IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF WASHINGTON In the Matter of the Name Change of _____________________________ (Minor's Present Legal Name - First Middle Last) Case No. ______________ to _____________________________ (Minor's New Name - First Middle Last) PETITION FOR APPOINTMENT OF GUARDIAN AD LITEM (Form 2) ORCP Rule 27(A)(1) and (2) Check all that apply: Petitioner represents to the Court as the legal parent of the child under the age of 14, and petitions the court for the appointment as Guardian Ad Litem. Petitioner's relationship with the parent listed on the birth certificate is: Married Divorced Separated Never Married Other parent not listed on the Birth Certificate Other parent deceased If the parents are unmarried, has legal paternity of the child been established? If yes, paternity has been established by the following legal means: Yes / No The other legal parent of the child consents to the petition before the Court to appoint a Guardian Ad Litem. Evidence of the consent to Guardian Ad Litem and Name Change is either filed herein or will be submitted at the name change hearing. OR I have not obtained the other legal parent's consent; however, I will be sending them notice of this name change hearing by certified mail. Proof of certified mailing will be submitted at the name change hearing. The child, over the age of 14 but under the age of 18, consents to the petition before the Court to appoint a Guardian Ad Litem. Evidence of the consent to Guardian Ad Litem and Name Change is filed herein. For Court use only: _____________________ _____________________ Page 1 - PETITION FOR APPOINTMENT OF GUARDIAN AD LITEM American LegalNet, Inc. www.FormsWorkFlow.com The child is now living with: ____________________________, at the following address: Street__________________________________, City/State/Zip_____________________________ The child has resided in the State of Oregon since ________? (Month/Year) Is there any other court order now in effect concerning the child? Yes / No If yes: Case number: ________________________ filed in ____________________ County, State of _________________ I have/ have not participated as a party, witness or in any other capacity in any other proceeding concerning the custody, parenting time or visitation of the child. I know of no other proceeding that could affect this case (including any other proceeding concerning custody, parenting time enforcement, protective orders, termination of parental rights and adoptions) in this or any other state EXCEPT:____________________________________ (If none, so state) I know of no other person who has the physical or legal custody of the child or who claims custody, parenting time or visitation rights with the child EXCEPT:_______________________ (If none, so state) Mother Therefore, ______________________________, as the legal ____________________ (Name of Proposed Guardian Ad Litem) (Mother/Father) of the above named minor, is properly qualified to act as Guardian Ad Litem for ____________ less than one ___________________________, a minor who is ____________ years old. (Name of Minor) 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 for perjury. Dated this ____ day of ____________________, 20____. __________________________ Signature of Petitioner Page 2 - PETITION FOR APPOINTMENT OF GUARDIAN AD LITEM American LegalNet, Inc. www.FormsWorkFlow.com