Justice of the Peace – Resignation Form All questions must be answered, unless marked (optional). PersonalYour Justice of the Peace Number Date of Birth Family Name Given Name/s Previous Family/Given Name (If you have changed your name please attach proof of name change) Reason for resignation I no longer reside in Tasmania I am no longer an Australian Citizen I am insolvent I have been convicted of an offence beyond minor traffic offences I am subject to a Guardianship Order I have attained the age of 75 years, or will do so within the next 4 weeks I am no longer capable of carrying out the duties of a Justice of the Peace (for any reason)(If you are no longer capable of undertaking the duties of a Justice of the Peace please attach a medical certificate or a duly witnessed statutory declaration form) I no longer wish to carry out the duties of a Justice of the Peace (for any reason) Other, please detail below Documentsproof of name change medical certificate or a duly witnessed statutory declaration Last Updated: 2nd October 2023