Free Form #16M - Oregon

1 2 3 4 5 6 7 8 9 10 11 __________________________________________ 12 13 14 15 TO ALL INTERESTED PERSONS: 16 This notice is posted to advise all persons that a judgment was entered in this case 17 on_____________________changing the name(s) of ___________________________________ 18 ___________________________________to_________________________________________ 19 ___________________________________. 20 21 Dated_______________ 22 23 24 25 26 27 28
NOTICE OF NAME CHANGE JUDGMENT - Page 1 of 2 FC(3/1/04)(Form 16M)

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

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

__________________________________________ (New Name(s) of Minor Child/ren) __________________________________________ (Petitioner/Guardian Ad Litem)

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

Case No: __________ NOTICE OF NAME CHANGE JUDGMENT

_______________________________ Petitioner/Guardian Ad Litem

1 2 3 4 5 6 7 8 9 Certificate of Document Preparation 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
NOTICE OF NAME CHANGE JUDGMENT - Page 2 of 2 FC(3/1/04)(Form 16M)

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

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