IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF WASHINGTON In the Matter of the Name Change of Case No. ______________ _____________ ________________ ____________________ FIRST MIDDLE (Minor's Present Legal Name) LAST PETITION FOR NAME CHANGE FOR MINOR to (Form 1) _____________ ________________ ____________________ FIRST MIDDLE (Minor's New Name) LAST Petitioner requests a Judgment changing minor's name from ___________________________ _________________________________ to_______________________________________________ (Minor's Present Legal Name ­First Middle Last) (Minor's New Name ­ First Middle Last) and a hearing scheduled concerning the name change petition. The name change is not requested for any purpose which is contrary to public policy. 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 _______________________________________ Petitioner's Name (Please Print) _______________________________________ Address _______________________________________ City/State/Zip Code (123) 456-7890 _______________________________________ Telephone Number - 10 Digits (e.g. 1234567890) Verification of Petitioner; For Court Use Only: I.D. Provided:____________________ Expires: ____________________ Page 1 - PETITION FOR NAME CHANGE FOR MINOR American LegalNet, Inc. www.FormsWorkFlow.com