CONFIDENTIAL ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): ICWA-030 FOR COURT USE ONLY TELEPHONE NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: TELEPHONE NO.: CASE NAME: CASE NUMBER: NOTICE OF CHILD CUSTODY PROCEEDING FOR INDIAN CHILD (check all that apply): Dependency Delinquency JUVENILE ADOPTION CUSTODY (Fam. Code, § 3041) CONSERVATORSHIP* DECLARATION OF FREEDOM FROM CONTROL OF PARENT GUARDIANSHIP TERMINATION OF PARENTAL RIGHTS VOLUNTARY RELINQUISHMENT OF CHILD BY PARENT NOTICE TO (check all that apply): Parents or Legal Guardians Secretary of the Interior Tribes Indian Custodians HEARING DATE: DEPT.: Sacramento Area Director, BIA 1. NOTICE is given that based on the petition, a copy of which is attached to this notice, a child custody proceeding under the Indian Child Welfare Act (25 U.S.C. § 1901 et seq.) has been initiated for the following child (a separate notice must be filed for each child): Name Date of Birth Place of Birth 2. HEARING INFORMATION a. Date: Time: Type of hearing: b. Address and telephone number of court same as noted above is (specify): Dept.: Room: 3. The child is or may be eligible for membership in the following Indian tribes (list each): *Use this form in a conservatorship only if the proposed conservatee is a formerly married minor. Form Adopted for Mandatory Use Judicial Council of California ICWA-030 [New January 1, 2008] Page 1 of 10 25 U.S.C. § 1901 et seq.; Welfare & Institutions Code, §§ 224.2, 224.3; Probate Code, §§ 1449, 1459.5; 1460.2; Cal. Rules of Court, rules 5.480­5.487 and 7.1015 www.courtinfo.ca.gov American LegalNet, Inc. www.FormsWorkflow.com NOTICE OF CHILD CUSTODY PROCEEDING FOR INDIAN CHILD (Indian Child Welfare Act) ICWA-030 CASE NAME: CASE NUMBER: 4. Under the Indian Child Welfare Act (ICWA) and California law: a. The child's parents, Indian custodian, and the child's tribe have the right to be present at all hearings. b. The child's Indian custodian and the child's tribe have the right to intervene in the proceedings when ICWA applies. c. The child's parent, Indian custodian, or tribe may petition the court to transfer the case to the tribal court of the Indian child's tribe. The child's parent or tribe also have the right to refuse to have the case transferred to the tribal court. d. With the limited exceptions of the detention hearing in juvenile cases and the jurisdiction and disposition hearings in delinquency cases as identified in rule 5.482, the court will give up to 20 days from the time of the scheduled hearing if the child's parent, Indian custodian, or tribe request such time to prepare for the hearing. e. The proceedings could lead to the removal of the child from the custody of the parent or Indian custodian and possible adoption of the child. f. If the child's parents or Indian custodian have a right to be represented by a lawyer and if they cannot afford to hire one, a lawyer will be appointed for them. g. The information contained in this notice and all attachments is confidential. Any tribal representative or agent or any other person or entity receiving this information must maintain the confidentiality of this information and not reveal it to anyone who does not need the information in order to exercise the tribe's rights under the Indian Child Welfare Act (25 U.S.C. § 1901 et seq.). h. An Indian custodian is any person who has legal custody of the child under tribal law or custom or state law, or to whom temporary physical custody, care, and control of the child has been transferred by a parent. 5. INFORMATION ON THE CHILD NAMED IN 1 a. The child's birth certificate is attached b. A copy of the tribal registration card of the child unavailable the parent is attached. c. Biological relative information is listed below. (Indicate if any of the information requested below is unknown or does not apply. Do not use the abbreviation "N/A".) (Required by Fam. Code, § 180; Prob. Code, § 1460.2; and Welf. & Inst. Code, § 224.2.) Biological Mother Name (include maiden, married, and former names or aliases): Biological Father Name (include former names or aliases): Current address: Current address: Former address: Former address: Birth date and place: Birth date and place: Tribe or band, and location: Tribe or band, and location: Tribal membership or enrollment number, if known: If deceased, date and place of death: Tribal membership or enrollment number, if known: If deceased, date and place of death: Additional information: Additional information: ICWA-030 [New January 1, 2008] NOTICE OF CHILD CUSTODY PROCEEDING FOR INDIAN CHILD (Indian Child Welfare Act) Page 2 of 10 ICWA-030 CASE NAME: CASE NUMBER: 5. c. INFORMATION ON THE CHILD NAMED IN 1 (Indicate if any of the information requested below is unknown or does not apply; do not use the abbreviation "N/A".) Mother's Biological Mother (Child's Maternal Grandmother) Name (include maiden, married, and former names or aliases): Father's Biological Mother (Child's Paternal Grandmother) Name (include maiden, married, and former names or aliases): Current address: Current address: Former address: Former address: Birth date and place: Birth date and place: Tribe or band, and location: Tribe or band, and location: Tribal membership or enrollment number, if known: Tribal membership or enrollment number, if known: If deceased, date and place of death: If deceased, date and place of death: Mother's Biological Father (Child's Maternal Grandfather) Name (include former names or aliases): Father's Biological Father (Child's Paternal Grandfather) Name (include former names or aliases): Current address: Current address: Former address: Former address: Birth date and place: Birth date and place: Tribe or band, and location: Tribe or band, and location: Tribal membership or enrollment number, if known: Tribal membership or enrollment number, if known: If deceased, date and place of death: If deceased, date and place of death: ICWA-030 [New January 1, 2008] NOTICE OF CHILD CUSTODY PROCEEDING FOR INDIAN CHILD (Indian Child Welfare Act) Page 3 of 10 ICWA-030 CASE NAME: CASE NUMBER: 5. d. INFORMATION ON THE CHILD NAMED IN 1 (Indicate if any of the information requested below is unknown or does not apply; do not use the abbreviation "N/A".) Mother's Biological Grandmother (Child's Maternal Great-grandmother) Name (include maiden