Rule 8.34 — Form 7 February 2002 IN THE IOWA DISTRICT COURT FOR ________________________ COUNTY (JUVENILE DIVISION) IN THE INTEREST OF ____________________________________, A Minor. Juvenile No. _______________________ FINDINGS OF FACT, CONCLUSIONS OF LAW AND ORDER This matter came before the court on _____________________, 20 _____, for hearing held pursuant to Iowa Code section 135L.3 on waiver of parental notification of a minor’s abortion. Present for the hearing were the following: _______________________________________________, the minor; _______________________________________________, the minor’s attorney; _______________________________________________, the minor’s guardian ad litem; and _______________________________________________, _________________________________________. The proceeding was reported [tape recorded]. The following exhibits and testimony were received into evidence: _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ The court now makes the following FINDINGS OF FACT: 1. Notice of this hearing and a copy of the petition were served in accordance with Iowa R. Juv. P. 8.28. 2. The petitioner is a pregnant minor, _________ years of age. She is approximately __________ weeks pregnant and seeks an abortion but objects to the notification of a parent. 3. (Check one) ____ a. The petitioner is mature and capable of providing informed consent for the performance of an abortion. This decision is based upon the following facts: __________________________________________________ _____________________________________________________________________________________ ____________________________________________________________________________________. OR ____ b. The petitioner is not mature or does not claim to be mature, but notification to the petitioner’s parent is not in the petitioner’s best interest. This decision is based upon the following facts: _______________________ ____________________________________________________________________________________ ____________________________________________________________________________________. OR ____ c. The petitioner has not shown she is mature and capable of providing informed consent, nor has she shown that notification to a parent is not in her best interest. This decision is based upon the following facts: ________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________. American LegalNet, Inc. www.FormsWorkflow.com 0 CONCLUSIONS OF LAW 1. The court has jurisdiction of the petitioner and the subject matter as provided in Iowa Code chapter 135L. 2. The burden of proof is on the petitioner by a preponderance of the evidence. 3. (Check one) ____ a. A preponderance of the evidence shows that the petitioner is mature and capable of providing informed consent for the performance of the abortion within the scope and meaning of Iowa Code section 135L.3(3)(e)(1). OR ____ b. A preponderance of the evidence shows that the petitioner is not mature or does not claim to be mature, but notification of the abortion to a parent is not in the best interest of the petitioner within the scope and meaning of Iowa Code section 135L.3(3)(e)(2). OR ____ c. The evidence does not support a judicial waiver of parental notification. 4. The notification requirements as provided in Iowa Code section 135L.3 should [should not] be waived. IT IS ORDERED, ADJUDGED AND DECREED that the petition for waiver of parental notification is granted [denied]. The clerk shall provide a copy of this order to the petitioner’s attorney, guardian ad litem, if any, physician, and the following person(s) designated by the petitioner: _______________________________________________________ _____________________________________________________________________________________________ ____________________________________________________________________________________________. The clerk shall provide notice of this decision to the petitioner as requested in the following manner: ______________ ____________________________________________________________________________________________. Notice: (Delete if petition is granted). You have the right to appeal this ruling to the Iowa Supreme Court. You must file a notice of appeal with the district court clerk within 24 hours of this ruling. The rules you must follow for the appeal are attached to this order. Dated this __________________ day of ___________________, 20 _____. __________________________________________________ JUDGE ___________________ JUDICIAL DISTRICT OF IOWA American LegalNet, Inc. www.FormsWorkflow.com