Louisiana Emancipation of Minor

EMANCIPATION OF UNITED STATES OF AMERICA

STATE OF LOUISIANA

PARISH OF

BE IT KNOWN that on , before me, , a Notary Public duly commissioned and qualified in and for the parish and state indicated, and in the presence of the undersigned witnesses, personally came and appeared:

and , husband and wife, domiciled in , and having as their present mailing address ;

who declared under oath that availing themselves of the provisions of Article 366 of the Revised Civil Code of Louisiana, they do emancipate their , , born , it being the intention of and that the said shall have and enjoy all of the rights and privileges of an emancipated minor, according to law.

THUS SIGNED ON the date indicated above at , Louisiana, in the presence of the undersigned Notary Public, qualified in said State and Parish, and the undersigned competent witnesses, who have signed with the parties after due reading of the whole.

WITNESSES:

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NOTARIAL EMANCIPATION - F1DFAM3:

This is an act of notarial emancipation of a minor fifteen years or older, in accordance with R.C.C. 366, conferring power of administration as limited by R.C.C. 370 et seq.