Mendocino — EM-140

Source: http://www.courts.ca.gov/documents/em140.pdf

EM-140 ATTORNEY OR PARTY WITHOUT ATTORNEY STATE BAR NUMBER: FOR COURT USE ONLY NAME: FIRM NAME: STREET ADDRESS: CITY: STATE: ZIP CODE: TELEPHONE NO.: FAX NO.: E-MAIL ADDRESS: ATTORNEY FOR (name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: IN THE MATTER OF (NAME):

EMANCIPATED MINOR'S APPLICATION TO CALIFORNIA CASE NUMBER:
DEPARTMENT OF MOTOR VEHICLES

On I was declared to be emancipated for the purposes set forth in Family Code (DATE OF EMANCIPATION ORDER) section 7050 et seq. by order of the Honorable , (NAME OF JUDICIAL OFFICER) Judge of the Superior Court of County. (NAME OF COUNTY)

I apply to the California Department of Motor Vehicles for entry of identifying information in its law enforcement computer network and for inclusion of the fact of my emancipation on any identification card issued to me by the Department. I have attached a certified copy of the Declaration of Emancipation.

Date: (SIGNATURE OF EMANCIPATED MINOR)

Form Approved for Optional Use EMANCIPATED MINOR'S APPLICATION TO CALIFORNIA Family Code, § 7000 etJudicial Council of California seq.www.courts.ca.gov EM-140 [Rev. September 1, 2018] DEPARTMENT OF MOTOR VEHICLES For your protection and privacy, please press the Clear This Form button after you have printed the form. Print this form Save this form Clear this form