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)