Person Filing: Mailing Address: City, State, Zip: Day/Evening Phone: Person Filing is: If Attorney, Bar No.: / SELF (No Attorney) OR Attorney Atty. Phone: FOR CLERK’S USE ONLY SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY JUVENILE COURT In the matter of Emancipation of Case Number JE JUVENILE EMANCIPATION INFORMATION SHEET A Minor Female Male NOTE: THIS FORM IS FOR COURT USE ONLY AND IS NOT A PUBLIC RECORD. COMPLETE THIS FORM AND RETURN IT TO THE CLERK WHEN FILING THE PETITION. INFORMATION ABOUT THE MINOR WHO WANTS TO BE EMANCIPATED Name First Middle Last Is there currently an “Order of Protection” between you and either parent or any legal guardian? No Yes If “Yes”, does that Order say your address is “protected”? No Yes Mailing Address (if same as above, leave blank) City, State, Zip Street Address (if different from mailing address) City, State, Zip Code Telephone Number (If different from above) ( ) Date of Birth (Month/Day/Year) Social Security Number Will you or any person required to receive notice need a court interpreter? Yes No If “Yes”, what language(s) ? © Superior Court of Arizona in Maricopa County July 11, 2007 ALL RIGHTS RESERVED JE10f Use only most current version Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com