Fill and Sign the Proof Mailing Form

Superior Court of Washington, County of In re custody of: Children : Petitioner/s (person/s who started this case) : Respondents ( parents and any guardian or custodian) : No. Proof of Mailing (Indian Child Welfare Act Notice) (AFML) Proof of Mailing (Indian Child Welfare Act Notice) Server declares: 1. I am age 18 or older and not a party to this case. 2. On (date): , I personally mailed copies of the:  Non-Parent Custody Petition  Indian Child Welfare Act Notice (Non-Parent Custody) Other documents: to the following people by certified mail with return receipt requested: Tribe/s (mail to the agent listed in the Federal Register) (Tribal agent): (Tribe): street number or P.O. box city state zip (Tribal agent): (Tribe): RCW 26.10.034, 13.38.070 Mandatory Form (05/2016) FL Non-Parent 404 Proof of Mailing (Indian Child Welfare Act Notice) p. 1 of 2 street number or P.O. box city state zip (Tribal agent): (Tribe): street number or P.O. box city state zip Parents (Name): street number or P.O. box city state zip (Name): street number or P.O. box city state zip BIA Regional Director, Bureau of Indian Affairs 911 NE 11 th Avenue Portland, OR 97232 Indian custodian/s (if any) (Name): street number or P.O. box city state zip 3. Other information (if any): I declare under penalty of perjury under the laws of the state of Washington that the statements on this form are true. Signed at Date: city state Signature of server (not a party to this case) Print or type name of server Tape return receipt/s below: RCW 26.10.034, 13.38.070 Mandatory Form (05/2016) FL Non-Parent 404 Proof of Mailing (Indian Child Welfare Act Notice) p. 2 of 2