Mendocino — EM-109

Source: http://www.courts.ca.gov/documents/em109.pdf

EM-109 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 NOTICE OF HEARING—EMANCIPATION OF MINOR CASE NUMBER: CONSENT AND WAIVER OF NOTICE

1. The minor (name): has filed a petition asking the court to declare the minor an EMANCIPATED MINOR. If the petition is granted, the minor will be considered to be over the age of majority for purposes set forth in California Family Code section 7050.
2. A HEARING for the court to consider the petition will be held: on (date): at (time): in Dept.: Room: TO PARENTS: IF THE PETITION IS GRANTED, THE MINOR, THE MINOR'S REPRESENTATIVE, OR THE DISTRICT ATTORNEY MAY LATER PETITION THE COURT TO RESCIND THE DECLARATION OF EMANCIPATION AND YOU MAY BE LIABLE FOR SUPPORT AND MEDICAL COVERAGE FOR THE MINOR.

Date:

(TYPE OR PRINT NAME) PETITIONER CLERK

CONSENT AND WAIVER OF NOTICE The undersigned give up the right to notice of a hearing on the Petition for Declaration of Emancipation, and consent to a declaration of emancipation without a hearing. a. Mother: Signature: Dated: Address: Telephone number: b. Father: Signature: Dated: Address: Telephone number: c. Legal guardian: Signature: Dated: Address: Telephone number: d. Social worker: Probation officer: Signature: Dated: Address: Telephone number: e. District attorney: Signature: Dated: Address: Telephone number:

Form Adopted for Mandatory Use NOTICE OF HEARING—EMANCIPATION OF MINOR Family Code, § 7000 et seq.Judicial Council of California EM-109 [Rev. September 1, 2018] 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