STATE OF NEBRASKA FORM NO. JC 14:10 1/98 Rev. Sec. 71-6903
PARENTAL NOTIFICATION ORDER AND FINDINGS OF FACT
CASE NUMBER
IN THE __________________________COURT OF _____________________COUNTY, NEBRASKA
(County, District or Separate Juvenile)
IN THE MATTER OF THE PETITION OF: Name:
ORDER AND FINDINGS OF FACT CONFIDENTIAL
The above-entitled matter came on for hearing before the court on
,
, pursuant to the
petition for waiver of parental notification to proceed with an abortion without prior parental or guardian notification which was filed by the petitioner on Petitioner ( present) present. (Name if present) was Upon evidence presented at the hearing and upon the files and records herein, the court now makes the following FINDINGS OF FACT Petitioner is a mature minor and is capable of giving informed consent to the proposed abortion. OR It is in the best interests of the petitioner for the physician to perform the proposed abortion upon her without prior notification to her parent(s) or guardian. OR Petitioner is not a mature minor and is not capable of giving informed consent to the proposed abortion, and it is not in the best interests of the petitioner for the physician to perform the proposed abortion upon her without prior notification to her parent(s) or guardian. IT IS THEREFORE ORDERED In compliance with Neb. Rev. Stat. sec. 71-6903, petitioner's physician is hereby authorized to perform the proposed abortion on the petitioner as requested by her without prior notification to Petitioner's parent(s) or guardian. OR Petitioner's request for an authorized abortion without prior notification to her parent(s) or guardian, is hereby denied. Petitioner is further notified of her right to appeal this decision to the Nebraska Supreme Court. Date: By the Court: Judge was) ( was not) personally present and ( , was) ( . was not) represented by an attorney. (Name if was) ( was not)
. Guardian ad litem for the petitioner (
. Also present at the request of .