IW-1720, 05/19 Summons Indian Child Welfare Act 24724748.028, 48.23, 48.27, 48.977, 938.028, 938.23, and 938.27, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 1 of 2 STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Date of Birth Summons Indian Child Welfare Act Case No. TO : A P etition alleging the child/juvenile is in need of protection and services under Chapter 48 protection and services under Chapter 938 a guardian under Chapter 48 was filed and is attached to this Summons. IT IS ORDERED THAT you appear for a hearing on : NOTICE OF HEARING Date Time Nature of Hearing Location (Include Room No.) and Telephone Number Circuit Court Judge/Circuit Court Commissioner If the child/juvenile wants to be represented by an attorney, or the child/juvenile is required to be represented by one, the State Public Defender will appoint an attorney. Based on ability to pay, the parents may be ordered to reimburse the state or county for the cost of an attorney . If a parent or Indian custodian wants to be represented by an attorney and cannot afford one, the State Public Defender may appoint an attorney. A parent, Indian custodian, or tribe has the right to : Intervene at any point in the proceeding. Request up to 20 additional days to prepare for this proceeding. Petition the court for transfer to tribal court. Potential consequences of this proceeding may include: Removal from the home of the parent(s), guardian, or Indian custodian. Placement outside the home, including relative home, foster home, group home, or residential care center. A finding that the child/juvenile is in need of protection or services, or a guardian under Chapter 48. A dispositional order entered containing specific conditions of supervision and/or return. Transfer of legal custody. American LegalNet, Inc. www.FormsWorkFlow.com IW-1720, 05/19 Summons Indian Child Welfare Act 24724748.028, 48.23, 48.27, 48.977, 938.028, 938.23, and 938.27, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 Potential grounds for future termination of parental rights. Parties shall keep all information contained in this notice confidential. IF YOU FAIL TO APPEAR AS SUMMONED , y ou may be held in contempt of court, or a capias (warrant) may be issued for your arrest. If you require reasonable accommodations due to a disability to participate in the court process, please call prior to the scheduled court date. Please note that the court does not provide transportation. (if not signed by a Circuit Court Judge/Circuit Court Commissioner) Name Printed or Typed Date American LegalNet, Inc. www.FormsWorkFlow.com