IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF WASHINGTON In the Matter of the Name Change of Case No. ______________ _____________________________ (Minor’s Present Legal Name - First, Middle, Last) DECLARATION SUPPORTING PETITION FOR CHANGE OF NAME to (Form 8) _____________________________ (Minor’s New Name - First, Middle, Last) I am the_________________________ of the above cited minor child. The name of the (Relationship to minor child) biological mother/father of the minor child is_________________________________________ (Circle one) (Name of minor’s parent(s)) I have/have not obtained the parent’s consent to the proposed change of name. I have/have not (Circle one) (Circle one) given notice of the time and date of the hearing on this change of name to the biological parent. I do/do not request that the Court waive the statutory notice requirement to the mother/father for (Circle one) (Circle one) the following reasons:_____________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ 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 Guardian Ad Litem Page 1 - DECLARATION SUPPORTING PETITION FOR CHANGE OF NAME American LegalNet, Inc. www.FormsWorkFlow.com