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INSTRUCTIONS FOR COMPLETING PETITION FOR JUDGMENT OF EMANCIPATION HEADING: • • • Enter the name of the county where you are filing the Petition. o This must be the county in which you are living. Enter your first, middle, and last names. You are the petitioner. The clerk of the district court will give you a case number when you file the Petition. You must include the case number on any papers you file. BODY OF PETITION: Enter the county you will have this document notarized. If you do not know this information yet, you may leave this spot blank and handwrite it in when you take the completed paper with you to sign in front of a notary public or the clerk of the district court. It is important that you do not sign this form until that authorized person witnesses it and can verify your signature and identity. The numbers below give instructions for completing the paragraphs with the same numbers in the Petition. Paragraph 1. Paragraph 2. Paragraph 3. Paragraph 4. Paragraph 5. Paragraph 6. Paragraph 7. Paragraph 8. Enter your full name in the first blank. Enter your age in the second blank. Check the correct box(es) for if you are married, living apart from your parent(s) or legal guardian(s), or both. Enter the name of the county where you live. Check the next box ONLY if you do not speak English and enter the language that you speak in the blank. Enter your physical address. Enter your mailing address if different from your physical address. Check the correct box for if you agree to receive notification by e-mail from the court. If you agree to receive e-mails from the court, provide your full e-mail address in the blank provided and read the statement of understanding. Enter the name(s) and address(es) of your parent(s) if known. If your parent(s) are not your legal guardian(s), enter the name(s) and address(es) of your legal guardian(s) if known. If you cannot find either your parent(s) or legal guardian(s), enter the name(s) and address(es) of your nearest known relative that lives in Nebraska, if there are any. Check the correct box for if you are part of (the subject of, or a party to) any pending court case or if you are part of any court order of any kind that was issued as part of any pending court case in Nebraska or any other place. If you answered that you are part of a case, use the blanks to enter the type of court, the county and state where the case is at and the case number if you know them. Check the correct box for if there is an order for your support in Nebraska or any other place. If you answered that there is an order for your support, use the blanks to enter the county and state where the order is and the case number if you know them. Page 1 of 2 Instructions for Petition for Emancipation DC 6:16.3a NEW 06/19 Paragraph 9. Read each of the statements carefully. Check the correct box for if you can support yourself or if you DO NOT have a parent, legal guardian, or custodian who is supporting you. Use the blanks provided to enter your school and/or employer's information. Write the reason(s) that emancipation is in your best interest. Write the reason(s) that you are requesting emancipation. SIGNATURE BLOCK: • • • • • • • DO NOT SIGN UNTIL YOU ARE PRESENT IN FRONT OF A NOTARY OR THE CLERK OF THE DISTRICT COURT. On the next line enter the date that you are signing. On the third line enter or print your first, middle and last names. On the fourth line enter your full street address/P.O. Box. On the fifth line enter your city, state, and ZIP code. On the sixth line enter your telephone number, including the area code. On the seventh line enter your e-mail address, if any. NOTARY VERIFICATION STATEMENT: • The notary public or Clerk of the District Court will complete this section. Page 2 of 2 Instructions for Petition for Emancipation DC 6:16.3a NEW 06/19