Approved, SCAO STATE OF MICHIGAN JUDICIAL CIRCUIT - FAMILY DIVISION COUNTY ORDER GRANTING / DENYING WAIVER OF PARENTAL CONSENT FOR AN ABORTION , a minor, for waiver of parental consent FILE NO. In the matter of the petition of Initials Date of birth: USE NOTE: Check one of the three boxes in the Findings portion of this form and one of the two boxes in the Order portion of this form. 1. Date of hearing: Judge: Bar no. 2. At a hearing after testimony was presented, the court made findings of fact and conclusions of law. THE COURT FINDS: 3. The waiver of parental consent must be granted because the minor is sufficiently mature and well enough informed to make the decision regarding abortion independently of her parent(s) or legal guardian. the waiver is in the best interests of the minor. 4. The waiver of parental consent must be denied because the minor is not sufficiently mature and well enough informed to make the decision regarding abortion independently of her parent or legal guardian and it is not in the best interests of the minor. 5. The petition has been withdrawn. IT IS ORDERED: 6. The petition of Name is granted and this order shall expire 90 days from the date of entry. Nothing in this order shall require or permit an abortion that is prohibited by law. 7. The petition is dismissed. denied. Date and time Judge Do not write below this line - For court use only PC 120 (9/10) ORDER GRANTING / DENYING WAIVER OF PARENTAL CONSENT FOR AN ABORTION MCL 722.904, MCR 3.615 American LegalNet, Inc. www.FormsWorkFlow.com