4-991

[Kinship Guardianship Act, Sections

40-10B-1 to 40-10B-14 NMSA 1978.]

STATE OF NEW MEXICO

COUNTY OF ___________________________

____________________ JUDICIAL DISTRICT

                                                                                                No. ___________¹

___________________________________________

Petitioner (kinship guardian or guardians)

v.

_________________ and ______________________

Respondents (parent or parents of child)

IN THE MATTER OF THE GUARDIANSHIP

OF ________________________________²

MOTION FOR REVOCATION OF

KINSHIP GUARDIANSHIP

1.         INFORMATION ABOUT THE PARENTS

            A.        _______________________ (mother's name) is the mother of the above named child. Her current address is _____________________________ (city, county and state and zip code).

            B.        _________________________ (father's name) is the father of the child. His current address is ___________________________________ (city, county and state and zip code).

            C.        The [respondent is] [respondents are] the child's:

[ ]parents

                        [ ]        father

                        [ ]        mother

            D.        The kinship guardianship should be revoked because of the following change of circumstances: ___________________________________

__________________________________________________ (describe change of circumstances)

2.         INFORMATION RELATING TO CHILD

            A.        The [respondent requests] [respondents request] the court to enter an order terminating the kinship guardianship and to return the following child to ___________________ [and ___________________]³.

3.         TRANSITION PLAN.

A transition plan that demonstrates how the child will be reintegrated into our home is attached to this motion.⁴

STATE OF NEW MEXICO              } ss

COUNTY OF ________________    }

The [respondent was sworn and states] [respondents were sworn and state]: [I] [We] have read this motion and it is true to the best of [my] [our] knowledge and belief. [I] [We] understand that [I] [We] can be punished both civilly and criminally if any information in this motion is false.

__________________                                                __________________________

Date                                                                            Signature of Respondent

__________________                                                __________________________

Date                                                                            Signature of Respondent

Signed and sworn before me on this ____ day of ______________, ______.

Notary public

_________________________________

My commission expires: _______________________.

USE NOTES

1.         This form is to be filed in the same court as the court appointing the kinship guardians. The clerk will use the same docket number.

2.         This form may be modified if there is more than one child who was subject to a kinship guardianship.

3.         Service of this request shall also be made on the child if the child is fourteen (14) years of age or older.

4.         A transition plan is required to be filed with this motion. A transition plan should include, but not be limited to, information about the child's health, doctors, dentists, special medical needs, school, extra-curricular activities, religious worship, all visitation rights of the parties and other persons and any other matters relevant to the best interests of the child and how the needs of the child will be met after the termination of the kinship guardianship. Domestic Relations Form 4A-313 NMRA, Parenting Plan and Child Support Obligation, may be modified and used as a "transition plan".

[Provisionally approved, effective August 15, 2003 until August 31, 2004; approved, October 14, 2004.]