GF-210, 02/10 Request for Hearing on Case Transfer to Tribal Court 247801.54, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY CIRCUIT COURT BRANCH IN RE : Amended Request for Hearing on Case Transfer to Tribe Petitioner - VS - Respondent Case No. TO THE CIRCUIT COURT JUDGE OF COUNTY: I request a hearing to contest the transfer of my case regarding the issues of legal custody, physical placement and child support to the [Name of Tribe] Tribe of Indians. Signature Name Printed or Typed Date ------------------------------------------------------- FOR AGENCY USE ONLY -------------------------------------------------------- The above requested hearing is scheduled for: Date: Time: Room: Presiding Official: Address: American LegalNet, Inc. www.FormsWorkFlow.com