Fill and Sign the Order on Waiver of Parental Consent for Abortion Wisconsin Form

STATE OF WISCONSIN, CIRCUIT COURT,       COUNTY For Official Use IN THE INTEREST OF Jane Doe, Order on Waiver of Parental Consent for Abortion       Date of Birth a person under the age of 18. Case No.       THE COURT FINDS AND CONCLUDES THAT: 1. A petition has been filed to waive parental consent for an abortion. 2. A clergyperson has filed with the petition an affidavit under s.48.375(7)(bm), Wisconsin Statutes. 3. A hearing was held on the petition at which time evidence was heard relating to: • the emotional development, maturity, intellect and understanding of the minor; • the understanding of the minor about the nature of, possible consequences of, and alternatives to the intended abortion procedure; and • other evidence the court found useful in making the determination about waiver of parental consent, including the report of the guardian-ad-litem, if one was appointed. 4a. The minor is mature and well-informed enough to make the abortion decision on her own. 4b. The minor is not mature and well-informed enough to make the abortion decision on her own, in which case I further find that: The performance or inducement of the abortion is in the minor's best interest. The performance or inducement of the abortion is not in the minor's best interest. 5. Other findings or conclusions relevant t o the order:       THE COURT ORDERS THAT: 1a. The petition is granted. An abortion may be performed without parental consent. • A certified copy of this decision shall be personally served on the minor or her attorney, or the member of the clergy who filed the petition on her behalf. 1b. The petition is denied. An abortion may not be performed except as otherwise provided by law. • A copy of this decision shall be personally served on the minor or her attorney, or the member of the clergy who filed the petition on her behalf. • The minor is also notified that she has an immediate right to appeal this decision under s.809.105, Wisconsin Statutes. JC-1623 , 05/00 Order on Waiver of Parental Consent for Abortion §48.375(7), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Order on Waiver of Parental Consent for Abortion Page 2 of 2 Case No. BY THE COURT: Signature of Circuit Court Judge       Name Printed or Typed       Date JC-1623 , 05/00 Order on Waiver of Parental Consent for Abortion §48.375(7), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2