Free Petition for Declaration of Emancipation of a Minor - Utah

_________________________________ Name _________________________________ Address _________________________________ City _________________________________ Telephone ______________________________________________________________________________ IN THE_________________DISTRICT JUVENILE COURT FOR ____________________COUNTY ______________________________________________________________________________ IN THE INTEREST OF_________________, ) PETITION FOR DECLARATION A MINOR. ) OF EMANCIPATION OF A MINOR ) JUVENILE NO.__________________ ) ) ______________________________________________________________________________ 1. 2. My name:____________________________________ My address:______________________________________________________________

______________________________________________________________________________ 3. 4. I am at least 16 years of age. My birthdate is:__________________ I am/am not currently enrolled in school. My school is: ___________________________ 5 I am capable of living separate and apart from my parents. I have been living apart from

them since (date):__________________________ 6. I am capable of managing my own financial affairs. I have completed and attached my

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declaration of income and expenses. 7. Please explain below why you want to be emancipated. Please also explain how you

believe that you will be able to live independently from your parents, guardian or custodian: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 5. My mother's name is:____________________________

Her address is:__________________________________________________________________ 6. My father's name is:_____________________________

His address is:__________________________________________________________________ 7. I have a legal guardian. yes/no (circle one)

My guardian's name is:_________________________________ My guardian's address is:_________________________________________________________ 8. Other person entitled to notice.

This person's name is:__________________________________ This person's address is:__________________________________________________________
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This person's relationship to me is:________________________ 8. I am a [ ] dependent child [ ] probation ward of the juvenile court of

Case number (if known) My probationer officer is (name):_________________________________ 9. I am in state custody. yes/no. (circle one)

The state agency with custody is: ___________________________ I declare under penalty of perjury that the foregoing is true and correct and that this declaration is executed at (place):_______________________, Utah. on (date):__________________.

_____________________________ Petitioner
Notary Clause

_______________________________, Petitioner, is personally known to me or presented satisfactory proof of identity to me. After being sworn and while under oath, Petitioner stated that he or she was acting voluntarily, had read and understood the preceding document, and that the contents were true. Petitioner then signed the document in my presence. Signed on__________________________, 20_____. X____________________________________ Notary Public/ Court Clerk (Notary Seal)

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