Proof Of Mailing {JU 05.0255}

Proof of Mailing (AFML) 226 Page 1 of 1 WPF JU 05.0255 (07/2017) 226 RCW 13.32A.152(3), GR 22(c)(3), 25 C.F.R. 247 23.111(d)(6)(ix) Superior Court of Washington County of Juvenile Court In the Interest of: D.O.B.: NO: Proof of Mailing ICWA Notice (AFML) Clerk222s action required: ACCESS IS RESTRICTED PER GR 22(c)(3) and 25 C.F.R. 247 23.11 1(d)(6)(iv) I certify under the penalty of perjury under the laws of the state of Washington that I am 18 years of age or older and I am not the petitioner, and that on (date), I deposited one copy of the following document/s: Other: Indian Child Welfare Act Notice in the U.S. mail, postage prepaid, certified (return receipt requested), addressed to the following persons at their last known mailing addresses: Name , mailing address: . Name , mailing address: . Name , mailing address: . Signed at , (City) (State), on (Date). . Signature Address . Print Name American LegalNet, Inc. www.FormsWorkFlow.com