Fill and Sign the Emancipation Form Document

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 IN THE CIRCUIT OF THE STATE OF OREGON FOR THE COUNTY OF ____________ Juvenile Department Juv. No. In the Matter of the Emancipation of ) ) ) APPLICATION FOR DECREE OF EMANCIPATION Applicant ) The Applicant states as follows: I. I was born on the day of , ____ and I am now years of age. II. I currently reside at ________________________________, in the city of _____________, County of ____________, Oregon, and I intend that _____________ County be my place of residence for the indefinite future. III. My custodial parent(s) or guardian(s) do ____ do ____ not consent to my emancipation. Application for Decree of Emancipation 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 IV. I am substantially able to be self-sufficient and self-supporting without parental guidance and supervision. V. I am sufficiently mature and knowledgeable to manage my own affairs without parental assistance. WHEREFORE, I request that the Court enter a Decree as follows: A. Declaring me to be an emancipated minor; B. Advising me of my civil and criminal rights and liabilities; and C. Instructing me to obtain from the Oregon Motor Division an Oregon driver’s license or identification card with a notation thereon of my emancipated status. _______________________________ ___________________________ Parent’s Name Applicant _________________________________ ______________________________ Street Address Street Address _______________________________ ____________________________ City, State, Zip Code City, State, Zip Code _______________________________ ____________________________ Phone Phone ____________________________ Applicant Signature Application for Decree of Emancipation 2 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 SUBSCRIBED AND SWORN to me before this _______day of _____________________, _______. Notary Public for Oregon My Commission expires__________________ _____________________________________ Application for Decree of Emancipation 3