Free Form #1 - Oregon

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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) Petitioner to:_________________________________________ (Proposed New Name) 1.

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Case No: _____________ PETITION FOR CHANGE OF NAME

9 I, petitioner, request a judgment changing my name as set forth in the title of this petition. 10 2. 11 I am age 18 or older and I reside in Marion County. 12 3. 13 I am requesting this name change because: _____________________________________ 14 ______________________________________________________________________________ 15 ______________________________________________________________________________ 16 17 18 19 20 21 22 23 24
Certificate of Document Preparation

I hereby declare that the above statement is true to the best of my knowledge and belief, and that I understand it is made for use as evidence in court and is subject to penalty for perjury. _______________________________ Petitioner Submitted by: ______________________________________________________________________________ Attorney/Petitioner's Name Address _____________________________________________________________________________ City State Zip Phone No. If Attorney: Bar No. E-mail Fax

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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

PETITION FOR CHANGE OF NAME - Page 1 of 1

FC(1/1/08)(Form 1)