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Consent To Custody Of An Indian Child To Non-Parent And Court Certification D-243 - California
| Consent To Custody Of An Indian Child To Non-Parent And Court Certification Form. This is a California form and can be used in Family San Diego Local County . |
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ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO.(Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRAL DIVISION, FAMILY COURT, 1555 6TH AVE., SAN DIEGO, CA 92101 CENTRAL DIVISION, MADGE BRADLEY, 1409 4TH AVE., SAN DIEGO, CA 92101 EAST COUNTY DIVISION, 250 E. MAIN ST., EL CAJON, CA 92020 EAST COUNTY DIVISION, RAMONA, 1428 MONTECITO RD., RAMONA, CA 92065 NORTH COUNTY DIVISION, 325 S. MELROSE DR., VISTA, CA 92081 SOUTH COUNTY DIVISION, 500 3RD AVE., CHULA VISTA, CA 91910 PETITIONER(S) RESPONDENT(S) THIRD-PARTY CLAIMANT(S) CONSENT TO CUSTODY OF AN INDIAN CHILD TO NON-PARENT AND COURT CERTIFICATION 1. Your Name: Mother 2. Your Address: City: Telephone Number: 3. Your Name of Tribe(s)/Band(s): Your Enrollment Number: 4. Name of Indian Child: Date of Birth: Age: State: Father CASE NUMBER Custodian (Check only one. Each parent/custodian must complete a separate form.) Zip Code: Check here if you do not know the enrollment number. (Note: Consent not valid unless child is at least 10 days old.) 5. Indian Tribe(s)/Band(s) of Which Child is a Member or Eligible for Membership: Child's Enrollment Number: Check here if you do not know the enrollment number. 6. In contemplation of the pending custody claim under California Fam.Code § 3041, I VOLUNTARILY CONSENT AND AGREE: (Check only one) a. ______________________________ shall have partial legal and/or physical custody of the child named above. (Name of Non-Parent) -ORb. ______________________________ shall have full legal and physical custody of the child named above. (Name of Non-Parent) SDSC D-243 (New 4/09) CONSENT TO CUSTODY OF AN INDIAN CHILD TO NON-PARENT AND COURT CERTIFICATION Fam. Code § 3041 25 U.S.C §1913 Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com CASE TITLE CASE NUMBER 7. Relationship of Non-Parent to Indian Child: 8. Address of Non-Parent: City: Telephone Number: State: Zip Code: By signing below, I am certifying I know and fully understand the terms and consequences of this consent. I understand I am not waiving my rights under the Indian Child Welfare Act (25 U.S.C. § 1901 et seq.). I understand I may withdraw and revoke my consent at any time and for any reason, and upon such withdrawal of consent, all provisions of the Indian Child Welfare Act shall apply. Pursuant to 25 U.S.C § 1913(b), I further understand that upon withdrawal of my consent, my child shall be returned to me as soon as is practicable. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: Type or Print Name Signature of Indian Parent/Custodian JUDGE'S CERTIFICATION Pursuant to 25 U.S.C § 1913(a), I, Judge/Commissioner Superior Court of California, County of San Diego, hereby certify: This consent was completed in writing and recorded before me. I fully explained the terms and consequences of this consent to (name of parent/custodian): , of the The parent/custodian fully understood the terms and consequences of this consent. The parent/custodian understands English or the hearing was interpreted into a language the parent/custodian understood. Date: Judge/Commissioner of the Superior Court SDSC D-243 (New 4/09) CONSENT TO CUSTODY OF AN INDIAN CHILD TO NON-PARENT AND COURT CERTIFICATION Fam. Code § 3041 25 U.S.C §1913 Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com
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