IN THE DISTRICT SUPERIOR COURT FOR THE STATE OF ALASKA AT In the matter of: , ) ) ) ) ) ) ) ) A minor under 18 years of age. Date of birth: 1. CASE NO. REQUEST TO REGISTER TRIBAL COURT ICWA CUSTODY ORDER I want the state court to register a tribal court ICWA custody order concerning: foster care placement (and guardianships)1 termination of parental rights adoptive placement but not an adoption decree pre-adoptive placement The above order was issued by the tribal court of the Indian child's tribe in an ICWA child custody proceeding.2 The date of the tribal court order is: The tribal court order case number is: Attached are two copies of the tribal court order. Contact information about interested persons: [If you need more space to list all the interested persons, please use a separate piece of paper.] A. Tribal court that issued the order: Contact person (if known): Phone: Mailing Address: Child's Indian tribe: Contact person (if known): Phone: Mailing Address: Person requesting registration: Phone: Mailing Address: 2. 3. 4. Email: B. Email: C. Email: D. Parent(s) or person(s) acting as parent who was awarded custody or visitation in the tribal court order: Phone: Email: Mailing Address: 1 This includes temporary placement in a foster home, guardian's home, conservator's home, or institution, where parental rights have not been terminated. 2 "Indian child's tribe" means (a) the tribe in which the Indian child is a member or eligible to be a member, or (b) if eligible to be a member in more than one tribe, the tribe with which the child has more significant contacts. Page 1 of 2 CN-600 (3/15)(cs) 25 USC §§ 1901-1963; REQUEST TO REGISTER TRIBAL COURT ICWA CUSTODY ORDER CINA Rules 24-25; AS 09.63.020 American LegalNet, Inc. www.FormsWorkFlow.com E. If someone other than a parent or person awarded custody or visitation actually has the child, or claims a right to have or visit the child, list them here: Phone: Mailing Address: Email: F. If the tribal court removed the child from someone other than the mother or father, list them here: Phone: Email: Mailing Address: Mother's name, if her rights were not terminated before the tribal court order was issued: Phone: Email: Mailing Address: Father's name, if his rights were not terminated before the tribal court order was issued: Phone: Email: Mailing Address: G. H. 5. I certify under penalty of perjury that the tribal court order I want registered has not been vacated, stayed, or modified.3 I also certify under penalty of perjury that the tribal court order or any other order about the same child has not been has been registered here or somewhere else. (If this or another order has already been registered, write the name of the state and state court case numbers here: ) SIGNATURE AND NOTARY I certify under penalty of perjury that the information in this document is true. Signature (sign in front of the notary or court clerk) Subscribed and sworn to or affirmed before me at (SEAL) , Alaska on Clerk of Court, Notary Public or other person authorized to administer oaths. My commission expires CERTIFICATION (IF NO NOTARY AVAILABLE) I certify under penalty of perjury that the information in this document is true, and a notary or other official empowered to administer oaths is not available to administer an oath. Date Place (city or village) 3 Signature Print Name "Vacated" means cancelled. "Stayed" means postponed. "Modified" means changed. Page 2 of 2 CN-600 (3/15)(cs) 25 USC §§ 1901-1963; REQUEST TO REGISTER TRIBAL COURT ICWA CUSTODY ORDER CINA Rules 24-25; AS 09.63.020 American LegalNet, Inc. www.FormsWorkFlow.com