Free (pc118.pdf) - Michigan

Approved, SCAO

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

COUNTY

REQUEST AND ORDER FOR COURT APPOINTED ATTORNEY/ GUARDIAN AD LITEM FOR WAIVER OF PARENTAL CONSENT

FILE NO.

In the matter of the petition of
Initials

, a minor, for waiver of parental consent for an abortion REQUEST

1. The minor requests the appointment of for a waiver of parental consent for an abortion.

an attorney

a guardian ad litem

to assist her in proceedings

Date

Initials of minor / Signature of next friend

ORDER 2. Date of hearing: IT IS ORDERED: 3.
Name of attorney/guardian ad litem (type or print) Address City, state, zip Telephone no. Bar no.

Judge:
Bar no.

is appointed

attorney

guardian ad litem

to represent the minor on her petition for waiver of parental

consent for an abortion.

Date

Judge

Notice: · The minor must contact the attorney or guardian ad litem within the next 24 hours. · The attorney or guardian ad litem must consult with the minor within the next 48 hours and must ensure the confidentiality of proceedings at all times. · The hearing on the petition will be held within 72 hours after the petition is filed.

Do not write below this line - For court use only

PC 118 (9/97)

REQUEST AND ORDER FOR COURT APPOINTED ATTORNEY / GUARDIAN AD LITEM FOR WAIVER OF PARENTAL CONSENT MCL 722.904(2); MSA 25.248(104)(2), MCR 5.783(C), (F), (G)