IW-1724, 02/17 Notice of Hearing (Juvenile) Indian Child Welfare Act 24724748.21, 48.27, 48.273, 938.21, 938.27, 938.273 and Chapters 48 and 938, Wisconsin Statutes; 25 U.S.C. 1912 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 Notice of Hearing (Juvenile) Indian Child Welfare Act Case No. This case is scheduled for a hearing as indicated below: NOTICE OF HEARING Date Time Location (Include Room No.) and Telephone N umber Circuit Court Judge/Circuit Court Commissioner PARTY INFORMATION Name and Address Na me and Address Name and Address Birth D ate irth ffiliation Name and Address ate irth ffiliation Name and Address Legal Status: See attached for additional parties Alleged Adjudicated Presumed Biological Unknown irth D ate lace of B irth ribal A ffiliation Other known information in regard to tribal affiliation or enrollment, including all potential tribes that the child/juvenile may be a member and aliases or enrollment numbers of parents, grandparents, or other direct lineal ancestors: Temporary Physical Custody Plea Hearing on Petition Motion(s) Pre - trial Fact Finding Court Jury person(s) Disposition Extension Change of Placement Revision Permanency Hearing Other: If this is the first notice in a child in need of protection or services, juvenile in need of protection or services, or involuntary termination of parental rights proceeding involving a child/juvenile subject to the Indian Child Welfare Act: Notice must be provided to the parent, Indian custodian and the tribe by registered mail with return receipt requested. In addition, notice must be sent as required by 247938.27 and 24748.27, Wis. Stats. If the identity or location of the parent or tribe cannot be determined, notice must be sent by registered mail with return receipt requested to the Secretary of the Interior, Bureau of In dian Affairs. The parent, Indian custodian, or tribe has the right to request up to 20 additional days to prepare for the hearing. Notice to the parent, Indian custodian, and tribe of subsequent hearings must be in writing by mail, personal delivery, or fa x, but not by email. A parent, Indian custodian, or tribe has the right to intervene at any point in the proceeding and to request transfer to tribal court. 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. If a child/juvenile wants to be represented by an attorney, or the child/juvenile is required to be represented by an attorney, the State Public Defender may appoint an attorney. 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. American LegalNet, Inc. www.FormsWorkFlow.com IW-1724, 02/17 Notice of Hearing (Juvenile) Indian Child Welfare Act 24724748.21, 48.27, 48.273, 938.21, 938.27, 938.273 and Chapters 48 and 938, Wisconsin Statutes; 25 U.S.C. 1912 This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 Based on ability to pay, the p arents may be ordered to reimburse the state or county for the cost of an attorney. Potential consequences of this proceeding may include: Removal of child/juvenile from the home of the parent(s), guardian, or Indian custodian. Placement outside the home , including a relative home, foster home, group home, or residential care center. A finding that the child/juvenile is in need of protection or services. A dispositional order entered containing specific conditions of supervision and/or return. Transfer o f legal custody. Potential grounds for future termination of parental rights. Parties shall keep all information contained in this notice confidential. See attached County Circuit Court Date DISTRIBUTION Personal Service Mail Notice TELEPHONE NOTICE 1. Court Registered Mail Return Receipt NAME DATE TIME BY 2. Child/Juvenile 3. Mother 4. Father 5. Indian Custodian 6. Prosecutor 7. Child's/Juvenile's Attorney/GAL 8. Dept. Soc. Services 9. Foster Parents 10. Tribe 11. Other: American LegalNet, Inc. www.FormsWorkFlow.com