IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF WASHINGTON In the Matter of the Name Change of Case No. ______________ _______________________________ (Your Present Legal Name - First, Middle, Last) to DECLARATION OF POSTING NOTICE OF NAME CHANGE HEARING (Form 4) _____________________________ (Your New Name - First, Middle, Last) I, __________________________________________ hereby declare that in accordance (Your Present Legal Name) with ORS 33.420, written notice stating the time, day, place and subject of the hearing for name change of the Petitioner was posted on the Washington County Courthouse Bulletin Board, 150 N. First Avenue, Hillsboro, Oregon and remained posted for the statutory number of days beginning ___________________, 20___ and ending ______________________________, 20___. (Date Notice was Posted) (Today’s Date) I hereby declare that the above statement is true to the best of my knowledge and belief, and that I understand it is made for use as evidence in court and is subject to penalty of perjury. Dated:_____________________ __________________________________ Signature of Petitioner (Your Present Legal Name) Page 1 - DECLARATION OF POSTING NOTICE OF NAME CHANGE HEARING American LegalNet, Inc. www.FormsWorkFlow.com