Print Form Petition for Declaration of Emancipation of a Minor Clear Form (3/23/09) CCCO 0027 A IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, COUNTY DIVISION In re the Matter of the Emancipation of: ________________________________________________, A Mature Minor A Homeless Minor } No. _______________________________ PETITION FOR DECLARATION OF EMANCIPATION OF A MINOR 1. Name of Petitioner: _____________________________________________________________ Parent Guardian Next Friend (Select and check one. Minor cannot file Petition on their own behalf.) 2. Name of Minor Child: ___________________________________________________________ 3. Child's Date of Birth: ______________________________ Age now: _______________ 4. The Minor Child: resides at (address) _________________________________________________________________________ within Cook County, Illinois; or was found in Cook County, Illinois at (location) ________________________________________________; or owns property at _________________________________________________ in Cook County, Illinois; or is a party to a proceeding pending in the Circuit Court of Cook County, Case No. _______________________, which affects the interest of the minor. (Attach a copy of the Complaint/Petition/Motion which identifies the minor as a party and demonstrates that the interest of the minor will be affected. NOTE: If the proceeding is pending in the Child Protection Section or the Juvenile Justice Division of this Court no Petition for Declaration of Emancipation will be granted.) 5. The Minor Child is a: Mature Minor, as defined by 750 ILCS 30/3-2, because of the following facts (detail): ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ OR Homeless Minor, as defined by 750 ILCS 30/3-2.5 because of the following facts (detail): ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ That on behalf of the homeless minor the following efforts at family reunification were undertaken (detail): ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________. That the youth transitional housing program willing and able to provide services and shelter or housing to the minor is: Name of Program: ____________________________________________________________________________ Address: ___________________________________________________________________________________ Contact Person: ______________________________________________________________________________ Telephone Number: ________________________________ (OVER) (1 of 2 Pages) (3/23/09) CCCO 0027 B This program will offer the following services to the Minor which are necessary and appropriate for the well being of the minor for the following stated reasons. (State in detail the services which will be provided and the reasons, in detail why such services are appropriate and necessary.) ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ IF YOU NEED ADDITIONAL SPACE TO ANSWER ANY PORTION OF SECTION 5, PLEASE ATTACH A SEPARATE SHEET. 6. The Mother of the Minor is (Name and Address): ___________________________________________________________________________________________ If deceased (Attach Death Certificate or state date and place of death) 7. The Father of the Minor is (Name and Address): ___________________________________________________________________________________________ If deceased (Attach Death Certificate or state date and place of death) 8. The Minor does does not (choose one) have a Guardian Name and Address of Guardian or Custodian: (State names and addresses of Guardian and Custodian, if apppropriate.): ___________________________________________________________________________________________ ___________________________________________________________________________________________ 9. The Minor is not the subject of any proceeding in the Child Protection or Juvenile Justice Division of the Circuit Court of Cook County, Illinois. 10. The Minor is not the ward of any court. 11. The Minor has been living wholly or partially independent from parents/legal guardian since (insert date): _______________ Wherefore your Petitioner, on behalf of the Minor Child, requests this Court enter a Declaration of Emancipation consistent with the grounds set out in this Petition. ______________________________________ Signature ______________________________________ Print Name Under the penalties of perjury as provided for in section 1-109 of the Code of Civil Procedure, the undersigned states the facts contained in this Petition for Declaration of Emancipation of a Minor are true and correct. Atty. No.: __________________ Name: ____________________________________________ Atty. for: ________________________________________ Address: ____________________________________________ City/State/Zip: ____________________________________ ______________________________________ Signature ______________________________________ Print Name Telephone: ____________________________________ (2 of 2 Pages) DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS