F.C.A. §115; S.S.L. §39(6) General Form 20 (Order Determining Petition for Transfer of Proceeding Concerning of Indian Child) 8/2010 At a term of the Family Court of the State of New York held in and for the County of , at New York on , . PRESENT: Hon. Judge _____________________________________ In the Matter of a Proceeding under Article of the Child's Name: Date of Birth: __________________________________ Docket No. ORDER DETERMINING PETITION FOR TRANSFER OF PROCEEDING CONCERNING AN INDIAN CHILD A petition having been filed in this Court, pursuant to Section [specify]: of the 9 Family Court Act 9 Social Services Law, involving the 9 foster care placement of 9 termination of parental rights to the above-named child [specify]: requesting the transfer of the proceeding concerning the child to the jurisdiction of the Indian tribe; And this Court having determined that the child [check applicable box(es)]: 9 is 9 is not a member of the Indian tribe [specify]: ; and that the child 9 is 9 is not domiciled or residing within the reservation of the tribe, And this Court having determined that good cause to the contrary 9 has 9 has not been shown, and that an objection 9 has 9 has not been filed by either parent; And the matter having duly come on to be heard before this Court, NOW, after examination and inquiry into the facts and circumstances of the case, it is hereby [Check applicable box]: 9 ORDERED that the petition for transfer of the proceeding to the jurisdiction of the Indian tribe is hereby GRANTED and the proceeding is so transferred, subject to declination by the tribal court; OR 9 ORDERED that the petition for transfer of the proceeding to the jurisdiction of the Indian tribe is hereby DENIED and the petition for transfer is dismissed; American LegalNet, Inc. www.FormsWorkFlow.com General Form 20 Page 2 And it is further ORDERED that [specify]: PURSUANT TO SECTION 1113 OF THE FAMILY COURT ACT, AN APPEAL FROM THIS ORDER MUST BE TAKEN WITHIN 30 DAYS OF RECEIPT OF THE ORDER BY APPELLANT IN COURT, 35 DAYS FROM THE DATE OF MAILING OF THE ORDER TO APPELLANT BY THE CLERK OF COURT, OR 30 DAYS AFTER SERVICE BY A PARTY OR THE ATTORNEY FOR THE CHILD UPON THE APPELLANT, WHICHEVER IS EARLIEST. ENTER _____________________________________ Judge of the Family. Court. Dated: ,. Check applicable box: 9 Order mailed on [specify date(s) and to whom mailed ]:___________________________ 9 Order received in court on [specify date(s) and to whom given]:_____________________ American LegalNet, Inc. www.FormsWorkFlow.com