1 2 3 4 IN THE CIRC UIT COURT OF THE STATE OF OREGON 5 FOR THE THIRD JUDICIAL DISTRICT 6 7 In the Matter of the Change of Name of: ) ) 8 __________________________________________ ) ) 9 __________________________________________ ) Case No: __________ (Former Name(s) of Minor Child/ren) ) 10 ) PROOF OF POSTING __________________________________________ ) OF NAME CHANGE11 ) JUDGMENT __________________________________________ ) 12 (New Name(s) of Minor Child/ren) ) ) 13 __________________________________________ ) (Petitioner/Guardian Ad Litem) ) 14 15 STATE OF OREGON ) 16 ) ss. County of Marion ) 17 I, ________________________, being first duly sworn, do hereby declare and say: on18 ______________________________, I posted written notice the judgment changing the name(s)19 of _________________________________, dated ________________, on the bulletin board at20 the Marion County courthouse. 21 _______________________________22 Petitioner/Guardian Ad Litem23 SIGNED AND SWORN to before me on ____________________________. 24 25 _____________________________________________________ Deputy Court Administrator/Notary Public for the State of ______26 My commission expires:_________________________________ 27 28 PROOF OF POSTING OF NAME CHANGE JUDGMENT - Page 1 of 2 FC (3/1/04)(Form 17M)>>>> 2 1 2 Submitted by: 3 ______________________________________ Attorney/Petitioners Name Bar No. (if any) 4 ______________________________________ 5 Address 6 ______________________________________ City State Zip Phone No. 7 ______________________________________ 8 Trial Attorney if other than above Bar No. 9 Certificate of Document Preparation 10 If this document was not completed by an attorney, I hereby certify that the following statements11 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.12 B. G I paid or will pay money to _________________ for assistance in preparing this form/document 13 __________________________ 14 Signature 15 16 17 18 19 20 21 22 23 24 25 26 27 28 PROOF OF POSTING OF NAME CHANGE JUDGMENT - Page 2 of 2 FC (3/1/04)(Form 17M)