Enter Name
Enter Address
Date
Hon. [ENTER NAME]
San Bernardino Juvenile Dependency Court
860 East Gilbert Street San Bernardino,
CA 92415
Phone: 909-269-8900
Fax: 909-269-8910
RE: Revocation of all verbal and written Consents
Respectfully,
The undersigned makes this letter with reference to Case No. [Enter Case Number]. The
undersigned hereby revokes any and all oral and written consents made to the social worker
in the aforesaid Case.
Thank you for your prompt consideration.
Respectfully,
Enter Name
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