Identity Record Change (Minor) 226 Petition Page 1 of 2 (Dec 2017) IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF In the Matter of: Case No: PETITION FOR CHANGE OF NAME SEX Minor Child (current name) Minor Child I (name) am the parent, legal guardian, or legal representative of the child named above. The child named above is an unemancipated minor. I ask the court for a judgment changing the child222s (check all that apply): NAME (use complete names. First, Middle, Last) from: to: Notice to legal guardians has been provided as stated in the Declaration of Notice Notice to the other parent: has been provided as stated in the Declaration of Notice or is not required in this case because the child has not lived with that parent and that parent has not contributed or tried to contribute to the support of the child except: Notice is required but cannot be provided because (explain and identify the person who is entitled to notice): SEX to: male female nonbinary The child has undergone surgical, hormonal, or other appropriate treatment for the purpose of affirming gender identity I ask the court to SEAL this case record American LegalNet, Inc. www.FormsWorkFlow.com Identity Record Change (Minor) 226 Petition Page 2 of 2 (Dec 2017) 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. Date Signature of Petitioner (parent or guardian) Name (printed) Contact Address City, State, ZIP Contact Phone American LegalNet, Inc. www.FormsWorkFlow.com