Petition For Emancipation Of A Minor
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1
2NO. _________________________
PETITIONER
IN THE DISTRICT COURT
JUDICIAL DISTRICT
{COUNTY, STATE}
PETITION FOR EMANCIPATION OF A MINOR
Petitioner’s Name:
Address:
Phone Number:
SSN:
DOB:
Birthplace:
Mother’s Name:
Address:
Phone Number:
DOB:
Father’s Name:
Address:
Phone Number:
DOB:
Legal Guardian’s Name:
Address:
Phone Number:
DOB:
I, the Petitioner, hereby swear and attest that I am at least sixteen years old and that the information
provided above and below is true and accurate to the best of my knowledge.
I currently live with my
, listed above. I would like to be released from
his/her custody for the following reason(s):
I have made new accommodations at
starting on
Petitioner Signature
Date
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