Dorothy Brown, Clerk of the Circuit Court of Cook County, Illinoiscookcountyclerkofcourt.orgPage 1 of 3en-USPetition for Declaration of Emacipation of a Minor � () 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: � en-US Parent � � Guardian � � � � � � � � � � � en-USbehalf.) 2. Name of Minor Child: � en-US 3. Child222s Date of Birth: � � � en-US 4. en-USThe Minor Child: Resides at (address) � � � en-USCook County, Illinois; or Was found in Cook County, Illinois at (location) � en-US ;en-USor � � en-US in Cooken-USCounty, Illinois;en-USor Is a party to a proceeding pending in the Circuit Court of Cook County, Case � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � en-USProtection Section or the Juvenile Justice Division of this Court no Petition for Declaration � � � � Case No. � en-US Dorothy Brown, Clerk of the Circuit Court of Cook County, Illinoiscookcountyclerkofcourt.orgPage 2 of 3 5. en-USThe Minor Child is a: � � � � � � � � � � � � � en-USOR Name of Program � � Address: � � Contact Person: � � Telephone Number: � en-US � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � en-USthe minor is: � � � � � � � � � � � � � � � � 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 � () CCCO 0027 B Dorothy Brown, Clerk of the Circuit Court of Cook County, Illinoiscookcountyclerkofcourt.orgPage 3 of 3 � � � � � � � � � � � � � � � � � � � 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 � () CCCO 0027 C Signature Print Name 8. The Minor � � does � � 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. � � � � � � � � 11. � � � � � � � � � � � � � date): � en-USen-USWherefore your Petitioner, on behalf of the Minor Child, requests this Court enter a Declaration of Emancipation � � � � � � � � Atty. No.: � en-US Atty Name: � � Atty. for: � � Address: � � City: � � State: � � Zip: � en-US Telephone: � en-US Primary Email: � �