Free Form #10(1)M - Oregon

1 2 3 4 5 6 7 8 9 10 *__________________________________________ 11 12 13 14 Based on the motion of petitioner and the supporting affidavit, 15 IT IS HEREBY ORDERED THAT: service of notice of the petition for name change on 16 the other parent is waived. 17 Dated:_________________ 18 19 20 21 22 23 24 25 26 27 28 ORDER WAIVING NOTICE TO OTHER PARENT - Page 1 of 1 FC(3/1/04)(Form 10M/1)
Submitted by: * ______________________________________ Attorney/Petitioner's Name Bar No. (if any) * ______________________________________ Address * ______________________________________ City State Zip Phone No. * ______________________________________ Trial Attorney 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 preparin g this d ocu me nt. * ____________________________________ Signature

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)

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

Case No: * ____________ ORDER WAIVING NOTICE TO OTHER PARENT

_______________________________ Circuit Court Judge _______________________________ Print, Type or Stamp Name of Judge