Free Form #17M - Oregon

1 2 3 4 5 6 7 8 9 10 __________________________________________ 11 12 13 14 15 STATE OF OREGON 16 County of Marion 17 I, ________________________, being first duly sworn, do hereby declare and say: on 18 ______________________________, I posted written notice the judgment changing the name(s) 19 of _________________________________, dated ________________, on the bulletin board at 20 the Marion County courthouse. 21 22 23 SIGNED AND SWORN to before me on ____________________________. 24 25 26 27 28
PROOF OF POSTING OF NAME CHANGE JUDGMENT - Page 1 of 2 FC (3/1/04)(Form 17M)

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: __________ PROOF OF POSTING OF NAME CHANGE JUDGMENT

) ) ss. )

_______________________________ Petitioner/Guardian Ad Litem

_____________________________________________________ Deputy Court Administrator/Notary Public for the State of ______ My commission expires:_________________________________

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
PROOF OF POSTING OF NAME CHANGE JUDGMENT - Page 2 of 2 FC (3/1/04)(Form 17M)

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