Fill and Sign the California Order Legal Form

––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– –– –– –– –– ––––– ––––– ––––– ––––– Based on a petition filed (date): ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– –– –– ––––– JV-135 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: FAX NO. (Optional): E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name) : SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: CASE NAME: NOTICE OF INVOLUNTARY CHILD CUSTODY PROCEEDINGS FOR AN INDIAN CHILD (Juvenile Court) CASE NUMBER NOTICE TO (check all that apply): Pare nt Trib e Indian Custodian Bureau of Indian Affairs (BIA) 1. a. Child's name: b. Date of birth: c. Place of birth (city, state, and, if applicable, reservation) : 2. Child is reported to be eligible for membership in the following tribe or band (name each): , the child has been temporarily placed in the custody of the county welfare department, probation department, or Indian custodian named below: 3. County welfare department (address) : 4. Probation department (address) : 5. Indian custodian (name each) : Tribe (name each) : 6. Name of social worker or probation officer: Telephone number: E-mail address: HEARING INFORMATION 7. Date of next hearing De pt: Tim e: Type of hearing: Located at above address Oth er Page 1 of 6 Form Adopted for Mandatory Use Judicial Council of California JV-135 [Rev. January 1, 2007] NOTICE OF INVOLUNTARY CHILD CUSTODY PROCEEDINGS FOR AN INDIAN CHILD (Juvenile Court) 25 U.S.C. § 1901 et. seq. Cal. Rules of Court, rule 5.664elec troni c form ã 2005 WWW.LawCA.co m L a w P u b l i s h e r s Birthdate and place: ––––– Birthdate and place: ––––– Tribe, band, and location: ––––– Tribe, band, and location: ––––– If available, provide enrollment number or BIA/tribal agency: ––––– If available, provide enrollment number or BIA/tribal agency: ––––– If deceased, date and place of death: ––––– If deceased, date and place of death: –––––––––– ––––– –– –– –– –– ––––– ––––– ––––– ––––– ––––– –––––CASE NAME: CASE NUMBER 8. UNDER THE INDIAN CHILD WELFARE ACT AND CALIFORNIA LAW: a. The biological or adoptive parents, any Indian custodian, and the child's tribe have the right to be present at all hearings. b. The biological or adoptive parents, any Indian custodian, and the child's tribe have the right to intervene in the proceedings. c. If the parents or custodians have a right to be represented by a lawyer and if they cannot afford to hire one, a lawyer will be appointed for them. d. If the child's tribe, any parent, or any Indian custodian requests it, the court will permit the hearing to be held up to 20 days after receipt of this notice. e. The date, time, and place of the hearing are on the first page of this form. If the tribe has a tribal court, the tribe, any parent, or any Indian custodian of the child may request a transfer of the case to the f. child's tribal court. They also have the right to refuse to have the case transferred to the tribal court. g. The proceedings could lead to the removal of the child from the custody of the parent or Indian custodian and possible adoption of the child. h. Juvenile court proceedings are confidential. Information concerning the juvenile court proceedings should be kept confidential. 9. a. INFORMATION ON CHILD WHO IS THE SUBJECT OF AN INVOLUNTARY CUSTODY PROCEEDING (indicate if any of the information requested below unknown or nonapplicable.) Attach any information that might be of assistance determining the child's Indian status, including names and addresses of extended family members who may have Indian heritage. Moth er Fath er Moth er Fath er Name (include maiden, married, and former or aliases) Name (include maiden, married, and former or aliases) Current and former addresses: Current and former addresses: Additional information: Additional information: JV-135 [Rev. January 1, 2007] NOTICE OF INVOLUNTARY CHILD CUSTODY PROCEEDINGS FOR AN INDIAN CHILD (Juvenile Court) Page 2 of 6el ectr onic form ã 2005 WWW.LawCA.co m L a w P u b l i s h e r s JV-135 Maternal Paternal Grandmother Grandfather Maternal Paternal Grandmother Grandfather ––––– Name (include maiden, married, and former or aliases): ––––– Current and former addresses: ––––– Current and former addresses: ––––– Birthdate and place: ––––– Birthdate and place: ––––– Tribe, band, and location: ––––– Tribe, band, and location: ––––– If available, provide enrollment number or BIA/tribal agency: ––––– If available, provide enrollment number or BIA/tribal agency: ––––– If deceased, date and place of death: ––––– If deceased, date and place of death: ––––– Maternal Paternal Grandmother Grandfather Maternal Paternal Grandmother Grandfather ––––– Name (include maiden, married, and former or aliases): ––––– Current and former addresses: ––––– Current and former addresses: ––––– Birthdate and place: ––––– Birthdate and place: ––––– Tribe, band, and location: ––––– Tribe, band, and location: ––––– If available, provide enrollment number or BIA/tribal agency: ––––– If available, provide enrollment number or BIA/tribal agency: ––––– If deceased, date and place of death: ––––– If deceased, date and place of death: –––––––––– ––––– –– –– –– –– –– –– –– –– ––––– ––––– –– –– –– –– –– –– –– –– ––––– –––––CASE NAME: CASE NUMBER 9. b. INFORMATION ON CHILD WHO IS THE SUBJECT OF AN INVOLUNTARY CHILD CUSTODY PROCEEDING (indicate if any of the information requested below unknown or nonapplicable) Name (include maiden, married, and former or aliases) Additional information: Additional information: Name (include maiden, married, and former or aliases) Additional information: Additional information: JV-135 [Rev. January 1, 2007] NOTICE OF INVOLUNTARY CHILD CUSTODY PROCEEDINGS FOR AN INDIAN CHILD (Juvenile Court) Page 3 of 6el ectr onic form ã 2005 WWW.LawCA.co m L a w P u b l i s h e r s JV-135 Maternal Paternal Great-grandmother Great-grandfather Maternal Paternal Great-grandmother Great-grandfather ––––– Name (include maiden, married, and former or aliases): ––––– Current and former addresses: ––––– Current and former addresses: ––––– Birthdate and place: ––––– Birthdate and place: ––––– Tribe, band, and location: ––––– Tribe, band, and location: ––––– If available, provide enrollment number or BIA/tribal agency: ––––– If available, provide enrollment number or BIA/tribal agency: ––––– If deceased, date and place of death: ––––– If deceased, date and place of death: ––––– Maternal Paternal Great-grandmother Maternal Paternal Great-grandmother Great-grandfather ––––– Name (include maiden, married, and former or aliases): ––––– Current and former addresses: ––––– Current and former addresses: ––––– Birthdate and place: ––––– Birthdate and place: ––––– Tribe, band, and location: ––––– Tribe, band, and location: ––––– If available, provide enrollment number or BIA/tribal agency: ––––– If available, provide enrollment number or BIA/tribal agency: ––––– If deceased, date and place of death: ––––– If deceased, date and place of death: –––––––––– ––––– –– –– –– –– –– –– –– –– ––––– ––––– –– –– –– –– –– –– –– –– ––––– –––––CASE NAME: CASE NUMBER 9. c. INFORMATION ON CHILD WHO IS THE SUBJECT OF AN INVOLUNTARY CHILD CUSTODY PROCEEDING (indicate if any of the information requested below unknown or nonapplicable) Name (include maiden, married, and former or aliases) Additional information: Additional information: Great- grandfather Name (include maiden, married, and former or aliases): Additional information: Additional information: JV-135 [Rev. January 1, 2007] NOTICE OF INVOLUNTARY CHILD CUSTODY PROCEEDINGS FOR AN INDIAN CHILD (Juvenile Court) Page 4 of 6el ectr onic form ã 2005 WWW.LawCA.co m L a w P u b l i s h e r s JV-135 Name/relationship Type of school Dates attended Location of school ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– Name/relationship Type of treatment Dates treatment received Location where treatment received ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– Name/relationship Name and address Dates ––––– ––––– ––––– ––––– ––––– –––––––––– ––––– –– –– –– –– –– –– –– ––––– –– –– –– –– –– –– –– –– –– –– ––––– –– ––––– –– –––––CASE NAME: CASE NUMBER INFORMATION ON CHILD WHO IS THE SUBJECT OF AN INVOLUNTARY CUSTODY PROCEEDING (indicate if any of the information requested below is unknown or nonapplicable.) 1 0 . Birth father is named on birth certificate Birth father has acknowledged paternity. There has been a judicial declaration of paternity. Other alleged father (name each): Unknow n 1 1 . Unknow n 1 2 . Unknow n 1 3 . The following optional questions may be helpful in tracing the ancestry of any person alleging Indian descent. 14. Have you or any of members of your family ever: a. Attended an Indian school? Ye s N o Unknow n b. Received medical treatment at an Indian health clinic or U.S. Public Health Service hospital? Ye s N o Unknow n c. Lived on federal trust land, a reservation or rancheria, or an allotment? Ye s N o Unknow n 15. Tribal affiliation and location (check any that apply). a . 1906 Final Roll Name of relative: The 1906 Final Roll was prepared by the Dawes Commission. Individuals who allege to be of Chickasaw, Creek, Cherokee, Choctaw, or Seminole ancestry from Oklahoma must provide the name of a relative who is listed on this final roll. b . Roll of 1924 Name of relative: The Roll of 1924 relates to the Eastern Band of Cherokees who were from states other than Oklahoma (such as North Carolina, Georgia, Mississippi, or another southeastern state). Individuals who allege to be of Eastern Cherokee descent must provide the name of a relative listed on the Roll of 1924. c . California Judgment Roll Roll number if available JV-135 [Rev. January 1, 2007] NOTICE OF INVOLUNTARY CHILD CUSTODY PROCEEDINGS FOR AN INDIAN CHILD (Juvenile Court) Page 5 of 6el ectr onic form ã 2005 WWW.LawCA.co m L a w P u b l i s h e r s JV-135 ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– –––––CASE NAME: CASE NUMBER: CERTIFICATE OF MAILING (To be completed by social worker, probation officer, or clerk of juvenile court) I certify that a copy of the Notice of Involuntary Child Custody Proceedings for an Indian Child , with a copy of the petition, was mailed as follows. Each copy was enclosed in an envelope with postage for registered or certified mail, return receipt requested, fully prepaid. The envelopes were addressed to each person, tribe, or bureau as indicated below. Each envelope was sealed and deposited with the United States Postal Service at (place): on (date): Dat e: Titl e:Departme nt: (TYPE OR PRINT NAME) (SIGNATURE ) This form and any return receipts must be filed with the court. List all persons, tribes, or agencies provided notice with the full mailing address (attach extra sheets if necessary): JV-135 [Rev. January 1, 2007] NOTICE OF INVOLUNTARY CHILD CUSTODY PROCEEDINGS FOR AN INDIAN CHILD (Juvenile Court) Page 6 of 6el ectr onic form ã 2005 WWW.LawCA.co m L a w P u b l i s h e r s JV-135