) FOR CHANGE OF NAME 9 STATE OF OREGON ) 10 ) ss. County of Marion ) 11 I, __________________________, being first duly sworn, do hereby declare and say: on12 ______________________________, I posted written notice of my petition to change my name13 on the bulletin board at the Marion County courthouse, with instructions not to remove the notice14 until ___________________________. 15 _______________________________16 Petitioner 17 SIGNED AND SWORN to before me on ________________________________. 18 ___________________________________________________________ Deputy Court Administrator/Notary Public for the State of ____________19 My commission expires: _______________________________________ Submitted by: 20 _____________________________________________________________________________ 21 Attorney/Petitioners Name Bar No. (if any) Address 22 _____________________________________________________________________________ City State Zip Phone No. Trial Attorney (if other than above) Bar No.23 24 Certificate of Document Preparation 25 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) 26 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 this27 form/document _______________________________28 Signature PROOF OF POSTING - Page 1 of 1 FC(3/1/04)(Form 3)