STATE OF MAINE DISTRICT COURT Location Docket No.
In re: Petitioner
REQUEST FOR APPOINTMENT OF COUNSEL FOR EMANCIPATION PETITION
I, age. My date of birth is
, am .
years of
The names and addresses of my parents, guardians or custodians are:
Name Address
Name Address
Relationship
Relationship
I desire to petition this court for an order of emancipation. I request this court to appoint an attorney to petition for my emancipation.
Date: Petitioner
Address
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ORDER The court appoints to represent the Petitioner named above in an emancipation proceeding pursuant to 15 M.R.S.A. ยง 3506-A. Date: Judge
CV-065, Rev. 05/03