Emancipation Petition Form

Please fill out the petition form regarding emancipation request. In order for your request to be accepted by the Court, your statement under oath will be taken on the following matters;

You are at least 16 years old.
You are financially sufficent and able to support yourself.
You know the rights and obligations of an emancipated minor and legal consequences of emancipation.

Name of Minor

First NameLast Name

Date of Birth

Date

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Please check the ones below that apply to your situation.

Please add any other issues that may cause to be emancipated.

Does your current parent or guardian consent to your request?

Mother

Name of the Mother

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Father

Name of the Father

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name of the Guardian

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

The information I have provided above is correct and complete to best of my knowledge. In this regard, I request the preparation of my petition for emancipation and filing in the competent court.

Name

First NameLast Name

Date

Signature

Emancipation Petition Form

Personal Information

Ground for Emancipation

Information Regarding Parents/Guardians

Guardian