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CIVIL FORM 4-991.Supreme Court ApprovedOctober 14, 20044-991[Kinship Guardianship Act, Sections 40-10B-1 to 40-10B-14 NMSA 1978.]STATE OF NEW MEXICOCOUNTY OF _______________________________________________ JUDICIAL DISTRICTNo. ___________1___________________________________________Petitioner (kinship guardian or guardians)v._________________ and ______________________Respondents (parent or parents of child)IN THE MATTER OF THE GUARDIANSHIPOF ________________________________2 MOTION FOR REVOCATION OF KINSHIP GUARDIANSHIP 1.INFORMATION ABOUT THE PARENTSA._______________________ (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[ ] motherD. The kinship guardianship should be revoked because of the following change of circumstances: _____________________________________________________________________________________ (describe change of circumstances)2. INFORMATION RELATING TO CHILD CIVIL FORM 4-991.Supreme Court ApprovedOctober 14, 2004A.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.4STATE OF NEW MEXICO } ssCOUNTY 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.__________________ __________________________DateSignature of Respondent____________________________________________DateSignature of RespondentSigned 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, CIVIL FORM 4-991.Supreme Court ApprovedOctober 14, 2004 3 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.]

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