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.
A HEARING for the court to consider the petition will be held:
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.
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.
Signature:
Address:
Dated:
Mother:
Telephone number:
Signature:
Address:
Dated:
Father:
Telephone number:
Signature:
Address:
Dated:
Legal guardian:
Telephone number:
Signature:
Address:
Dated:Probation officer:
Telephone number:
Social worker:
Signature:
Address:
Dated:
District attorney:
Telephone number:
NOTICE OF HEARING—EMANCIPATION OF MINOR
Family Code, § 7000 et seq.Form Adopted for Mandatory Use
Judicial Council of California
EM-109 [Rev. September 1, 2018]
EM-109
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
Petitioner, a minor
IN THE MATTER OF (name):
FOR COURT USE ONLY
CASE NUMBER:
NOTICE OF HEARING—EMANCIPATION OF MINOR
CONSENT AND WAIVER OF NOTICE
ATTORNEY OR PARTY WITHOUT ATTORNEY STATE BAR NUMBER:
NAME:
FIRM NAME:
STREET ADDRESS:
CITY: STATE: ZIP CODE:
TELEPHONE NO.: FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
1.
2.
on (date): at (time):
in Dept.: Room:
Date:
(TYPE OR PRINT NAME)
PETITIONER
CLERK
The minor (name):
a.
b.
c.
d.
e.
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