Petition For Emancipation Of A Minor {JE12f}

Person Filing: Address (if not protected): City, State, Zip Code: Telephone: Email Address: Lawyer's Bar Number: Representing Self, without a Lawyer or Attorney for Petitioner OR Respondent For Clerk's Use Only SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY JUVENILE COURT In the Matter of the Emancipation of: Case Number JE: PETITION FOR EMANCIPATION OF A MINOR A.R.S. § 12-2451 A Minor Female Male STATEMENTS TO THE COURT UNDER OATH OR BY AFFIRMATION · · · · · I am at least 16 years old. I am a resident of Arizona and of the county where I am filing this request. I am financially self-sufficient; I am able to support myself and provide for my own food, housing, and medical care. I have read and understood the information provided by the Court that explains the rights and obligations of an emancipated minor and the potential risks and consequences of emancipation. I am not a ward of the court: I am not on probation or parole, or in the care or custody of DCS or other state agency, and no final order of "Dependency" has been entered. 1. PERSONAL INFORMATION EMANCIPATION: My Name: First ABOUT ME, "THE MINOR", REQUESTING Middle Last Mailing Address: City, State, Zip Code: Day/Evening Telephone: ( Date of Birth: (Month) (Day) (Year) ) / ( ) American LegalNet, Inc. www.FormsWorkFlow.com © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED Page 1 of 5 JE12f 031516 Use only most current version Case Number JE: 2. PERSONS ENTITLED TO NOTICE of this matter as required by the Court and under Arizona law, A.R.S. 12-2451. If applicable, check the box for "Parental Rights Terminated by Court Order" or "Deceased." If "Deceased", attach proof such as death certificate or obituary notice. MOTHER Name: Deceased Mailing Address: City, State, Zip Code: Day/Evening Telephone: FATHER Name: Deceased Mailing Address: City, State, Zip Code: Day/Evening Telephone: LEGAL GUARDIAN Name: Mailing Address: City, State, Zip Code: Day/Evening Telephone: LEGAL GUARDIAN Name: Mailing Address: City, State, Zip Code: Day/Evening Telephone: ( ) /( ) ( ) /( ) Deceased ( ) /( ) Deceased Parental Rights Terminated by Court Order ( ) /( ) Parental Rights Terminated by Court Order 3. I CURRENTLY HAVE ONE OR MORE LEGAL GUARDIANS BECAUSE: Explain what happened to cause someone to request to be appointed your guardian or the reasons or circumstances that caused the Court to appoint your guardian(s). FACTS TO SUPPORT MY REQUEST FOR EMANCIPATION: The following answers and statements explain how I will handle my financial, personal, and social affairs, provide for my own food, housing and medical care, maintain my educational or vocational training, and my employment situation. 4. My Street Address: City, State, Zip Code: I have been living there since: (month/date/year) American LegalNet, Inc. www.FormsWorkFlow.com © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED Page 2 of 5 JE12f 031516 Use only most current version Case Number JE: 5. I live there with (name and relationship of all persons, including children): 6. a. b. I attend (name of school) ______________________________ and I am in the ______ grade. I am NOT in school. The highest grade of education I have completed is ______ grade. c. My plans concerning education or job training are as follows: 7. a. b. c. I am not receiving public assistance or TANF and I do not intend to apply for either. I am receiving public assistance or TANF. The monthly amount received is: I have applied for or intend to apply for public assistance or TANF. I am currently employed by: (List name, address, and contact phone number for employers.) Employer # 2 (Attach pay stub) $ 8. a. Employer # 1 (Attach pay stub) Job Title: I started work: for Employer #1: (month/year) b. I am NOT currently employed. I last worked from: (starting month, year) To: (ending month and year) Job Title: Employer #2: My gross monthly earnings (before taxes or other deductions) were: $ Amount $ 9. My average gross monthly income (annual amount divided by 12) is shown below. a. Salary / Wages, including bonuses and overtime, before taxes or other deductions b. Money received from others (list name, your relationship to those persons and amounts (below)) Name, Relation: Name, Relation: c. Social Security Survivor Benefits (received due to death of a parent) d. Social Security Disability Benefits e. Child Support Received for MY Children f. Other source of income (specify source) g. $ $ $ $ $ $ (Add 9 a-f) TOTAL MONTHLY INCOME: $ American LegalNet, Inc. www.FormsWorkFlow.com © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED Page 3 of 5 JE12f 031516 Use only most current version Case Number JE: 10. I have the following assets (things of value that I own): a. Cash b. Checking Account(s) (total, if more than one) c. Savings Account(s) d. Stocks, Bonds e. Trust Fund(s) (total, if more than one) (total, if more than one) $ $ $ $ $ $ $ (Add 10 a-g) Value f. Vehicle (Year, Make, and Model _________________________ g. Other (specify) h. TOTAL VALUE OF ASSETS: $ 11. I have the following monthly expenses: a. Housing b. Food (groceries plus dining out) c. Clothing d. Utilities (phone plus electric, gas, cellular, water & sewer) Medical 1. (insurance) 2. (doctor, dentist, hospital, urgent care) 3. (prescription medications) e. Total Medical Expenses f. Transportation (add 1-3, carry to right column) Amount $________ $________ $________ $________ $________ $________ $________ $________ $________ (public transit, bus and taxi) Vehicle 1. (monthly payments) 2. (insurance) 3. (fuel/gasoline) 4. (service, maintenance and repair) $________ $________ $________ $________ $________ $________ $________ (Add 11 a-i) g. Total Vehicle Expenses (add 1-4, carry to right column) h. Child Support Paid for my Children (Amount I pay to someone else) i. Other (specify) j. TOTAL MONTHLY EXPENSES: $ 12. I will provide for my health care through If "Other", explain: insurance through employer AHCCS Other American LegalNet, Inc. www.FormsWorkFlow.com © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED Page 4 of 5 JE12f 031516 Use only most current version Case Number JE: 13. At least one of the following is included with this request: (At least one box must be checked; you may check and attach more than one to further support your request.) Attached is documentation that I have been living on my own for at least three consecutive months. Attached is a statement explaining why I believe the