251 ARIZONA SUPREME COURT JE10F-081107 ALL RIGHTS RESERVED PAGE 1 OF 1 Person Filing: Mailing Address: City, State, Zip: Day/Evening Phone: / Person Filing is: SELF (No Attorney) OR Attorney If Attorney, Bar No.: Atty. Phone: SUPERIOR COURT OF ARIZONA IN COUNTY In the matter of Emancipation of : Case Number 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 223Order of Protection224 between you and either parent or any legal guardian? No Yes If 223Yes224, does that Order say your address is 223protected224? 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 223Yes224, what language(s)? FOR CLERK222S USE ONLY American LegalNet, Inc. www.FormsWorkFlow.com