Free Form #12M - 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 This affidavit concerns the ______________________ (mother or father) of ________________ 18 ___________________(these children/this child/or name of specific child). The name of the 19 other parent is: _________________. The other parent has willfully deserted this child/these 20 children or neglected without just and sufficient cause to provide proper care and maintenance 21 for the child/ren for one year before the filing of the petition for name change. The facts which 22 demonstrate this are: ____________________________________________________________ 23 _____________________________________________________________________________ 24 _____________________________________________________________________________ 25 _____________________________________________________________________________. 26 I cannot find out the current address of the other parent by making reasonable efforts. 27
AFFIDAVIT IN SUPPORT OF MOTION FOR ALTERNATIVE FORM OF SERVICE - Page 1 of 3

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

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

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

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

Case No:__________ AFFIDAVIT IN SUPPORT OF MOTION FOR ALTERNATIVE FORM OF SERVICE

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FC(3 /1 /0 4)(Form 1 2M )

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This is a description of the efforts I have made to find out the other parent's address and what has happened as a result of those efforts:________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________. The last known address I have for the other parent is: ____________________________ ____________________________________________________________________. This is no longer a good address because:_____________________________________________________ _____________________________________________________________________________. The last time I or the child/ren had contact with the other parent was: ______________________________________________________________________________ _____________________________________________________________________________. The last time the other parent provided any financial support for the child/ren was:__________________________________________________________________________ _____________________________________________________________________________.

_______________________________ Petitioner/Guardian Ad Litem SIGNED AND SWORN to before me on _____________________________________. _________________________________________________________ Deputy Court Administrator/Notary Public for the State of __________ My commission expires:______________________________________

AFFIDAVIT IN SUPPORT OF MOTION FOR ALTERNATIVE FORM OF SERVICE - Page 2 of 3

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FC(3 /1 /0 4)(Form 1 2M )

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
AFFIDAVIT IN SUPPORT OF MOTION FOR ALTERNATIVE FORM OF SERVICE - Page 3 of 3

______________________________________ 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

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FC(3 /1 /0 4)(Form 1 2M )