Santa Clara — PB-4074*

Source: https://santaclara.courts.ca.gov/system/files/forms/pb-4074_rem.pdf

ATTACHMENT PB-4074 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:

RESPONSE TO APPLICATION TO BE RELIEVED AS COUNSEL FOR MINOR CHILD

Petitioner Respondent

1. I, , declare as follows:

a. I am the attorney for the Father/Mother/Joined party in this case.

b. I am the Father Mother other party _______________ in this case. I am self-represented.

2. I agree with the Counsel for Minor Child’s request to be relieved.

3. I object to the Counsel for Minor Child’s request to be relieved for the following reasons

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4. I served a copy of this Response to all parties, including Counsel for Minor Child on ________________

   by: mail personal service other _______________________________

Date: Name of Declarant

SIGN

Signature of Declarant

PB-4074 07/01/19 RESPONSE TO APPLICATION TO BE RELIEVED AS Page 1 of 1 COUNSEL FOR MINOR CHILD