STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION
REQUEST AND ORDER FOR COURT APPOINTED ATTORNEY/ GUARDIAN AD LITEM FOR WAIVER OF PARENTAL CONSENT
In the matter of the petition of
, a minor, for waiver of parental consent for an abortion REQUEST
1. The minor requests the appointment of for a waiver of parental consent for an abortion.
a guardian ad litem
to assist her in proceedings
Initials of minor / Signature of next friend
ORDER 2. Date of hearing: IT IS ORDERED: 3.
Name of attorney/guardian ad litem (type or print) Address City, state, zip Telephone no. Bar no.
guardian ad litem
to represent the minor on her petition for waiver of parental
consent for an abortion.
Notice: · The minor must contact the attorney or guardian ad litem within the next 24 hours. · The attorney or guardian ad litem must consult with the minor within the next 48 hours and must ensure the confidentiality of proceedings at all times. · The hearing on the petition will be held within 72 hours after the petition is filed.
Do not write below this line - For court use only
PC 118 (9/97)
REQUEST AND ORDER FOR COURT APPOINTED ATTORNEY / GUARDIAN AD LITEM FOR WAIVER OF PARENTAL CONSENT MCL 722.904(2); MSA 25.248(104)(2), MCR 5.783(C), (F), (G)