Free pc100.p65 - Michigan

Approved, SCAO

JIS CODE: PEM

STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

FILE NO. PETITION FOR EMANCIPATION, AFFIDAVIT, AND WAIVER OF NOTICE , a minor and my social security

COUNTY In the matter of the emancipation of 1. My full name is number is

First name, middle name, and last name (type or print)

Last 4 digits

.

2. An action within the jurisdiction of the family division of circuit court involving the family or family members of the minor has been previously filed in assigned to Judge 3. I am at least 16 years of age. I was born on County,
State Date

Court, Case Number , and remains in is no longer

, was pending.

. A certified copy of my birth certificate is attached to this petition.

4. The name(s) and last known address(es) of my parents, guardian, or custodian are: NAME RELATIONSHIP Father Mother Guardian Custodian 5. I presently reside within this county at
City, state, zip

ADDRESS

Street address

and I have lived there continuously since

Date

.

6. I am able to manage my own financial affairs as shown by the following facts:

I am employed by: (PLEASE SEE OTHER SIDE)
Do not write below this line - For court use only

PC 100 (11/05)

PETITION FOR EMANCIPATION, AFFIDAVIT, AND WAIVER OF NOTICE

MCL 722.4

7. I am able to manage my personal and social affairs as shown by the following facts:

My housing arrangements are: 8. I have read the Emancipation of Minors laws (Michigan Compiled Laws 722.1 through 722.6), and I understand my rights and responsibilities as an emancipated minor. I REQUEST the court to order my emancipation. I declare that this petition has been examined by me and that its contents are true to the best of my information, knowledge, and belief.
Date Minor's signature

Attorney signature Name (type or print) Address Bar no. City State Zip Telephone no.

AFFIDAVIT 1. I am a
Address

Occupation City Name (type or print)

, and I conduct business at or am employed at
State Zip Telephone no.

.

2. I have personally known

, a minor, for

years, and I have

personal knowledge of his/her current circumstances. 3. I believe that emancipation would be in the best interests of the minor because of the following circumstances:

4. I have reviewed this petition, and I waive notice of hearing and any adjournment of the hearing.
Date Signature of affiant Name (type or print) Address City, state zip Telephone no.

Subscribed and sworn to before me on My commission expires:
Date

Date

, Signature:
Notary public

County, Michigan.

Notary public, State of Michigan, County of