Petition for Physicians Authorization
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Petition for Physicians Authorization Form. This is a Minnesota form and can be use in District Court Statewide.
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Tags: Petition for Physicians Authorization, JUV201, Minnesota Statewide, District Court
State of Minnesota County Judicial District: Court File Number: Case Type: District Court Parental Notification In the Matter of the Petition of: Name Address Petition for Physician's Authorization Date of Birth Petitioner moves the court pursuant to Minn. Stat. §144.343, subd. 6(c)(i) for authorization to her physician to perform an abortion upon said petitioner without prior notification being required or given to petitioner's parent(s), guardian, or custodian. Petitioner bases her motion on one of the following alternative grounds: 1. 2. She is mature and capable of giving informed consent to the proposed abortion. It is in her best interests for the physician to perform the proposed abortion upon petitioner without prior notification of parent(s), guardian, or conservator. Wherefore, Petitioner requests an order authorizing her physician to perform an abortion upon her at her request and without prior notification being required or given to her parent(s), guardian, or custodian. Dated: Attorney for Petitioner Address E-mail address I declare under penalty of perjury that everything I have stated in this document is true and correct. Minn. Stat. § 358.116. Dated: Signature JUV201 State ENG Rev 7/15 www.mncourts.gov/forms American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 1
