22-02E (11/13) Declaration Supporting Petition to Change Name (ACP) FORM 2 IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF MULTNOMAH In the Matter of the Change of Name of: Case No: Your Present Name Last, First, Middle Petitioner DECLARATION SUPPORTING to PETITION TO CHANGE NAME (A CP) Your New Name Last, First, Middle I am the Petitioner (applicant) in this case. All of the following statements are true: 1. I have have not been convicted of a crime. I have been convicted of: N ame of County State Year Convicted Convicted of: 2. I am am not required to register as a sex offender. 3. I do not have a domestic violence, restraining order, stalking order, or no-contact order in effect against me in Oregon or in any other state or tribe except for: Name of County State Date Issued Type of Case: 4. I do do not have a obligation to pay child support or to pay off child support arrearages. 5. I have have not used other names. My former or other names are: Certificate of Document Preparation . Check all that apply: I chose this form for myself and completed it without paid help. A legal help organization helped me choose or complete this form, but I did not pay money to anyone. I paid (or will pay) for help choosing, completing, or reviewing this form.iew. I further declare that all the above statements are true to the best of my knowledge and belief. I understand they are made for use as evidence in court and I am subject to penalty for perjury Date Signature Name (printed) Contact Address City, State, ZIP Contact Phone American LegalNet, Inc. www.FormsWorkFlow.com