Fill and Sign the Of Petition for Guardianship of an Indian Child Form

PG-622 (4/15)(cs) REQUEST TO BIA 25 USC § 1912(a), 25 CFR § 23.11 REQUEST TO BIA TO NOTIFY INDIAN TRIBE OR PARENT OF PETITION FOR GUARDIANSHIP OF AN INDIAN CHILD To: or (for Metlakatla Indian Community) Portland Area Director, BIA 911 NE 11 th Avenue Human Services Director Bureau of Indian Affairs 3601 C Street, Suite 1 100 Anchorage, AK 99503-5947 Portland, OR 97232 From: (Petitioner’s Name) In the Matter of the Protective Proceeding of (Name of Child) Case Number I filed the attached petition in the Alaska Superior Court asking for a guardian to be appointed for the child named in the petition. Attached is a Notice of Hearing on the petition. I believe the child named above may be an Indian child as defined in the Indian Child Welfare Act (ICWA), but I have not been able to determine: the identity of the child’s tribe. I am sending this to you, as required by § 1912(a) of ICWA, so you can attempt to provide notice to the child’s tribe within the next 15 days. Please let me know if you are able to identify the tribe. the location of the child’s mother father Name: Last Known Address: This Parent’s Tribe or Possible Tribe: I am sending this to you, as required by § 1912(a) of ICWA, so you can attempt to provide notice to the child’s parent within the next 15 days. Please let me know if you are able to locate this parent. Thank you for your assistance. Date Petitioner’s Signature Type of Print Name Mailing Address City State ZIP Daytime Telephone Attachments: 1. Petition for Appointment of a Guardian for a Minor (PG-610) 2. Notice of Guardianship Hearing for Indian Child (PG-621)