Form EM-115 Emancipation of Minor Income and Expense Declaration - California

Form EM-115 or the "Emancipation Of Minor Income And Expense Declaration" is a form issued by the California Superior Court.

Download a PDF version of the Form EM-115 down below or find it on the California Superior Court Forms website.

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EM-115
ATTORNEY OR PARTY WITHOUT ATTORNEY
STATE BAR NUMBER:
FOR COURT USE ONLY
NAME:
FIRM NAME:
STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
TELEPHONE NO.:
FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
IN THE MATTER OF (name):
Petitioner, a minor
CASE NUMBER:
EMANCIPATION OF MINOR INCOME AND
EXPENSE DECLARATION
1. My name and address are:
My telephone number is:
I have been living at this address since:
I live there with (name and relationship of all persons, including children):
2. My date of birth is:
3.
a.
I am attending school (name of school and grade):
b.
I am not attending school. The highest year of education I have completed is:
4.
My occupation is:
5.
a.
I am employed. My place of employment is (name and address):
I started work there on (date):
b.
I am not employed at the present time. I last worked from (starting month and year):
My gross monthly earnings were: $
to (ending month and year):
6.
a.
I am not receiving welfare or AFDC and I do not intend to apply for welfare or AFDC.
b.
I am receiving welfare or AFDC. Monthly amount received: $
c.
I have applied for welfare or AFDC.
d.
I intend to apply for welfare or AFDC.
Page 1 of 2
Form Adopted for Mandatory Use
Family Code, § 7000, et seq.
EMANCIPATION OF MINOR INCOME
Judicial Council of California
www.courts.ca.gov
AND EXPENSE DECLARATION
EM-115 [Rev. September 1, 2018]
EM-115
ATTORNEY OR PARTY WITHOUT ATTORNEY
STATE BAR NUMBER:
FOR COURT USE ONLY
NAME:
FIRM NAME:
STREET ADDRESS:
CITY:
STATE:
ZIP CODE:
TELEPHONE NO.:
FAX NO.:
E-MAIL ADDRESS:
ATTORNEY FOR (name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
IN THE MATTER OF (name):
Petitioner, a minor
CASE NUMBER:
EMANCIPATION OF MINOR INCOME AND
EXPENSE DECLARATION
1. My name and address are:
My telephone number is:
I have been living at this address since:
I live there with (name and relationship of all persons, including children):
2. My date of birth is:
3.
a.
I am attending school (name of school and grade):
b.
I am not attending school. The highest year of education I have completed is:
4.
My occupation is:
5.
a.
I am employed. My place of employment is (name and address):
I started work there on (date):
b.
I am not employed at the present time. I last worked from (starting month and year):
My gross monthly earnings were: $
to (ending month and year):
6.
a.
I am not receiving welfare or AFDC and I do not intend to apply for welfare or AFDC.
b.
I am receiving welfare or AFDC. Monthly amount received: $
c.
I have applied for welfare or AFDC.
d.
I intend to apply for welfare or AFDC.
Page 1 of 2
Form Adopted for Mandatory Use
Family Code, § 7000, et seq.
EMANCIPATION OF MINOR INCOME
Judicial Council of California
www.courts.ca.gov
AND EXPENSE DECLARATION
EM-115 [Rev. September 1, 2018]
EM-115
IN THE MATTER OF (name):
CASE NUMBER:
The average of my gross monthly earnings is:
Amount
7.
a.
Salary and wages, including bonuses and overtime
$
b.
Money received from parents or other adults assisting me
$
(name and relationship):
c.
Other
(specify source and amount):
$
8.
I have the following assets:
Value
a.
Cash
$
b.
Checking account
$
c.
Savings account
$
d.
Stocks, bonds
$
e.
Vehicle
(year, make, model):
$
f.
Other
(specify):
$
9.
My monthly expenses are:
Amount
a.
Rent or
Mortgage
$
b.
Food
$
c.
Clothing
$
d.
Phone and utilities
$
e.
Vehicle
$
(1)
Loan payments
$
(2) Maintenance
$
I declare under penalty of perjury that the foregoing is true and correct.
Date:
(SIGNATURE OF PETITIONER)
(TYPE OR PRINT NAME)
EM-115 [Rev. September 1, 2018]
EMANCIPATION OF MINOR INCOME
Page 2 of 2
AND EXPENSE DECLARATION
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