Mendocino — EM-130

Source: http://www.courts.ca.gov/documents/em130.pdf

EM-130 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): Petitioner, a minor

CASE NUMBER:

DECLARATION OF EMANCIPATION OF MINOR AFTER HEARING

1. This proceeding came on for hearing as follows: a. Date: Time: Dept.: Room: b. Judge (name):

   c. Present in court: Petitioner Attorney (name): Father Attorney (name): Mother Attorney (name): Probation officer (name): Social worker (name): County counsel (name): District attorney (name): Other (name and relationship to minor):

2. THE COURT FINDS THAT: a. Notice was given as prescribed by the court. b. Warning has been given to the petitioner's Mother Father that a court may rescind the declaration of emancipation and the parents may become liable for the minor's support and medical coverage. c. The petitioner is a person described by Family Code section 7120. d. Emancipation is not contrary to the best interests of the petitioner.

3. THE PETITION IS GRANTED. THE PETITIONER IS DECLARED TO BE EMANCIPATED FOR THE PURPOSES SET FORTH IN FAMILY CODE SECTION 7050 ET SEQ.

Date: (JUDGE OF THE SUPERIOR COURT)

[SEAL]
CLERK'S CERTIFICATE
I certify that the foregoing is a true and correct copy of the original on file in my office.

Date: Clerk, by , Deputy

Form Adopted for Mandatory Judicial Council of California Use DECLARATION OF EMANCIPATION OF MINOR Family Code,www.courts.ca.gov§ 7000, et seq. EM-130 [Rev. September 1, 2018] AFTER HEARING 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