Dorothy Brown, Clerk of the Circuit Court of Cook County, Illinoiscookcountyclerkofcourt.orgPage 1 of 3en-USPetition for Declaration of Emacipation of a Minor þ () CCCO 0027 A en-USIN THE CIRCUIT COURT OF COOK COUNTY, ILLINOISen-USCOUNTY DEPARTMENT, COUNTY DIVISION en-USIn re the matter of the Emancipation of: en-US, A Mature Minor A Homeless Minor en-USPETITION FOR DECLARATION OF EMANCIPATION OF A MINOR 1. Name of the Petitioner: þ en-US Parent þ þ Guardian þ þ þ þ þ þ þ þ þ þ þ en-USbehalf.) 2. Name of Minor Child: þ en-US 3. Child222s Date of Birth: þ þ þ en-US 4. en-USThe Minor Child: Resides at (address) þ þ þ en-USCook County, Illinois; or Was found in Cook County, Illinois at (location) þ en-US ;en-USor þ þ en-US in Cooken-USCounty, Illinois;en-USor Is a party to a proceeding pending in the Circuit Court of Cook County, Case þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ en-USProtection Section or the Juvenile Justice Division of this Court no Petition for Declaration þ þ þ þ Case No. þ en-US Dorothy Brown, Clerk of the Circuit Court of Cook County, Illinoiscookcountyclerkofcourt.orgPage 2 of 3 5. en-USThe Minor Child is a: þ þ þ þ þ þ þ þ þ þ þ þ þ en-USOR Name of Program þ þ Address: þ þ Contact Person: þ þ Telephone Number: þ en-US þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ en-USthe minor is: þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ 6. en-USThe Mother of the Minor is (Name and Address): en-USThe Father of the Minor is (Name and Address): en-USPetition for Declaration of Emacipation of a Minor þ () CCCO 0027 B Dorothy Brown, Clerk of the Circuit Court of Cook County, Illinoiscookcountyclerkofcourt.orgPage 3 of 3 þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ en-USstates the facts contained in this Petition for Declaration of Emancipation of a Minor are true and correct. Signature Print Name en-USPetition for Declaration of Emacipation of a Minor þ () CCCO 0027 C Signature Print Name 8. The Minor þ þ does þ þ does not (choose one) have a Guardian en-USName and Address of Guardian or Custodian: (State names and addresses of Guardian and Custodian, ifen-USappropriate) en-USThe Minor is not the subject of any proceeding in the Child Protection or Juvenile Justice Division of theen-USCircuit Court of Cook County, Illinois. þ þ þ þ þ þ þ þ 11. þ þ þ þ þ þ þ þ þ þ þ þ þ date): þ en-USen-USWherefore your Petitioner, on behalf of the Minor Child, requests this Court enter a Declaration of Emancipation þ þ þ þ þ þ þ þ Atty. No.: þ en-US Atty Name: þ þ Atty. for: þ þ Address: þ þ City: þ þ State: þ þ Zip: þ en-US Telephone: þ en-US Primary Email: þ þ