IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF POLK In the Matter of the Change of Name of: ________________________________ to: _____________________________ (Proposed New Name) ) ) ) ) ) ) ) Case No: _______________ ORDER TO GIVE NOTICE AND APPEAR AND SHOW CAUSE Based upon the petition filed in this case by the petitioner requesting a change of name, it is hereby ORDERED: On ____________________________________, 20____ m, in Courtroom _____ of the Polk County Courthouse located at 850 Main Street, Dallas, Oregon 97338, a hearing shall be held to determine whether or not the change of name request made by petitioner should be granted. Any and all persons having an interest in this matter shall appear at the hearing. Persons objecting to the petition may also file written objections prior to the hearing to show cause why the request should not be granted. Public notice of the petition and terms of this order shall be posted in a public place in this county for a period of at least fourteen (14) days prior to the hearing. DATED: _____________________________ _______________________________ Circuit Court Judge ______________________________________ Address ______________________________________ City State Zip Phone No. _________________________________________ Trial Attorney (if different) & OSB No. . tnemucod si t gn raperp ni ecna ts ssa __________________h ___i______________i___ _ ro f o t yenom yap lli w ro diap I .B .ecna tsissa diap tuoh ti w ti de telpmoc I dna ,fles ym ro f tnemucod sih t de tceles I . A ). ylppa tah t sknalb lla e telpmoc dna se xob lla kcehc( :eur t era s tneme ta ts gni wollo f eh t tah t yfi trec ybereh I ,yenro tta na yb de telpmoc ton sa w tnemucod sih t fI noi taraperP tnemucoD fo e taci fi treC eru tan gi ________________________________________S _ American LegalNet, Inc. www.FormsWorkFlow.com Submitted by: ______________________________________ OSB No. (if any) 0102/90 esuaC wohS dna raeppA dna ecitoN eviG ot redrO