FORM 8.988. SWORN STATEMENT OF TRUE NAME AND PSEUDONYM
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FORM 8.988. SWORN STATEMENT OF TRUE NAME AND
PSEUDONYM
SWORN STATEMENT OF TRUE NAME AND PSEUDONYM
PDF page 460NOTICE TO THE CLERK OF COURT: A CERTIFIED COPY OF THIS DECLARATION WITH THE CASE NUMBER NOTED ON IT SHALL BE GIVEN TO THE MINOR AFTER SHE SIGNS IT.
THE ORIGINAL SHALL IMMEDIATELY BE PLACED IN A SEALED ENVELOPE WHICH SHALL BE FILED UNDER SEAL AND KEPT UNDER SEAL AT ALL TIMES.
(1) My true name is , and my address is .
(print your name) (print your address)
(2) My date of birth is .
(3) I have filed a Petition for Judicial Waiver of Parental Notice and Consent or Consent Only to Termination of Pregnancy under the name or initials on .
(date)
I understand that by signing this form I am swearing to or affirming the truthfulness of the information herein and that the punishment for knowingly making a false statement includes fines, imprisonment or both.
Dated:
Signature:
(You must sign your true name.)