1 2 3 In the Matter of: 4 5 6 7 8 9 10 TO: IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF MARION Juvenile Department ) ) ,) a youth. ) Case No. SUMMONS (Emancipation) IN THE NAME OF THE STATE OF OREGON: 11 You are directed to appear before the above entitled court at the Marion County Juvenile Department, 2970 Center Street NE, Salem, Oregon 97301 on: 12 at a.m/p.m. for the preliminary hearing. 13 14 15 NOTICE: READ THESE PAPERS CAREFULLY! STATEMENT OF FACTS 16 The attached Emancipation Petition has been filed by the youth and is within the jurisdiction of the Court because the youth reside in Marion County. A true copy of the 17 original Emancipation Petition is attached and incorporated by reference into this 18 Summons. 19 20 21 22 23 24 25 26 27 28 STATE OF OREGON ) ) County of Marion ) ORIGINAL I certify that this is a true copy of the original Summons and Emancipation Petition on this case. Dated Issued: By: Deputy Court Administrator/Designee ss. Deputy Court Administrator/Designee By: IF YOU DO NOT APPEAR IN COURT, THE COURT WILL CONTINUE WITH THE PROCEEDINGS WITHOUT YOU. IT IS YOUR RESPONSIBILITY TO KEEP IN CONTACT WITH THE COURT. SUMMONS (Emancipation) Page 1 of 2 FC (6/20/13) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Printed Names Phone Number Signature Date STATE OR OREGON ) ) County of Marion ) I, ss. , hereby certify that I am a competent person 18 years PROOF OF SERVICE of age or older and a resident of the state of service or the State of Oregon and that I am not a party nor an officer, director or employee of, nor attorney for any party, corporate or otherwise, and that on the day of , 20 , , The parent/guardian of the your named therein, personally and in person at the following address: , at a.m./p.m. I served a true copy of the attached Summons and Emancipation Petition on SUMMONS (Emancipation) Page 2 of 2 FC (6/20/13)