Free Form #9(1)M - Oregon

1 2 3 4 5 6 7 8 9 10 __________________________________________ 11 12 13 14 STATE OF OREGON 15 County of Marion 16 I, __________________________, being first duly sworn, do hereby declare and say: 17 To the best of my knowledge and belief, the other parent of this child is: ___________________. 18 The child has not lived with the other parent and the other parent has not contributed, or 19 tried to contribute to the child's support at any time since the child's birth. 20 21 22 SIGNED AND SWORN to before me on ______________________________. 23 24 25 26 27 28
AFFID AV IT FOR MO TION TO W AIV E NO TICE TO O THE R PA REN T - Page 1 o f 2 FC(3/1/04)(Form9M /1)

IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE THIRD JUDICIAL DISTRICT

In the Matter of the Change of Name of: __________________________________________ __________________________________________ (Present Name(s) of Minor Child/ren)

__________________________________________ (Proposed Name(s) of Minor Child/ren) __________________________________________ (Petitioner/Guardian Ad Litem) ) ) ss. )

) ) ) ) ) ) ) ) ) ) ) ) ) )

Case No: _____________ AFFIDAVIT FOR MOTION TO WAIVE NOTICE TO THE OTHER PARENT

_______________________________ Petitioner/Guardian Ad Litem

______________________________________________________ Deputy Court Administrator/Notary Public for the State of ______ My commission expires:__________________________________

1 Submitted by: 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
AFFID AV IT FOR MO TION TO W AIV E NO TICE TO O THE R PA REN T - Page 2 o f 2 FC(3/1/04)(Form9M /1)

______________________________________ Attorney/Petitioner's Name Bar No. (if any) _____________________________________ Address ______________________________________ City State Zip Phone No. ______________________________________ Trial Attorney if other than above Bar No.

Certificate of Document Preparation If this document was not completed by an attorney, I hereby certify that the following statements are true: (check all boxes and complete all blanks that apply) A. G I selected this document for myself, and I completed it without paid assistance. B. G I paid or will pay money to _________________ for assistance in preparing this form/document __________________________ Signature