Approved, SCAO

STATE OF MICHIGAN

JUDICIAL CIRCUIT - FAMILY DIVISION
COUNTY

ORDER GRANTING / DENYING
 WAIVER OF PARENTAL CONSENT
FOR AN ABORTION

FILE NO.

In the matter of the petition of

, a minor, for waiver of parental consent

Date of birth:

Initials

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 The petition has been withdrawn.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

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.

    is granted and this order shall expire 90 days

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