STATE OF WEST VIRGINIA DEPARTMENT OF HEALTH AND HUMAN RESOURCES RECOMMENDATION AND CONSENT FOR THE TRANSFER OF GUARDIANSHIP State of West Virginia County of ______________,
SS:
Whereas, the custody, care, control and guardianship of the minor child known as ________________________________ born on ________________________, was granted to the West Virginia Department of Health and Human Resources by an order of the Circuit Court of ____________________ County, West Virginia, entered on the _______________th day of ___________________. The West Virginia Department of Health and Human Resources is hereby authorized to consent to the transfer of guardianship of said minor child to __________________________________________. In executing this consent, it is the intention of the West Virginia Department of Health and Human Resources to relinquish and forfeit all claims to said child. When a decree is entered, said child will become the legal ward of the Petitioners and the Department will thereafter have no rights or duties with reference to . Therefore in consideration for the welfare and the best interests of said minor child, the West Virginia Department of Health and Human Resources does hereby recommend and consent to the appointment by decree of __________________________________ as the legal guardians of ________________________________________________. In witness whereof the said West Virginia Department of Health and Human Resources, Bureau for Children and Families, has caused its name to be hereto signed by _____________ ________________________, Regional Director, by its authority given, this the _______________ day of ____________________, ________. WV Department of Health and Human Resources Bureau for Children and Families
_____________________________________ Regional Director State of West Virginia County of ________________________: I, _____________________________, a notary public in and for said state and county, do hereby certify that ____________________________________ whose name is signed to the writing above, has this day acknowledged the same before me. Given under my hand this ______________ day of _______________________, _______. My commission expires _______________________________. ___________________________ Notary Public SG Consent (New 4/02)