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Petition for Judicial Waiver of Parental Notice of Termination of Pregnancy Form. This is a Florida form and can be use in Civil Statewide.
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Tags: Petition for Judicial Waiver of Parental Notice of Termination of Pregnancy, 8.987, Florida Statewide, Civil
IN THE COUNTY COURT
IN THE CIRCUIT COURT OF THE ___________ JUDICIAL CIRCUIT
IN AND FOR ___________________ COUNTY, FLORIDA
______________________ DIVISION
,
Petitioner,
-vs,
Respondent(s).
)
)
)
)
)
)
)
)
Case No.
Judge
PETITION FOR JUDICIAL WAIVER
OF PARENTAL NOTICE OF TERMINATION OF PREGNANCY
I certify that the following information is true and correct:
(1) The pseudonym or initials of the minor (is/are)
Statement of True Name and Pseudonym with the clerk.
(2) The minor is
, and the minor has filed a Sworn
years old.
(3) The minor is pregnant and notice has not been waived.
(4) The minor desires to terminate her pregnancy without notice to a parent or legal guardian for one or more of the
following reasons: [check all that apply]
a. The minor is sufficiently mature to decide whether to terminate her
pregnancy, for the following reason(s):
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
b. The minor is a victim of child abuse or sexual abuse by one or both of her parents or a guardian, for the
following reason(s):
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
c. Notification of a parent or guardian is not in the best interest of the minor, for the following reason(s):
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Petition for Judicial Waiver of Parental Notice of Termination of Pregnancy {8.987}
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(5) The minor requests that the court enter an order authorizing her to consent to the performance or inducement of a
termination of pregnancy without notification of a parent or guardian.
(6) The minor requests the appointment of an attorney to represent her in this matter: [check one]:
yes
no
(7) The minor elects the following method or methods for receiving notices of hearings or other court actions in this
case:
Through a third party whose name is ___________________________________ and whose address and phone
number for purposes of notice is __________________________________________________________________.
The minor will contact the office of the clerk of court at the following phone number: (
)
.
I understand that by signing this form I am swearing to or affirming the truthfulness of the claims made in this
petition and that the punishment for knowingly making a false statement includes fines, imprisonment, or both.
Signature: _______________________________ Date: ______________
(You may sign a name other than your true name,
such as Jane Doe or other pseudonym under
which your petition is being filed.)
Petition for Judicial Waiver of Parental Notice of Termination of Pregnancy {8.987}
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