Petition/Emancipation of Minor PC-905 REV. 4/17 CONNECTICUT PROBATE COURTS CONFIDENTIAL RECEIVED: Instructions: 1) A minor who is 16 years old or older and residing in Connecticut, or any parent or guardian of the minor, may use this form to petition the court for emancipation of the minor. 2) The petition may be filed in the court for the probate district in which the minor, or the minor's parents or guardian resides. A birth certificate for the minor should be filed with the petition. 3) For more information, see C.G.S. sections 46b-150 to 46b-150e. The legal effect of an emancipation is enumerated in C.G.S. section 46b-150d. 4) Type or print the form in ink. Use a separate sheet, or PC-180, if more space is needed. District Number Minor's Date of Birth Male Female Probate Court Name In the Matter of (Name, address and telephone number of minor.) Hereinafter referred to as the minor. Parents of minor (Name, address and telephone number of each parent.) Guardians of minor (Name, address and telephone number of each guardian, if any.) Petitioner (Name, address and telephone number.) Name and Address of Other Persons to Whom Notice Should be Given. (List relationship to minor) THE PETITIONER REPRESENTS THAT: The minor is 16 years of age or older and resides in the State of Connecticut. The minor has entered into a valid marriage (Box should be checked even if marriage has been terminated.) The minor is on active duty with any of the armed forces of the United States of America. The minor willingly lives separately and apart from his or her parents or guardian, with or without the consent of the parents or guardian, and is managing his or her own financial affairs. Emancipation is in the best interest of the minor, child of the minor or parents or guardian of the minor. Petition/Emancipation of Minor American LegalNet, Inc. www.FormsWorkFlow.com PC-905 Page 1 of 2 Petition/Emancipation of Minor PC-905 REV. 4/17 CONNECTICUT PROBATE COURTS CONFIDENTIAL In the Matter of (Name of minor.) ADDITIONAL FACTS/REASONS IN SUPPORT OF THE PETITION FOR EMANCIPATION: is is not a current safety or service agreement between the Department of Children and Families and the There parent/guardians of the minor child There is is not a current protection order or restraining order involving any party. If so, please attach. THE PETITIONER REQUESTS THAT: The court enter an order of emancipation of the minor. The representations made in this petition are made under penalty of false statement. Signature of Petitioner Type or Print Name Relationship to minor Date Petition/Emancipation of Minor American LegalNet, Inc. www.FormsWorkFlow.com PC-905 Page 2 of 2