Santa Clara — PB-4073*

Source: https://santaclara.courts.ca.gov/system/files/forms/pb-4073_rem.pdf

PB-4073 SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CLARA FOR COURT USE ONLY STREET ADDRESS: 201 North First Street, San José, CA 95113

MAILING ADDRESS: 191 North First Street

CITY AND ZIP CODE: San José, California 95113

BRANCH NAME: Family Justice Center

PETITIONER:

RESPONDENT:

CASE NUMBER:
EX PARTE APPLICATION AND ORDER TO BE RELIEVED
AS COUNSEL FOR MINOR CHILD

I, , declare as follows: (ATTORNEY’S NAME)

On the court appointed me to represent the minor(s) in this matter.

This matter as it pertains to my client(s) is complete.

I request an order to be relieved as counsel for the minor(s) in this matter.

I served a copy of this application to the parties or their attorneys of record on:

by: mail personal service other _______________________________

I declare under penalty of perjury, under the law of the State of California that the foregoing is true and correct.

Date: Attorney’s Name

SIGN

Attorney’s Signature

NOTICE TO PARTIES

If you wish to respond, complete the Response to Application to be Relieved as Counsel for Minor Child. Your response must be filed and served on all parties (including the Counsel for Minor Child) within 21 calendar days of the date of this application. If you do not submit a response, the court may make an order relieving the counsel for minor child without your input.

ORDER:

GRANTED. It appears from the application that the matter of appointment, as it pertains to the minor(s), is completed. Good cause having been shown, it is ordered that is relieved as attorney for the minor(s). (ATTORNEY’S NAME)

DENIED.

A Status Conference shall be calendared on in Dept. .

SIGN

Date: Judicial Officer of the Superior Court

PB- 4073 7/01/19 EX PARTE APPLICATION AND ORDER TO BE RELIEVED Page 1 of 1 AS COUNSEL FOR MINOR CHILD