Fill and Sign the Affidavit for Motion Form

IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR __________ COUNTY PROBATE DEPARTMENTIn the Matter of the Change of Name of:)) ) Case No.: ____________ )) ))) AFFIDAVIT FOR MOTION ) FOR ALTERNATIVE (Present Name(s) of Minor Child/ren)) FORM OF SERVICE ))To:)) ))) ))) ) (Proposed Name(s) of Minor Child/ren) ))) ) (Petitioner/Guardian Ad Litem) )STATE OF OREGON )) ss.County of _______________ )I, ___________________, being first duly sworn, do hereby declare and say:This affidavit concerns the ______________________ (mother or father) of _________ ___________________(these children/this child/or name of specific child). The name of the other parent is: _________________. The other parent has willfully deserted this child/these children or neglected without just and sufficient cause to provide proper care and maintenance for the child/ren for one year before the filing of the petition for name change. The facts which demonstrate this are: _____________________________ __________________________________________________________________ ___________________________________________________________________ __________________________________________________________________.I cannot find out the current address of the other parent by making reasonable efforts. This is a description of the efforts I have made to find out the other parent’s address and what has happened as a result of those efforts: __________________________________ _____________________________________________________________________ _____________________________________________________________________.The last known address I have for the other parent is: _________________________ ____________________________________________________________________.This is no longer a good address because: __________________________________.The last time I or the child/ren had contact with the other parent was: ____________________________________________________________________ ____________________________________________________________________.The last time the other parent provided any financial support for the child/renwas: _________________________________________________________________ _____________________________________________________________________._______________________________Petitioner/Guardian Ad LitemSIGNED AND SWORN to before me on ___________________. _______________________________________Court Clerk/Notary Public for the State of OregonMy commission expires: _______________Submitted by: Attorney/Petitioner’s Name Bar No. (if any) Address City State Zip Phone No. 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. I selected this document for myself, and I completed it without paid assistance. B. I paid or will pay money to _________________ for assistance in preparing this form/document __________________________Signature