IW-1630, 05/19 Petition for Termination of Parental Rights - Indian Child Welfare Act 24724748.41, 48.415, and 48.42, 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 a person under the age of 18 Date of Birth Amended Petition for Termination of Parental Rights Indian Child Welfare Act Case No. I state on information and bel ief that the following is true : [if unknown or cannot be ascertained, so state] 1. Name and Address Name and Address Address Name(s) of F oster Pa rent or Other Physical Custodian Place of Birth Tribal Affiliation Sex Female Male Child has previously been adopted? Yes No County where child is present at time of filing petition Name and Address Affiliation Name and Address Affiliation Other known information in regard to tribal affiliation or enrollment, including all potential tribes that the child may be a member and aliases or enrollment numbers of parents, grandparents, or oth er direct lineal ancestors: Legal 2. The petitioner is interested as . 3. The child is subject to the federal Indian Child Welfare Act (25 USC 2472471901 - 1963). Tribe/address: 4. The child is a marital non - marital child. 5. The above - named father is adjudicated presumed alleged biological (nonadjudicated) unknown. 6 . The petitioner seeks termin ation of parental rights of the mother, who will may will not consent to the termination of her parental rights under 24748.41, Wis. Stats. If involuntary, grounds for termination of parental rights exist under 24748.415 ( ), Wis. Stats. A statement of the facts and circumstances which support these grounds is as follows: See attached father, who will may will not consent to the termination of his parental rights under 24748.41, Wis. Stats. If involuntary, grounds for termination of parental rights exist under 24748.415 ( ), Wis. Stats. American LegalNet, Inc. www.FormsWorkFlow.com IW-1630, 05/19 Petition for Termination of Parental Rights - Indian Child Welfare Act 24724748.41, 48.415, and 48.42, Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 A statement of the facts and circumstances which support these grounds is as follows: See attached 7. Names and addresses of additional possible fathers, if known, are attached. The statutory grounds for termination of the parental rights of each possible father (known or unknown) and the facts and circumstances which support these grounds are attached. 8 . The Uniform Child Custody Jurisdiction Act Affidavit is attached to this P etition. 9 . If involuntary for one or both parents, continued custody of the child by the parent(s) or Indian custodian is is not likely to result in serious emotional or physical damage to the child. 10 . If involuntary for one or both parents, active efforts were were not made to provide remedial services and rehabilitation programs designed to prevent the brea kup of the Indian family. See attached Statement of Active Efforts (IW - 1609) 11 . The best interests of the Indian child will be served by termination of the parental rights of the parent(s). 1 2 . The best interests of the minor birth parent(s) will be served by the termination of his her their parental rights. Petitioner Name Printed or Typed Date Peti tioner Name Printed or Typed Date Name of Attorney Address Telephone Number Bar Number American LegalNet, Inc. www.FormsWorkFlow.com