RCW 26.10.034(1)(b), 13.38.070, 25 CFR 247 23.11 (e)(7), 25 USC 247 1912(a) Mandatory Form (07/2017) FL Non - Parent 402 ICWA Notice (Non - Parent Custody) p. 1 of 4 Superior Court of Washington, County of In re custody of: Children : Petitioner/s (person/s who started this case) : Respondents ( parents and any guardian or custodian) : No. Indian Child Welfare Act Notice (Non - Parent Custody) (BIAN) Cler k: Do not file in a public access file (GR 22(c)(3), 25 CFR 23.11(e)(7)) Indian Child Welfare Act Notice (Non-Parent Custody) To: Parent/s (name/s): Indian Custodian/s, if any (name/s): Designated ICWA Tribal Agent/s (name/s and tribe/s): I have filed a Non-Parent Custody Petition to ask a Washington State Court for custody of children who are members of (or may be eligible for membership in) the Indian tribe/s listed Indian custodians, and tribe/s. The children may be taken from their home temporarily or permanently. The court is located at: City State Zip American LegalNet, Inc. www.FormsWorkFlow.com RCW 26.10.034(1)(b), 13.38.070, 25 CFR 247 23.11 (e)(7), 25 USC 247 1912(a) Mandatory Form (07/2017) FL Non - Parent 402 ICWA Notice (Non - Parent Custody) p. 2 of 4 Court Hearing A court hearing or hearings have been scheduled. See attached hearing notice or case scheduling order. No court hearing has been scheduled in this case yet. Rights If you are the parent, Indian custodian, or agent of t To receive this notice at least 10 days before the first hearing in this case. To have up to 20 extra days to prepare for a hearing, if you ask the court. To see all documents and evidence filed with the court for this case. To be part of this case at any point (intervene as a party). To have the Court appoint a lawyer for you, if you are a parent or Indian custodian and the Court finds you are indigent (cannot afford your own lawyer). To ask this court to tapprove the transfer to tribal court unless one of the parents objects or there is a good reason to keep the case in state court. Information The information below is to help determexcept as needed for the tribe to exercise its rights under the Indian Child Welfare Act. Petitioner/s must make a good faith effort to provide this information. 1. Information about the person/s asking for custody of the children Name: Tel. #: Name: Tel. #: Address: (if any): Tel. #: 2. Date of birth: Place of birth: Tribe/s child belongs to (or may belong to): Tribal enrollment # or other tribal ID: There are (#) other children involved in this case. (For each additional child complete form FL Non- 3. Other names used, if any: Date of birth: Place of birth: Current address: American LegalNet, Inc. www.FormsWorkFlow.com RCW 26.10.034(1)(b), 13.38.070, 25 CFR 247 23.11 (e)(7), 25 USC 247 1912(a) Mandatory Form (07/2017) FL Non - Parent 402 ICWA Notice (Non - Parent Custody) p. 3 of 4 Former addresses: Tribe(s) Mother belongs to: Tribal enrollment # or other tribal ID: 4. rrent name: Other names used, if any: Date of birth: Place of birth: Address: Former addresses: Tribe/s Father belongs to: Tribal enrollment # or other tribal ID: 5. Information and great grandparents s parents Current name & other names used Current address Former addresses Date and place of birth Date and place of death, if no longer living Tribe Tribal Enrollment # or other tribal ID Current name & other name s used Current address Former addresses Date and place of birth Date and place of death, if no longer living Tribe Tribal Enrollment # or other tribal ID American LegalNet, Inc. www.FormsWorkFlow.com RCW 26.10.034(1)(b), 13.38.070, 25 CFR 247 23.11 (e)(7), 25 USC 247 1912(a) Mandatory Form (07/2017) FL Non - Parent 402 ICWA Notice (Non - Parent Custody) p. 4 of 4 (add pages, as needed) Current name & other names used Current address Former addresses Date and place of birth Date and place of death, if no longer living Tribe Tribal Enrollment # or other tribal ID (add pages, as needed) Current name & other names used Curre nt address Former addresses Date and place of birth Date and place of death, if no longer living Tribe Tribal Enrollment # or other tribal ID Petitioner or lawyer signs here Date Print name (if lawyer, also list WSBA No.) To Petitioner: You must have this Notice and a copy of the Petition served by certified mail, return receipt requested to the: signated to receive ICWA Notices are listed in the Federal Register: www.FederalRegister.gov Indian custodians (if any), and Bureau of Indian Affairs. Fill out an d file a Proof of Mailing form (FL Non - Parent 404) . (In addition to this mailing, you must have the Summons and Petition personally served on the parents and any Indian custodian.) American LegalNet, Inc. www.FormsWorkFlow.com