Free Form #3 - Oregon

1 2 3 4 5 6 7 8 9 STATE OF OREGON 10 County of Marion 11 I, __________________________, being first duly sworn, do hereby declare and say: on 12 ______________________________, I posted written notice of my petition to change my name 13 on the bulletin board at the Marion County courthouse, with instructions not to remove the notice 14 until ___________________________. 15 16 17 18 19 Submitted by: 20 21 22 23 24 25 26 27 28 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 PROOF OF POSTING - Page 1 of 1 FC(3/1/04)(Form 3) _____________________________________________________________________________ Attorney/Petitioner's Name Bar No. (if any) Address _____________________________________________________________________________ City State Zip Phone No. Trial Attorney (if other than above) Bar No. _______________________________ Petitioner SIGNED AND SWORN to before me on ________________________________. ___________________________________________________________ Deputy Court Administrator/Notary Public for the State of ____________ My commission expires: _______________________________________ ) ) ss. ) to:_________________________________________ (Proposed New Name) In the Matter of the Change of Name of: __________________________________________ (Present Name) Petitioner ) ) ) ) ) ) ) IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE THIRD JUDICIAL DISTRICT

Case No: ______________ PROOF OF POSTING NOTICE OF PETITION FOR CHANGE OF NAME