Fill and Sign the Pc 100 Petition for Emancipation Affidavit and Waiver of Form

1. My full name is and my social security number is . 2. An action within the jurisdiction of the family division of circuit court involving the family or family members of the minor has been previously filed in Court, Case Number , was assigned to Judge , andremains is no longerpending. 3. I am at least 16 years of age. I was born on in County, . A certified copy of my birth certificate is attached to this petition. 4. The name(s) and last known address(es) of my parents, guardian, or custodian are: 5. I presently reside within this county at and I have lived there continuously since . 6. I am able to manage my own financial affairs as shown by the following facts: I am employed by: (PLEASE SEE OTHER SIDE) PC 100 (11/05) PETITION FOR EMANCIPATION, AFFIDAVIT, AND WAIVER OF NOTICE In the matter of the emancipation of, a minor FILE NO. MCL 722.4 Approved, SCAO PETITION FOR EMANCIPATION, AFFIDAVIT, AND WAIVER OF NOTICE STATE OF MICHIGAN JUDICIAL CIRCUIT - FAMILY DIVISION COUNTY NAME RELATIONSHIP ADDRESS Father Mother Guardian Custodian Date Date State Street address City, state, zip Do not write below this line - For court use only First name, middle name, and last name (type or print) JIS CODE: PEM Last 4 digits 7. I am able to manage my personal and social affairs as shown by the following facts: My housing arrangements are: 8. I have read the Emancipation of Minors laws (Michigan Compiled Laws 722.1 through 722.6), and I understand my rights and responsibilities as an emancipated minor. I REQUEST the court to order my emancipation. I declare that this petition has been examined by me and that its contents are true to the best of my information, knowledge, and belief. Notary public Date Date AFFIDAVIT Name (type or print) AddressCity State Zip Telephone no. Occupation City, state zip Telephone no. Address Date Signature of affiant Name (type or print) 1. I am a , and I conduct business at or am employed at . 2. I have personally known , a minor, for years, and I have personal knowledge of his/her current circumstances. 3. I believe that emancipation would be in the best interests of the minor because of the following circumstances: 4. I have reviewed this petition, and I waive notice of hearing and any adjournment of the hearing. Subscribed and sworn to before me on , County, Michigan. My commission expires: Signature: Notary public, State of Michigan, County of DateMinor's signature Attorney signature Name (type or print)Bar no. Address City State Zip Telephone no.