Free State of Minnesota - Minnesota


File Size: 39.5 kB
Pages: 1
Date: August 29, 2008
File Format: PDF
State: Minnesota
Category: Court Forms - State
Author: gadamso
Word Count: 233 Words, 1,515 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.courts.state.mn.us/forms/public/forms/Parental_Notification/Abortion_Parental_Notification_Waiver/JUV201.pdf

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State of Minnesota
County

District Court
Judicial District: Court File Number: Case Type: Parental Notification

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In the Matter of the Petition of:
Name

Address

Petition for Physician's Authorization

Date of Birth

Petitioner moves the court pursuant to Minn. Stat. 144.343, subd. 6(c)(i) for authorization to her physician to perform an abortion upon said petitioner without prior notification being required or given to petitioner's parent(s), guardian, or custodian. Petitioner bases her motion on one of the following alternative grounds: 1. 2. She is mature and capable of giving informed consent to the proposed abortion. It is in her best interests for the physician to perform the proposed abortion upon petitioner without prior notification of parent(s), guardian, or conservator.

Wherefore, Petitioner requests an order authorizing her physician to perform an abortion upon her at her request and without prior notification being required or given to her parent(s), guardian, or custodian. Dated:
Attorney for Petitioner

Address

, petitioner, being first duly sworn on oath, states that she has read the foregoing petition subscribed by her, that she knows the contents thereof, and that the same is true to her best information and belief. Dated:
Signature (Sign only in front of notary public or court administrator.)

Sworn/affirmed before me this day of , .

Notary Public \ Deputy Court Administrator

JUV201

State

ENG

Rev 01/02-D

www.courts.state.mn.us/forms

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