Identity Record Change 226 Judgment Page 1 of 1 (Nov 2017) IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF In the Matter of: Case No: JUDGMENT FOR CHANGE OF NAME SEX Petitioner (current name) Adult For court use only: This record is ordered SEALED at Petitioner222s request because: Petitioner is a participant in the ORS 192.826 Address Confidentiality Program (ACP) Petitioner has requested a change of sex and that the record be sealed or Petitioner is a participant in the Address Confidentiality Program (ACP) and has requested a change of name only. The court finds good cause to not order the case record sealed (explain): Based on the application by Petitioner, the court orders the following changes to Petitioner222s: name (use complete names. First, Middle, Last) from: to: sex to: male female nonbinary Petitioner has attested to undergoing surgical, hormonal, or other appropriate treatment for the purpose of affirming gender identity Certificate of Document Preparation. Check all that apply: I chose this form for myself and completed it without paid help A legal help organization helped me choose or complete this form, but I did not pay money to anyone I paid (or will pay) for help choosing, completing, or reviewing this form Guide & File selected and completed this form and I did not pay anyone to review the completed form I hereby declare that the above statements are true to the best of my knowledge and belief. I understand they are made for use as evidence in court and I am subject to penalty for perjury. Certificate of Readiness per UTCR 5.100 This judgment is ready for signature because it is submitted ex parte as allowed by statute Submitted by Petitioner Judge Signature: American LegalNet, Inc. www.FormsWorkFlow.com