Free Petition for Waiver of Parental Notification, JC 14:7 - Nebraska

STATE OF NEBRASKA FORM NO. JC 14:7 1/98 Rev. Sec. 71-6903 IN THE

PETITION FOR WAIVER OF PARENTAL NOTIFICATION
COURT OF

CASE NUMBER

COUNTY, NEBRASKA

(County, District, or Separate Juvenile)

IN THE MATTER OF THE PETITION OF: Name: Address:

PETITION FOR WAIVER OF PARENTAL NOTIFICATION CONFIDENTIAL

Date of Birth: THE PETITIONER moves the court for authorization for her physician to perform an abortion without prior notification being required or given to her parent(s) or guardian. 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. If the court determines that she is not mature or she does not claim to be mature, a waiver of parental notification is in her best interests.

THEREFORE, the petitioner requests an order authorizing her physician to perform an abortion at her request and without prior notification being required or given to her parent(s) or guardian. Date: Petitioner's Signature: Attorney:

Pursuant to Neb. Rev. Stat. Sec. 71-6903 this document shall be made available in each courthouse in such a place that members of the public may obtain it without requesting it from the clerk of the court or other court personnel.