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Indian Child Welfare Act Notice Form. This is a Washington form and can be use in Domestic Relations Statewide.
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Tags: Indian Child Welfare Act Notice, CU 01.0250, Washington Statewide, Domestic Relations
Superior Court of Washington
County of
In re the Custody of:
No.
Petitioner(s),
Indian Child Welfare Act Notice
25 U.S.C. § 1912(a)
(Nonparental Custody ONLY)
(BIAN)
Respondent(s).
Clerk’s action required:
Access is Restricted Per GR
22(c)(3) and 25 C.F.R. § 23.11(e)(7)
Child(ren),
and
To:
(Parents, Indian Custodians, and Child’s Tribe(s))
This notice is given pursuant to the Indian Child Welfare Act, 25 U.S.C. § 1912. A child custody
proceeding involving the child named above is pending in the court named above. A copy of the petition
is attached. It is believed that the child named above is or may be a member or eligible for membership in
Tribe(s).
the
1.
Information on the Child
Name:
Present residence:
Date and Place of Birth:
Where child was taken into custody:
Tribal affiliation(s), enrollment number(s) or other identifying information:
Indian Child Welfare Act Notice (BIAN) – Page 1 of 4
WPF CU 01.0250 (6/2006) – RCW 26.10.034(1)(b), GR 22(c)(3), 25 C.F.R. § 23.11(e)(7)
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2.
Information on the Parents
Mother:
a. Name (and maiden name):
b. Address:
c. Date and Place of Birth:
d. Tribal affiliation(s), enrollment number(s), or other identifying information:
Father:
a.
b.
Address:
c.
Date and Place of Birth
d.
3.
Name:
Tribal affiliation(s), enrollment number(s), or other identifying information:
All Known Maternal Grandparents, Paternal Grandparents, Great
Grandparents
List names and maiden names; current and former addresses; dates and places of birth and death;
tribal affiliations; enrollment numbers; other identifying information about:
Maternal Grandparents:
.
Paternal Grandparents:
.
Indian Child Welfare Act Notice (BIAN) – Page 2 of 4
WPF CU 01.0250 (6/2006) – RCW 26.10.034(1)(b), GR 22(c)(3), 25 C.F.R. § 23.11(e)(7)
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Great Grandparents:
.
4.
Petitioner in This Proceeding
a.
b.
Address:
c.
5.
Name:
Phone Number:
Attorney for the Petitioner
a.
Name:
b.
Address:
c.
Phone Number:
The petition has been filed in the Superior Court for ______________________ County, State of
Washington.
A hearing is scheduled on _____________________________ [Date], at ____________a.m./p.m.
The address of the court is
.
The phone number of the court is
.
The hearing will take place in courtroom
.
No proceeding involving the child named above shall take place until at least ten (10) days after receipt of
this notice.
The child’s Tribe(s), the biological parents, and any Indian custodians of the child named above each
have the right to intervene and be made a party in this proceeding under the Indian Child Welfare Act.
If the parents or Indian custodians are unable to afford counsel, counsel will be appointed to represent
them. The parents or Indian custodians have the right to be represented by an attorney at every stage of
this proceeding. The court may, in its discretion, appoint an attorney to represent the child named above.
The child’s Tribe(s), the parents, or the Indian custodians of the child named above have the right, upon
request, to examine all documents or other material which may be used to make a decision in this matter.
Such request shall be made in writing to the court clerk, or the Court at the hearing.
The child’s Tribe(s), the parents, or the Indian custodians have the right to petition the court to transfer
this proceeding to the courts of the child’s Tribe(s). Such petition shall be in writing and presented to the
Indian Child Welfare Act Notice (BIAN) – Page 3 of 4
WPF CU 01.0250 (6/2006) – RCW 26.10.034(1)(b), GR 22(c)(3), 25 C.F.R. § 23.11(e)(7)
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court clerk or orally to the court at the scheduled hearing. The petition shall be granted in the absence of
good cause to the contrary or the objection of either parent.
A decision in this matter may affect the future custodial rights of the child’s Tribe(s), the parents, and the
Indian custodians of the child named above, and may result in the temporary or permanent removal of the
child from his or her home.
The information contained in this notice and the attached petition is confidential and
should not be disclosed or revealed to any person or agency which is not necessary for
proper notification of the parents, Indian custodians or the Tribe(s) of the above-named
minor child, and which is not necessary for the exercise of their rights under the Indian
Child Welfare Act. (25 C.F.R. §23.11(e)(7).)
This notice and the attached pleadings have been sent by certified mail, return receipt requested, to the
parents, Indian custodians and the child’s tribe(s) (tribe’s designated agent) on the date as stated in the
Proof of Mailing.
On the date as stated in the Proof of Mailing, copy of this notice and the attached pleadings have also
been sent by certified mail, return receipt requested to:
Portland Area Director
Bureau of Indian Affairs
911 NE 11th Avenue
Portland, OR 97232
___________________________________________
Signature of Petitioner or Lawyer/WSBA No.
Date
Indian Child Welfare Act Notice (BIAN) – Page 4 of 4
WPF CU 01.0250 (6/2006) – RCW 26.10.034(1)(b), GR 22(c)(3), 25 C.F.R. § 23.11(e)(7)
American LegalNet, Inc.
www.FormsWorkflow.com
