Fill and Sign the For Judgment of Form

Nebraska State Court Form REQUIRED PETITION FOR JUDGMENT OF EMANCIPATION DC 6:16.3 NEW 06/19 Neb. Rev. Stat. § 43-4801 et seq. IN THE DISTRICT COURT OF COUNTY, NEBRASKA (county where Complaint filed) IN RE EMANCIPATION OF: Case No. Petitioner (your name) , (case number assigned by clerk of the court) PETITION FOR JUDGMENT OF EMANCIPATION STATE OF NEBRASKA ) ) ss COUNTY OF (county where verification signed) 1. I, , am petitioning for a judgment of emancipation. • My age is: __________. I am married. • I am living apart from my parent(s) or legal guardian(s). • I am a legal resident of __________________________ County, Nebraska. (name of county where you live) I do not speak English. The language that I speak is: . 2. My address is: (Street or Route/Box) My mailing address (if different) is: (Street or Route/Box) 3. (City) (City) (State) (ZIP code) (State) (ZIP code) I do not agree to receive notification by e-mail. I agree to receive notification by e-mail. My e-mail address is: NOTE: By providing this e-mail address, I acknowledge that I am aware that this information will be public record. I also understand that I will only receive e-mail communications regarding this case from the court. Page 1 of 4 Petition for Judgment of Emancipation DC 6:16.3 NEW 06/19 4. The name(s) and current address(es) of my parent(s) is/are (if known): Name: Address: ___________________________________ ____________________________________________________ ___________________________________ ____________________________________________________ OR 5. My parents are not currently my legal guardians. The name(s) and address(es) of my legal guardian(s) is/are (if known): Name: Address: ____________________________________ ____________________________________________________ ____________________________________ ____________________________________________________ OR 6. I cannot find either my parent(s) or legal guardians(s). Below is the name and address of my nearest known relative that lives in Nebraska. Name: Address: ____________________________________ _____________________________________________________ ____________________________________ _____________________________________________________ 7. To the best of my knowledge, I am am not a party to, or the subject of a pending court case in Nebraska or any other place, nor am I the subject of any court order of any kind that was issued as part of any pending court case in Nebraska or any other place. If I answered that I am part of a pending court case: Type of Court: (district, county, juvenile, etc.) County and State: (where the case is at) Case Number _____________________________ ________________________________ _________________________ _____________________________ ________________________________ _________________________ _____________________________ ________________________________ _________________________ _____________________________ ________________________________ _________________________ Page 2 of 4 Petition for Judgment of Emancipation DC 6:16.3 NEW 06/19 8. There is is not an order for my support in Nebraska or any other place (If known). If I answered that there is an order for my support, I provide the following information about the case: County and State: Case No. _____________________________ __________________________ _____________________________ __________________________ 9. I am filing this petition as a free and voluntary act. 10. Specific facts supporting my request for emancipation are: • • I am willingly living apart from my parent(s) and/or legal guardian(s). I am able to support myself without financial assistance. OR I do not have a parent, a legal guardian, or a custodian who is providing support to me. • I am mature, knowledgeable, and able to manage my affairs without the guidance of a parent or legal guardian. • I have demonstrated the ability and commitment to obtain and maintain education, vocational training, or employment. • School and/or employer’s name: Address: Grade and/or how long employed: ________________________ ________________________________ __________________________ ________________________ ________________________________ __________________________ The reason(s) that emancipation is in my best interest is/are: __________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ • The reason(s) that I am requesting emancipation is/are: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Page 3 of 4 Petition for Judgment of Emancipation DC 6:16.3 NEW 06/19 ****DO NOT SIGN UNTIL YOU ARE IN THE PRESENCE OF A NOTARY*** I, the undersigned, first being sworn upon oath, depose and say that I am the petitioner in the aboveentitled matter and have read the foregoing Petition for Judgment of Emancipation. The facts contained therein are true. Date ***Signature Name Street Address/P.O. Box City/State/ZIP Code Phone E-mail Address The foregoing instrument was acknowledged before me by (Day) day of (Month) , (Year) (Name) . Notary Public (Signature of Person Taking Acknowledgment) (Title or Rank) Page 4 of 4 Petition for Judgment of Emancipation DC 6:16.3 NEW 06/19 (Serial Number, if any) My commission expires: , this