Washington > Statewide > Juvenile Court > Children In Need Of Services - At Risk Youth
Indian Child Welfare Act Notice JU 05.0250 - Washington
| Indian Child Welfare Act Notice Form. This is a Washington form and can be used in Children In Need Of Services - At Risk Youth Juvenile Court Statewide . |
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SUPERIOR COURT OF WASHINGTON COUNTY OF _______________________ JUVENILE COURT NO: In the Interest of: INDIAN CHILD WELFARE ACT NOTICE 25 U.S.C. 1912 (a) (****) Clerks action required : ACCESS IS RESTRICTED PER GR 22(c)(3) D.O.B.: and 25 C.F.R. 23.11(e)(7) TO: (Parents, Indian Custodians, and Childs Tribe(s)) This notice is given pursuant to the Indian Child Welfare Act, 25 U.S.C. 1912. A child custody proceeding involving the child named above is pending in the court named above. A copy of the petition is attached. It is believed that the child named above is or may be a member or eligible for membership in the _____________________________________________________________________ Tribe(s). 1. INFORMATION ON THE CHILD. a. Name: b. Present residence: c. Date and Place of Birth: d. Where child was taken into custody: e. Tribal affiliation(s), enrollment number(s) or other identifying information: 2. INFORMATION ON THE PARENTS. Mother: a. Name: b. Present residence: c. Date and Place of Birth: d. Where child was taken into custody: e. Tribal affiliation(s), enrollment number(s) or other identifying information: INDIAN CHILD WELFARE ACT NOTICE (****) Page 1 of 3 WPF JU 05.0250 (6/2004) RCW 13.32A.152(3) , GR 22(c)(3), 25 C.F.R. 23.11(e)(7) <<<<<<<<<********>>>>>>>>>>>>> 2 Father: a. Name: b. Present residence: c. Date and Place of Birth: d. Where child was taken into custody: e. Tribal affiliation(s), enrollment number(s) or other identifying information: 3. ALL KNOWN MATERNAL GRANDPAREN TS, PATERNAL GRANDPARENTS, GREAT GRANDPARENTS: List names and maiden names; current and former addresses; dates and placed of birth and death; tribal affiliations, enrollment numbers; other identifying information about: Maternal Grandparents: . Paternal Grandparents: . Great Grandparents: . 4. PETITIONER IN THIS PROCEEDING. a. Name: b. Address: c. Phone Number: 5. ATTORNEY FOR THE PETITIONER: d. Name: e. Address: f. Phone Number: INDIAN CHILD WELFARE ACT NOTICE (****) Page 2 of 3 WPF JU 05.0250 (6/2004) RCW 13.32A.152(3) , GR 22(c)(3), 25 C.F.R. 23.11(e)(7) <<<<<<<<<********>>>>>>>>>>>>> 3The petition has been filed in the Superior Court for ______________________ County, State of Washington. A hearing is scheduled on _____________________________ [Date], at ____________a.m./p.m. The address of the court is . The phone number of the court is . The hearing will take place in courtroom . No proceeding involving the child named above shall take place until at least ten (10) days after receipt of this notice. The childs Tribe(s), the biological parents, and any Indian custodians of the child named above each have the right to intervene and be made a party in this proceeding under the Indian Child Welfare Act. If the parents or Indian custodians are unable to afford counsel, counsel will be appointed to represent them. The parents or Indian custodians have the right to be represented by an attorney at every stage of this proceeding. The court may, in its discretion, appoint an attorney to represent the child named above. The childs Tribe(s), the parents, or the Indian custodians of the child named above have the right, upon request, to examine all documents or other material which may be used to make a decision in this matter. Such request shall be made in writing to the court clerk, or the Court at the hearing. The childs Tribe(s), the parents, or the Indian custodians have the right to petition the court to transfer this proceeding to the courts of the childs Tribe(s). Such petition shall be in writing and presented to the court clerk or orally to the court at the scheduled hearing. The petition shall be granted in the absence of good cause to the contrary or the objection of either parent. A decision in this matter may affect the future custod ial rights of the childs Tribe(s), the parents, and the Indian custodians of the child named above, and may result in the temporary or permanent removal of the child from his or her home. THE INFORMATION CONTAINED IN THIS NOTICE AND THE ATTACHED PETITION IS CONFIDENTIAL AND SHOULD NOT BE DISC LOSED OR REVEALED TO ANY PERSON OR AGENCY WHICH IS NOT NECESSARY FOR PROPER NOTIFICATION OF THE PARENTS, INDIAN CUSTODIANS OR THE TRIBE(S) OF THE ABOVE-NAMED MINOR CHILD, AND WHICH IS NOT NECESSARY FOR THE EXERCISE OF THEIR RIGHTS UNDER THE INDIAN CHILD WELFARE ACT. (25 C.F.R. 23.11(e)(7).) This notice and the attached pleadings have been sent by certified mail, return receipt requested, to the parents, Indian custodians and the childs tribe(s) (tribes designated agent) on the date as stated in the Proof of Mailing. On the date as stated in the Proof of Mailing, a copy of this notice and the attached pleadings have also been sent by certified mail, return receipt requested to: Portland Area Director Bureau of Indian Affairs th 911 NE 11 Avenue Portland, OR 97232 ___________________________________________ Petitioner, Pro Se/Petitioners Attorney/ WSBA No. Date INDIAN CHILD WELFARE ACT NOTICE (****) Page 3 of 3 WPF JU 05.0250 (6/2004) RCW 13.32A.152(3) , GR 22(c)(3), 25 C.F.R. 23.11(e)(7)
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