Enter Name

Enter Address

 

Date

 

Hon. [ENTER NAME]

San Bernardino Juvenile Dependency Court 

ADDRESS

 

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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