Free Form #5 - Oregon

1 2 3 4 5 6 7 8 9 10 11 12 13 14 Dated_________________ 15 16 17 18 19 20 21 22 23 24 25 26 27 28 NOTICE OF NAME CHANGE JUDGMENT - Page 1 of 1 FC(3/1/04)(Form 5) ______________________________________ Trial Attorney if other than above Bar No. 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 ______________________________________ Address ______________________________________ City State Zip Phone No. Submitted by: ______________________________________ Attorney/Petitioner's Name Bar No. (if any) _______________________________ Petitioner (New name) to:_________________________________________ (New Name) TO ALL INTERESTED PERSONS: This notice is posted to advise all persons that a judgment was entered in this case on__________________changing the name of _____________________________________ to_________________________________________. In the Matter of the Change of Name of: __________________________________________ (Former Name) Petitioner ) ) ) ) ) ) ) IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE THIRD JUDICIAL DISTRICT

Case No: ___________ NOTICE OF NAME CHANGE JUDGMENT