Fill and Sign the To Change of Name 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.: ____________ ) ) ) ) ) WAIVER AND CONSENT ) TO CHANGE OF NAME (Present Name(s) of Minor Child/ren) ) OF MINOR CHILD - PARENT OR ) GUARDIAN ) To: ) ) ) ) ) ) ) ) ) (Proposed Name(s) of Minor Child/ren) ) ) ) ) (Petitioner/Guardian Ad Litem) ) I, ___________________, am the ______________________________ (relationship) of ______________________________ (child/ren’s name(s)). I hereby consent to the petition to change the child/ren’s name(s) to _________________________________________ and waive further notice in this proceeding. _____________________________ Parent or Guardian 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