Original - Court 1st copy - Michigan Department of Human Services JIS CODE: NPI Additional copies as needed Approved, SCAO STATE OF MICHIGAN JUDICIAL CIRCUIT - FAMILY DIVISION COUNTY NOTICE OF PROCEEDINGS CONCERNING AN INDIAN CHILD CASE NO. PETITION NO. Court telephone no. Court address 1. In the matter of name(s), alias(es), DOB, tribal affiliation TO: (Name and telephone no. of natural father or Indian custodian. State if unknown.) (Name and telephone no. of natural mother or Indian custodian. State if unknown.) (Name and telephone no. of Tribal chairperson. State if unknown.) Bureau of Indian Affairs, Midwest Regional Office Norman Pointe II 5600 West American Blvd., Suite 500 Bloomington, MN 55437 (612) 725-4571 or 4572 (Use only if identity of parents, custodian, or tribe is unknown. If grandparent(s) are known, please attach a sheet with name(s) and date(s) of birth.) TAKE NOTICE: 2. A hearing will be held concerning the Indian child named above on at Date at Time . Location 3. This hearing will concern removal from the home or placement in foster care. termination of parental rights. 4. A copy of the petition is attached to this notice. 5. You have the absolute right to intervene in this proceeding and, absent objection by either Indian parent, you have the right to petition the court to have this case transferred to the Tribal court of the Tribe. The Tribal court may decline the transfer. 6. You may object to a transfer of this case to the Tribal court. 7. You may request an adjournment of this case for a period of up to 20 days. A request must be in writing and filed with the court before the date now scheduled for hearing. 8. As a parent or Indian custodian, you have the right to a court-appointed attorney if you are determined indigent. If you intend to request a court-appointed attorney, you should contact the court immediately by telephone or in writing. You are not required to attend this hearing unless this notice is accompanied by a summons or subpoena. If you choose to attend this hearing and you require special accommodations to use the court because of a disability or if you require a foreign language interpreter to help you fully participate in court proceedings, please contact the court immediately to make arrangements. USE NOTE: This notice must be sent to the parties by registered mail, return receipt requested. JC 48 (7/11) NOTICE OF PROCEEDINGS CONCERNING AN INDIAN CHILD 25 USC 1912, MCR 3.920(C)(1) American LegalNet, Inc. www.FormsWorkFlow.com