Fill and Sign the Change Name Minor 497324122 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.: ____________ ) )       ) ) ) CONSENT TO CHANGE       ) OF NAME OF MINOR (Present Name(s) of Minor Child/ren) ) CHILD – CONSENT OF ) CHILD ) To: ) )       ) ) )       ) ) )       ) (Proposed Name(s) of Minor Child/ren) ) ) )       ) (Petitioner/Guardian Ad Litem) ) I hereby consent to the petition to change my name from ________________ to ___________________ , and waive further notice in this proceeding. _______________________________ Signature (present name) STATE OF OREGON ) ) ss. County of _______________ ) The above named ________________________ personally appeared before me and acknowledged the foregoing instrument to be his/her voluntary act and deed this _____ day of ___________________ , _________ . ________________________________ Court Clerk/Notary Public for the State of ________ 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