Free Form #4 - 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)

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Case No: *_____________ CHANGE OF NAME GENERAL JUDGMENT

Based on the petition, and the court finding that proper notice to interested parties has 9 been made and no person has shown cause why the requested judgment should not be granted; 10 now, therefore: 11 IT IS HEREBY ADJUDGED: 12 The name of *_________________________________ is changed to 13 *__________________________________, and notice of the change of name shall be posted at 14 a public place in this county. 15 Dated:__________________ 16 17 18 19 20 21 22 23 24 25 26 27 28 CHANGE OF NAME GENERAL JUDGMENT - Page 1 of 1 FC(3/1/04)(Form 4) *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 Submitted by: * _____________________________________________________________________________ Attorney/Petitioner's Name Bar No. (if any) Address * _____________________________________________________________________________ City State Zip Phone No. Trial Attorney (if other than above) Bar No. __________________________________ Circuit Court Judge __________________________________ Print, Type or Stamp Name of Judge