Fill and Sign the Affidavit of Proof of Form

IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR __________ COUNTY PROBATE DEPARTMENT In the Matter of the Change of Name of: ) ) ) Case No.: ____________ ) ) ) ) ) AFFIDAVIT OF PROOF OF ) MAILING OR DELIVERY (Present Name(s) of Minor Child/ren) ) OF NOTICE RE FILING OF ) PETITION FOR CHANGE ) OF NAME OF MINOR To: ) CHILD ) ) ) ) ) ) ) ) (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: on ______________________________, I mailed or delivered written notice of the petition and a copy of the petition to change the child/ren’s name(s) to _________________________, who is the _______________________(relationship) of the child/ren. The return receipt from the post office and the notice that I mailed are attached._______________________________ Petitioner SIGNED AND SWORN to before me on ___________________. ________________________________ Court Clerk/Notary Public for the State of Oregon My 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