IN THE CIRCUIT COURT OF _______________ COUNTY, WEST VIRGINIA
For Clerk’s Use Only
IN RE: ___________________________________________, A PROTECTED PERSON
DATE FILED: ____________________________________ CASE NUMBER ___________ - G - __________
PETITION FOR PERMISSION TO RESIGN
AS GUARDIAN/CONSERVATOR
[West Virginia Code: § 44A-4-3]
NOW COMES the Petitioner in the above captioned cause, __________________________________________,
who is a [check applicable office] _________ guardian __________ conservator for ____________________________
_______________________________, a protected person, and hereby respectfully petitions the Court for permission to
resign such office(s). The facts, circumstances and reasons in support of this petition are as follows [insert reason or
reasons for resignation]: ___________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
_________________________________________________________________.[Attach additional pages, if necessary.]
Respectfully presented this _______ day of ____________________________[month], __________[year]..
____________________________________________________
GUARDIAN/CONSERVATOR'S SIGNATURE
[NOTE
: This form must be completed and filed with the Circuit Court having jurisdiction of the Protected
Person or the case at least sixty (60) days prior to the effective date of the resignation.]
C CL GC2010 Form 19 / SCA-CG 910M PETITION TO RESIGN AS GUARDIAN/CONSERVATOR-Page 1 of 1
