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Legal Guardianship Form by owy17991

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Legal Guardianship Form document sample

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									                                  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, Bure au 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)

								
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