I am willingly living separate and apart from my parents or legal guardian, with the consent of my parents or legal guardian. I
have been living apart from them since
I am a resident of or temporarily domiciled in this county.
No part of my income comes from any activity that is a crime under the laws of the State of California or of the United States.
6.
7.
8. County.
My
His / her consent is attached.
I declare under penalty of perjury that the foregoing is true and correct and that this declaration is executed at
PETITION FOR DECLARATION OF EMANCIPATION OF MINOR,
ORDER PRESCRIBING NOTICE, DECLARATION OF
EMANCIPATION, AND ORDER DENYING PETITION
Form Adopted for Mandatory Use
Judicial Council of California
EM-100 [Rev. September 1, 2018]
Family Code § 7000, et seq.
www.courts.ca.gov.
Page 1 of 2
1.
2.
a.
I request that the court declare me to be emancipated.
b.
c.
d.
4.
5.
EM-100
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
IN THE MATTER OF (name):
Petitioner, a minor
FOR COURT USE ONLY
CASE NUMBER:
PETITION FOR DECLARATION OF EMANCIPATION OF MINOR
ORDER PRESCRIBING NOTICE
DECLARATION OF EMANCIPATION
ORDER DENYING PETITION
ATTORNEY OR PARTY WITHOUT ATTORNEY
STATE: ZIP CODE:CITY:
STREET ADDRESS:
FIRM NAME:
NAME:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
STATE BAR NUMBER:
I am managing my own financial affairs. I have completed my declaration of income and expenses on form EM-115 and
attached it to this petition.
My name:
My address:
I am at least 14 years of age and my date of birth is:3.
My mother's name is:
Her address is:
Her consent to my emancipation is attached.
Notice to her should not be required because (state reasons):
My father's name is:
His address is:
His consent to my emancipation is attached.
Notice to him should not be required because (state reasons):
I have a legal guardian.
My guardian's name is:
My guardian's address is:
My guardian's consent to my emancipation is attached.
Notice to my guardian should not be required because (state reasons):
This person's address is:
This person's consent to my emancipation is attached.
Notice to this person should not be required because (state reasons):
This person's name is:
Other person entitled to notice.
I am a dependent child [probation] ward of the Juvenile Court of
Case number (if known):
social worker
probation officer
is (name):
(place):
Date:
(SIGNATURE)
(date):
, California.
