Page 2 of 3 Approved by the Coalition for Court Access
CCA-DC-0519-1011
3. The following child(ren) is/are emancipated:
___________________________________________________________________________________
4. The reason that my child(ren) is/are emancipated as follows:
☐ _____________________________ has turned nineteen (19) years of age.
☐ _____________________________ is at least eighteen (18) years of age; has not
attended secondary or post-secondary school for the past four (4) months and is not enrolled in a secondary
or post-secondary school; and is or is capable of supporting himself/herself through employment.
☐ _____________________________ has joined the United States armed services.
☐ _____________________________ has married.
☐ _____________________________ is not under the care or control of either parent
nor an individual or agency approved by the court.
5. The date upon which my child(ren) became emancipated was ___________________.
6. My child support obligation should be terminated because of the emancipation of my
child(ren), _______________________________________________________________________.
7. The termination of my support obligation should be retroactive to the date(s) stated in
Paragraph 5 above.
8.
☐ There is not an arrearage on this account.
☐ There is an arrearage on this account of $___________ as of _________________.
_______________________________ agrees to pay $_______________ per week on the arrearage until
such time as the arrearage is paid in full.
9. The Income Withholding Order previously issued in this matter should be terminated.
10. Parties waive their right to a hearing.
WHEREFORE,_____________________________ and ________________________________
request that this Court declare our child(ren) emancipated, terminated the child support obligation, and
order all other further relief that is just and proper in the premises.