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STATE OF MICHIGAN

JUDICIAL CIRCUIT - FAMILY DIVISION
PROBATE COURT
COUNTY

PETITION FOR EMANCIPATION,
AFFIDAVIT, AND WAIVER OF NOTICE

CASE NO. and JUDGE

Court address

Court telephone no.

In the matter of

First, middle, and last name of the minor

Petitioner’s name, address, and telephone no.

Petitioner’s attorney, bar no., address, and telephone no.

1. My full name is

First, middle, and last name (type or print)

and my social security

number is

Put last 4 digits of SSN in Ref. No. row 10 on MC 97a.
Last 4 digits

2. An action within the jurisdiction of the family division of circuit court involving the family or family members of the minor

has been previously filed in

was assigned to Judge

Court, Case Number

, and

remains

is no longer

pending.

3. I am at least 16 years of age. I was born on

Put DOB in Ref. No. row 10 on MC 97a.
Date

County,

State

. A certified copy of my birth certificate accompanies this petition.

4. The name(s) and last known address(es) of my parents, guardian, or custodian are:

NAME

RELATIONSHIP

ADDRESS

Parent

Guardian

Custodian

5. I presently reside within this county at

Street address

City, state, zip

and I have lived there continuously since

Date

Approved, SCAO
Form PC 100, Rev. 1/21
MCL 722.4
Page 1 of 3

JIS Code: PEMPetition for Emancipation, Affidavit, and Waiver of Notice
Page 2 of 3

(1/21)

Case No.

6. I am able to manage my own financial affairs as shown by the following facts:

I am employed by:

7. I am able to manage my personal and social affairs as shown by the following facts:

8. I have read the Emancipation of Minors laws (Michigan Compiled Laws 722.1 through 722.6), and I understand my rights
and responsibilities as an emancipated minor.

My housing arrangements are:

I REQUEST the court to order my emancipation.

I declare under the penalties of perjury that this petition has been examined by me and that its contents are true to the best
of my information, knowledge, and belief.

Minor’s signature

Attorney’s signature

AFFIDAVIT

1. I am a

Occupation

, and I conduct business at or am employed at

Address City State Zip Telephone no.

2. I have personally known

Name (type or print)

, a minor, for

I have personal knowledge of his/her current circumstances.

years, and

3. I believe that emancipation would be in the best interests of the minor because of the following circumstances:

Date

Petition for Emancipation, Affidavit, and Waiver of Notice
Page 3 of 3

(1/21)

Case No.

4. I have reviewed this petition, and I waive notice of hearing and any adjournment of the hearing.

Date

Signature of affiant

Name (type or print)

Address

City, state, zip Telephone no.

Subscribed and sworn to before me on

Date

My commission expires on

Notary public, State of Michigan, County of

Deputy clerk/Notary public signature

Name (type or print)

Acting in the County of

This notarial act was performed using an electronic notarization system or a remote electronic notarization platform.

PC 100, Petition for Emancipation, Affidavit, and Waiver of Notice

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the Michigan state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from www.courts.michigan.gov/emancipation (2023-03)
Page(s): 3
Fields(s): 63
Average fields per page: 21
Reading Level: Grade 7
LIST Grouping(s): Unknown

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Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

court_address was Court address (0.63 conf)
first_middle_last_name_minor was First middle and last name of the minor (0.38 conf)
petitioners_name_address was Petitioners name address and telephone no (0.40 conf)
petitioners_attorney_address was Petitioners attorney bar no address and telephone no (0.52 conf)
first_middle_last_name_type was First middle and last name type or print (0.41 conf)
action_division_involving was 2 An action within the jurisdiction of the family division of circuit court involving the family or family members of the minor (0.37 conf)
remains was remains (0.32 conf)
longer was is no longer (0.37 conf)
name_row__1 was NAMERow1 (0.43 conf)
address_parent__1 was ADDRESSParent (0.40 conf)
name_row__2 was NAMERow2 (0.43 conf)
address_parent__2 was ADDRESSParent_2 (0.39 conf)
name_row__3 was NAMERow3 (0.43 conf)
address_guardian was ADDRESSGuardian (0.42 conf)
name_row__4 was NAMERow4 (0.43 conf)
address_custodian was ADDRESSCustodian (0.47 conf)
users1_address_line_one__1 was Street address (1.00 conf)
users1_address_line_two was City state zip (1.00 conf)
signature_date__1 was Date (1.00 conf)
judge__1 was Judge (0.39 conf)
county__1 was county2 (0.35 conf)
users1_address_state was state (1.00 conf)
judge__2 was judge2 (0.35 conf)
case_number was case number2 (0.49 conf)
court was court2 (0.35 conf)
county__2 was county (0.39 conf)
circuit was circuit (0.33 conf)
court_telephone was Court telephone no (0.51 conf)
financial_affairs_following was 6 I am able to manage my own financial affairs as shown by the following facts (0.41 conf)
unknown__1 was 1 (0.38 conf)
unknown__2 was 2 (0.38 conf)
unknown__3 was 3 (0.38 conf)
employed was I am employed by (0.47 conf)
manage_personal_affairs was 7 I am able to manage my personal and social affairs as shown by the following facts (0.34 conf)
1_2 was 1_2 (0.38 conf)
2_2 was 2_2 (0.38 conf)
housing_arrangements was My housing arrangements are (0.38 conf)
signature_date__2 was Date_2 (1.00 conf)
signature_date__3 was Date_3 (1.00 conf)
1_i_am_a was 1 I am a (0.37 conf)
users1_address_line_one__2 was Address (1.00 conf)
telephone__1 was Telephone no (0.44 conf)
personally_known was 2 I have personally known (0.39 conf)
minor was a minor for (0.44 conf)
would_minor_circumstances__1 was 3 I believe that emancipation would be in the best interests of the minor because of the following circumstances 1 (0.40 conf)
would_minor_circumstances__2 was 3 I believe that emancipation would be in the best interests of the minor because of the following circumstances 2 (0.40 conf)
would_minor_circumstances__3 was 3 I believe that emancipation would be in the best interests of the minor because of the following circumstances 3 (0.40 conf)
text__1 was Text5 (0.35 conf)
text__2 was Text6 (0.35 conf)
petition_notice_hearing was 4 I have reviewed this petition and I waive notice of hearing and any adjournment of the hearing (0.43 conf)
signature_date__4 was Date_4 (1.00 conf)
name_type_print__1 was Name type or print (0.45 conf)
address was Address_2 (0.35 conf)
city_state_zip was City state zip_2 (0.35 conf)
telephone__2 was Telephone no_2 (0.45 conf)
signature_date__5 was Date_5 (1.00 conf)
undefined__1 was undefined_2 (0.39 conf)
name_type_print__2 was Name type or print_2 (0.40 conf)
undefined__2 was undefined_3 (0.39 conf)
acting_county was Acting in the County of (0.37 conf)
undefined__3 was undefined_4 (0.39 conf)
notarial_act_performed_using_electronic_notarization_system_remote_platform was This notarial act was performed using an electronic notarization system or a remote electronic notarization platform (0.44 conf)
text__3 was Text7 (0.35 conf)
text__4 was Text8 (0.35 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

PC 100, Petition for Emancipation, Affidavit, and Waiver of Notice

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Identified Data Fields:

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02