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VOLUNTARY WITHDRAWAL OF APPLICATION FOR LICENSURE OR RELINQUISHMENT OF FOSTER FAMILY HOME LICENSE AND EXIT SURVEY State Form 53237 (R / 2-11) / CW 3340 DEPARTMENT OF CHILD SERVICES Reset Form INSTRUCTIONS:

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licensee LICENSURE childs RELINQUISHMENT CW FCM licensing applicable Applicant Relocation knowledgeable relinquish withdrew appropriately strengths optional Conferences attentive hearings requirements

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