Fill and Sign the 25 Cfr Ch I 4 1 18 Edition Bureau of Indian Affairs Form

a. b. R ela te d t o c h ild ( s p ecify ):M em bers o f c h ild 's t r ib e In dia n p are n tsm eetd o n ot m eet t h e p la cem en t In dia n c h ild ( n am e): D ate o f b ir th E nro llm en t C heck h ere i f y o u d o n ot k n ow t h e e n ro llm en t # . Y our n am e M oth erF ath er ( C heck o nly o ne. E ach p are n t f ills o ut a s e p ara te f o rm .) C ity : P hone # : E nro llm en t # : C heck h ere i f y o u d o n ot k n ow t h e e n ro llm en t # .  A DO PT-2 25Pare n t o f In dia n C hild A gre es to E nd P are n ta l R ig htsClerk stamps below when form is filed.I want my child to be adopted by (name(s))Their relationship to Indian child: (Check all that apply) None of the aboveCourt name and street addressThe parent(s) in  .Superior Court of California, County ofpreference requirements of the Indian Child Welfare Act.Age:Child's tribe(s):Case Number:Your address (skip this if you have a lawyer):State:Zip:Your tribe(s):Your lawyer (if you have one): (Name, address, phone #, and State Bar #):I am the parent in  and I understand and say:a. I agree to give up my parental rights.b. I agree to the adoption of my child by the parent(s) listed in .c. I understand what will happen when I sign this form.d. No one has threatened me or made promises to me to get me to sign this form.e. I understand that until the judge signs an Adoption Order (ADOPT-215) or an order to end my parental rights, I can change my mind and my child will be returned to me.f. I want the court to let me know if the adoption is canceled so I can ask the court to give custody of my childback to me The court will give the custody of my child back to me if the judge decides it is in my child's bestinterest.g. I do not give up any of my rights under the Indian Child Welfare Act by signing this form.h. My child was at least 10 days old when I signed this form.i. I understand that notice of the adoption request will be sent to any Indian tribe of which my child may be a member or eligible for membershipJudicial Council of California, Rev. January 1, 2005, Mandatory Form 25 U.S.C. § 1913Parent of Indian Child Agrees to End Parental RightsADOPT-225, Page 1 of 2  ele ctr o nic f o rm  2 005 WWW.LawCA.com La w P ublis h ers Your n am e D ate : I, J u dge S uperio r C ourt o f C alif o rn ia , C ounty o f • I f u lly e x pla in ed t h e t e rm s a n d c o nse q uen ces t o ( n am e o f p are n t) : D ate Case Number:At the time of signing this form, I do not live and am not domiciled on an Indian reservation.Type or print your nameSignature of Indian parentJudge's Cettification,, certify:• This form was completed in writing and recorded before me.• The parent fully understood the terms and consequences • The parent speaks English or used an interpreter at the hearing.Certified:Judge (or Judicial Officer) Parent of Indian Child Agrees to End Parental Rights ADOPT-225, Page 2 of 2  ele ctr o nic f o rm  2 005 WWW.LawCA.com La w P ublis h ers