STATE OF MAINE DISTRICT COURT Location Docket No. In re: Petitioner PETITION FOR EMANCIPATION 15 M.R.S. § 3506-A(1) is on years of age, having been . 1. The Petitioner, born at 2. The Petitioner is male female. 3. The Petitioner resides at 4. The Petitioner's mother is 5. The Petitioner's father is 6. The Petitioner's guardian or other custodian is whose address is 7. The Petitioner refuses to live in the home provided by for the following reasons: See attached. and her address is and his address is 8. The Petitioner has made reasonable provisions for room, board, health care and education, vocational training or employment. The Petitioner is sufficiently mature to assume responsibility for the petitioner's own care and it is in the petitioner's best interest to do so. The Petitioner requests this court, after notice and hearing, to order the emancipation of the Petitioner in accordance with 15 M.R.S. § 3506-A. Date: Attorney for Petitioner Address FM-064, Rev. 04/14 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com