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Petition For Judicial Authorization Of Abortion DC-502(A) - Virginia
| Petition For Judicial Authorization Of Abortion Form. This is a Virginia form and can be used in General District Court Statewide . |
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PETITION FOR JUDICIAL AUTHORIZATION OF ABORTION Court Case No. Commonwealth of Virginia VA. CODE 16.1-241 (V) Hearing Date and Time PLEASE NOTE: All papers and hearings in this matter are confidential Juvenile and Domestic Relations District Court In re a petitioner under eighteen years of age: PETITIONERS NAME CONTACT TELEPHONE NUMBER (OPTIONAL) DATE OF BIRTH AGE I, the undersigned, request this court to authorize a physician to perfo rm an abortion pursuant to Virginia Code 16.1- 241(V). I verify that the information given above is correct, and that I have elected not to allow notice to an authorized person as defined in Virginia Code 16.1-241(V). DATE PETITIONERS SIGNATURE Sworn/affirmed and signed before me on DATE CLERK DEPUTY CLERK INTAKE OFFICER NOTARY PUBLIC My commission expires: Filed by: Petitioner with Intake Officer Counsel for Petitioner SIGNATURE OF COUNSEL Date and Time Petition Filed: CLERK DEPUTY CLERK INTAKE OFFICER HEARING DATE A hearing on this petition has been set for , at m., at the DATE TIME Juvenile and Domestic Relations District Court ADDRESS AND COURTROOM COURT TELEPHONE NUMBER I DATE CLERK DEPUTY CLERK INTAKE OFFICER ACKNOWLEDGMENT OF HEARING DATE AND TIME 1. I understand that a hearing on this petition has been scheduled as noted above. 2. I acknowledge that I have received a copy of this petition and notice of hearing in person on this date. I waive all other forms of notice for hearing on this date. DATE PETITIONERS SIGNATURE SIGNATURE OF COUNSEL FOR THE PETITIONER FORM DC-502 (A) (PAGE ONE OF ONE) 7/03 PDF American LegalNet, Inc. www.USCourtForms.com
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