JV-036 (Rev. 04/22/2014) RESIGNATION OF APPOINTMENTAS CUSTODIAN(S)G.L. c. 119, 247 26 DOCKET NUMBER Trial Court of MassachusettsJuvenile Court Department CARE AND PROTECTION OF DIVISIONI/We having been appointed by this court on to be the custodian(s) withpermanent custody of the above named minor(s), represent that it is inconvenient for me/us to continue toserve 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: American LegalNet, Inc. www.FormsWorkFlow.com