CONFIDENTIAL COURT RECORD IW-1647, 11/17 Order on Petition for Minor Child Adoption - Indian Child Welfare Act 24724748.028, 48.91 and 48.94, Wisconsin Statutes; 25 U.S.C. 2471915. 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 Order on Petition for Minor Child Adoption Indian Child Welfare Act Case No. THE COURT FINDS: 1. The petitioner(s), [Name] , is a relative(s). a stepparent(s). the proposed adoptive parent(s) with whom the minor child was placed. 2. The minor child has lived with the petitioner(s) since [Date] . 3. The guardian does does not consent to this adoption. 4. The recommendation and written report of [Agency] was filed. 5. The minor child is suitable for adoption. The petitioner(s) is/are a fit and proper person of reputable standing in the community with the ability to maintain and support this minor child. The adoption is in the best interests of the minor child. 6. All legal requirements concerning this adoption readoption were met. 7. The adoptive parent(s) has requested that the birth certificate not be changed. 8. The child is subject to the federal Indian Child Welfare Act, AND placement has been made in accordance with the order of preference set forth in the Indian Child Welfare Act. OR there is good cause to depart from the order of placement preference in the Indian Child Welfare Act: THE COURT ORDERS: The Petition for adoption is 1. granted. A. The birth certificate for this minor child shall shall not be changed. B. The name of this minor child shall be changed to . American LegalNet, Inc. www.FormsWorkFlow.com CONFIDENTIAL COURT RECORD IW-1647, 11/17 Order on Petition for Minor Child Adoption - Indian Child Welfare Act 24724748.028, 48.91 and 48.94, Wisconsin Statutes; 25 U.S.C. 2471915. This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 C. A copy of this Order and the Indian Child Adoptee Information (IW-1649) form shall be provided within 30 days to the Bureau of Indian Affairs in an en 2. denied for the following reason(s): THIS IS A FINAL ORDER FOR THE PURPOSE OF APPEAL. DISTRIBUTION: 1. Court 2. Adoptive Parent(s) 3. Tribe 4. Bureau of Indian Affairs American LegalNet, Inc. www.FormsWorkFlow.com