Superior Court of Washington, County of In re custody of: Children: No. Proof of Mailing (Indian Child Welfare Act Notice) (AFML) Petitioner/s (person/s who started this case): Respondents (parents and any guardian or custodian): Proof of Mailing (Indian Child Welfare Act Notice) Server declares: 1. 2. I am age 18 or older and not a party to this case. On (date): , I personally mailed copies of the: Non-Parent Custody Petition Indian Child Welfare Act Notice (Non-Parent Custody) Other documents: to the following people by certified mail with return receipt requested: Tribe/s (mail to the agent listed in the Federal Register) (Tribal agent): (Tribe): street number or P.O. box city state zip (Tribal agent): (Tribe): street number or P.O. box RCW 26.10.034, 13.38.070 Mandatory Form (05/2016) FL Non-Parent 404 city state zip Proof of Mailing (Indian Child Welfare Act Notice) p. 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com (Tribal agent): (Tribe): street number or P.O. box city state zip Parents (Name): street number or P.O. box city state zip (Name): street number or P.O. box city state zip BIA Regional Director, Bureau of Indian Affairs 911 NE 11th Avenue Portland, OR 97232 Indian custodian/s (if any) (Name): street number or P.O. box city state zip 3. Other information (if any): I declare under penalty of perjury under the laws of the state of Washington that the statements on this form are true. Signed at city Signature of server (not a party to this case) state Print or type name of server Date: Tape return receipt/s below: RCW 26.10.034, 13.38.070 Mandatory Form (05/2016) FL Non-Parent 404 Proof of Mailing (Indian Child Welfare Act Notice) p. 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com