Fill and Sign the Fillable Online Icwa 010av11 101007 Mcofm Fax Email Form

The child or the child's family has received services or benefit s from a tribe or services that are available to Indians from tribes or the federal government, such as the Indian Heal th Service or Tribal Temporary Assistance to Needy Families (TANF). CHILD'S NAME: CASE NUMBER: INDIAN CHILD INQUIRY ATTACHMENT Page 1 of ____ Form Adopted for Mandatory Use Judicial Council of California ICWA-010(A) [New January 1, 2008] ICWA-010(A) The child is or may be a member of or eligible for membership in a tribe. The child's parents, grandparents, or great-gra ndparents are or were members of a tribe. The residence or domicile of the child, child's parents, or Indian custodian is in a pr edominantly Indian community. Indian child inquiry made a. b. c. d. not made and (check all that apply): 1. Name of child: The child may have Indian ancestry. The child has no known Indian ancestry. Other reason to know the child may be an Indian child: e. f. g. Name: Person(s) questioned: Address: City, state, zip: Telephone: Date questioned: Means of communication: Relationship to child: Summary of information: Name: Person(s) questioned: Address: City, state, zip: Telephone: Date questioned: Means of communication: Relationship to child: Summary of information: Information about other pers ons questioned is attached. 2. If this is a delinquency proceeding under Welfare and Institutions Code, § 601 or 602: The child is in foster care. It is probable the child will be entering foster care. (TYPE OR PRINT NAME) Date: (SIGNATURE) I declare under penalty of perjury under t he laws of the State of California t hat the foregoing is true and correct. Name of tribe(s): Name of band (if applicable): Name of band (if applicable): Name of tribe(s): h.