Free Form #15M - Oregon

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

In the Matter of the Change of Name of: *(1)__________________________________________ *(2)___________________________________________ (Present Name(s) of Minor Child/ren) *(1)__________________________________________ *(2)___________________________________________ (Proposed Name(s) of Minor Child/ren) *__________________________________________ (Petitioner/Guardian Ad Litem)

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No: *_____________ CHANGE OF NAME GENERAL JUDGMENT

Based on the petition, and the court finding that proper notice to interested parties has been made and no person has shown cause why the requested judgment should not be granted; now, therefore: IT IS HEREBY ADJUDGED: The name(s) of *(1)_______________________, *(2)_______________________ is/are changed to *(1)_______________________, *(2)____________________ and notice of the change of name shall be posted at a public place in this county.

Dated:________________

_______________________________ Circuit Court Judge/Pro Tem _______________________________ Print, Type or Stamp Name of Judge

CHANGE OF NAME GENERAL JUDGMENT - Page 1 of 2

(Form 15M) FC(11/20/08)

Submitted by: ______________________________________ 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 __________________________________ Print Name

CHANGE OF NAME GENERAL JUDGMENT - Page 2 of 2

(Form 15M) FC(11/20/08)