JV-036 (Rev. 04/22/2014)
RESIGNATION OF APPOINTMENT
AS CUSTODIAN(S)
G.L. c. 119, § 26
DOCKET NUMBER
Trial Court of Massachusetts
Juvenile Court Department
CARE AND PROTECTION OF
DIVISION
I/We having been appointed by this court on to be the custodian(s) with
permanent custody of the above named minor(s), represent that it is inconvenient for me/us to continue to
serve as custodian/custodians for the following reasons:
_________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
I/We resign the appointment as custodian/custodians and relinquish custody of: _______________________
______________________________________________________________________________________
and respectfully ask this Court to appoint some other suitable person or agency to serve as custodian/
custodians of the minor child/children.
Date:
(Signature of Custodian)
(Print Name)
(Signature of Co-Custodian)
(Print Name)
(Address)
(For Court Use Only)
Telephone Number:
