COURT COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : ADOPT-225 1 1 Parent of Indian Child Agrees to End Parental Rights Clerk stamps Index No. below when form is filed. : : : : Calendar No. I want my child to be adopted by (name(s)): Plaintiff(s) a. -againstb. Their relationship to Indian child: (Check all that apply) Related to child (specify): JUDICIAL SUBPOENA 2 2 : Members of child's tribe Indian parents None of the above Defendant(s) : ...................................................... do not meet the placement meet The parent(s) in 1 preference requirements of the Indian Child Welfare Act. THE PEOPLE OF THE STATE OF NEW YORK Indian child (name): Date Age: TO of birth: Child's tribe(s): Enrollment #: Check here GREETINGS: if you do not know the enrollment #. Court name and street address: Superior Court of California, County of 3 Case Number: 4 4 WE Your name: COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable Father (Check only one. Each parentat the a separate form.) Court Mother fills out located at County of Your address (skip this if you have a lawyer): in room , on the day of , 20 , at o'clock in the noon, and at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the City: State: Zip: Phone #: Your tribe(s): Enrollment #: CheckYour if you doto comply with this subpoena is punishable as a contempt of court and will make you liable to here failure not know the enrollment #. the party on whose have one): (Name, address, phone #, for a maximum penalty of $50 and all damages sustained as a Your lawyer (if you behalf this subpoena was issued and State Bar #): result of your failure to comply. 5 5 Witness, Honorable , one of the Justices of the Court in County, day of , 20 I am the parent in 4 and I understand and say: a. I agree to give up my parental rights. 1. b. I agree to the adoption of my child by the parent(s) listed in (Attorney must sign above and type name below) c. I understand what will happen when I sign this form. d. No one has threatened me or made promises to me to get me to sign this form. e. I understand that until the judge signs an Adoption Order (ADOPT-215) for an order to end my parental Attorney(s) or rights, I can change my mind and my child will be returned to me. f. I want the court to let me know if the adoption is canceled so I can ask the court to give custody of my child back to me. The court will give the custody of my child back to me if the judge decides it is in my child's best interest. Office and P.O. Address g. I do not give up any of my rights under the Indian Child Welfare Act by signing this form. h. My child was at least 10 days old when I signed this form. i. I understand that notice of the adoption request will be sent to any Indian tribe of which my child may be a Telephone No.: member or eligible for membership. Facsimile No.: Judicial Council of California, www.courtinfo.ca.gov Rev. January 1, 2005, Mandatory Form 25 U.S.C. § 1913 Parent of Indian Child E-Mail Address: Agrees Mobile to End Parental Rights Tel. No.: ADOPT-225, Page 1 of 2 American LegalNet, Inc. www.USCourtForms.com Case Number: Your name: 6 6 At the time of signing this form, I do not live and am not domiciled on an Indian reservation. Date: Type or print your name Signature of Indian parent Judge's Certification I, Judge Superior Court of California, County of , , certify: This form was completed in writing and recorded before me. I fully explained the terms and consequences to (name of parent): The parent fully understood the terms and consequences. The parent speaks English or used an interpreter at the hearing. Certified: Date: Judge (or Judicial Officer) Rev. January 1, 2005 Parent of Indian Child Agrees to End Parental Rights ADOPT-225, Page 2 of 2