Arizona Supreme Court Page 1 of 2 JE13F-071207 Person Filing: Address (if not protected): City, State, Zip Code: Telephone: Email Address: Representing [ ] Self or [ ] Lawyer for Lawyer222s Bar Number: SUPERIOR COURT OF ARIZONA IN COUNTY In the Matter of the Emancipation of: Case Number: (Optional) CONSENT TO EMANCIPATION OF A MINOR A Minor REQUIRED INFORMATION FROM PARENT OR LEGAL GUARDIAN: 1. INFORMATION ABOUT ME: Name: Mailing Address: City, State, Zip Code: Day / Evening Phone: ( ) ( ) I am the [ ] MOTHER [ ] FATHER [ ] LEGAL GUARDIAN of the minor child named above, who is requesting emancipation. 2. I have read the 223Petition for Emancipation of a Minor224 and consent to the emancipation of the named minor because: (Explanation REQUIRED). For Clerk222s Use Only American LegalNet, Inc. www.FormsWorkFlow.com Case Number: Arizona Supreme Court Page 2 of 2 JE13F-071207 OATH OR AFFIRMATION OF PARENT OR LEGAL GUARDIAN I have read, understood, and completed the above statements concerning the petition for emancipation of the above named minor. By signing this document I am stating to the Court the information I have provided is true and correct to the best of my knowledge, information and belief, under penalty of perjury. Date Signature of Parent or Guardian STATE OF COUNTY OF Signed and sworn or affirmed before me this: (date) by: . Michael K. Jeanes, Clerk of Superior Court By: Deputy Clerk OR (notary seal) Notary Public American LegalNet, Inc. www.FormsWorkFlow.com