Fill and Sign the Notice Father 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 FOR MOTION TO       ) WAIVE NOTICE TO (Present Name(s) of Minor Child/ren) ) PUTATIVE FATHER ) 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: To the best of my knowledge and belief, the father of this child is: _______________ . Paternity of the child has not been established because the mother was not married to the father at the time of conception of the child, birth of the child, or after the birth of the child; the father has not voluntarily acknowledged paternity by signing the birth certificate or filing an acknowledgment of paternity with the State Registrar of the Center for Vital Statistics; and no other legal proceeding has declared this person to be the father of this child. The child has not lived with the father at any time during the 60 days immediately before the filing of this petition for name change, or at any time since the child’s birth if the child was less than 60 days old when the petition was filed. The father has not tried to contribute to the child’s support in the year before the filing of the petition for this name change, or at any time since the child’s birth if the child was less than one year old when the petition was filed. _______________________________ Petitioner/Guardian Ad Litem 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