Free (pc118.pdf) - Michigan


File Size: 11.9 kB
Pages: 1
Date: November 23, 2004
File Format: PDF
State: Michigan
Category: Court Forms - State
Author: unknown
Word Count: 231 Words, 1,368 Characters
Page Size: Letter (8 1/2" x 11")
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http://courts.michigan.gov/scao/courtforms/abortionwaiver/pc118.pdf

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STATE OF MICHIGAN
JUDICIAL CIRCUIT - FAMILY DIVISION

COUNTY

REQUEST AND ORDER FOR COURT APPOINTED ATTORNEY/ GUARDIAN AD LITEM FOR WAIVER OF PARENTAL CONSENT

FILE NO.

In the matter of the petition of
Initials

, 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.

an attorney

a guardian ad litem

to assist her in proceedings

Date

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.

Judge:
Bar no.

is appointed

attorney

guardian ad litem

to represent the minor on her petition for waiver of parental

consent for an abortion.

Date

Judge

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)