Fill and Sign the Wa Welfare 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. Indian Child Welfare Act Notice (Non- Parent Custody) (BIAN)  Clerk: Do not file in a public access file (GR 22(c)(3), 25 CFR 23.11(e)(7)) Indian Child Welfare Act Notice (Non-Parent Custody) To: Parent/s (name/s): Indian Custodian/s, if any (name/s): Designated ICWA Tribal Agent/s (name/s and tribe/s): I have filed a Non-Parent Custody Petition to ask a Washington State Court for custody of children who are members of (or may be eligible for membership in) the Indian tribe/s listed above. The Court’s decision may affect the rights of the children’s parents, Indian custodians, and tribe/s. The children may be taken from their home temporarily or permanently. The court is located at: Court’s street address Court’s phone number Court’s mailing address (if different) City State Zip RCW 26.10.034(1)(b), 13.38.070, 25 CFR § 23.11(e)(7), 25 USC § 1912(a) Mandatory Form (07/2017) FL Non-Parent 402 ICWA Notice (Non-Parent Custody) p. 1 of 5  Court Hearing A court hearing or hearings have been scheduled. See attached hearing notice or case scheduling order. No court hearing has been scheduled in this case yet.  Rights If you are the parent, Indian custodian, or agent of the children’s tribe, you have these rights:  To receive this notice at least 10 days before the first hearing in this case.  To have up to 20 extra days to prepare for a hearing, if you ask the court.  To see all documents and evidence filed with the court for this case.  To be part of this case at any point (intervene as a party).  To have the Court appoint a lawyer for you, if you are a parent or Indian custodian and the Court finds you are indigent (cannot afford your own lawyer).  To ask this court to transfer this case to the court of the child’s tribe. This court will approve the transfer to tribal court unless one of the parents objects or there is a good reason to keep the case in state court.  Information The information below is to help determine the children’s Indian status. Do not share this information with others, except as needed for the tribe to exercise its rights under the Indian Child Welfare Act. Petitioner/s must make a good faith effort to provide this information. 1. Information about the person/s asking for custody of the children Name: Tel. #: Name: Tel. #: Address: Lawyer’s name (if any): Lawyer’s address: Tel. #: 2. Child’s Information Child’s name: Date of birth: Place of birth: Tribe/s child belongs to (or may belong to): Tribal enrollment # or other tribal ID: RCW 26.10.034(1)(b), 13.38.070, 25 CFR § 23.11(e)(7), 25 USC § 1912(a) Mandatory Form (07/2017) FL Non-Parent 402 ICWA Notice (Non-Parent Custody) p. 2 of 5 There are (#) other children involved in this case. (For each additional child complete form FL Non-Parent 403, “ICWA Notice – Attachment for Additional Child”.) 3. Mother’s Information Mother’s current name: Other names used, if any: Date of birth: Place of birth: Current address: Former addresses: Tribe(s) Mother belongs to: Tribal enrollment # or other tribal ID: 4. Father’s Information Father’s current name: Other names used, if any: Date of birth: Place of birth: Address: Former addresses: Tribe/s Father belongs to: Tribal enrollment # or other tribal ID: 5. Information about the child’s grandparents and great grandparents Mother’s parents Current name & other names used Current address Former addresses Date and place of birth RCW 26.10.034(1)(b), 13.38.070, 25 CFR § 23.11(e)(7), 25 USC § 1912(a) Mandatory Form (07/2017) FL Non-Parent 402 ICWA Notice (Non-Parent Custody) p. 3 of 5 Mother’s parents Date and place of death, if no longer living Tribe Tribal Enrollment # or other tribal ID Father’s parents Current name & other names used Current address Former addresses Date and place of birth Date and place of death, if no longer living Tribe Tribal Enrollment # or other tribal ID Mother’s grandparents (add pages, as needed) Current name & other names used Current address Former addresses Date and place of birth Date and place of death, if no longer living Tribe Tribal Enrollment # or other tribal ID Father’s grandparents (add pages, as needed) Current name & other names used Current address Former addresses Date and place of birth Date and place of RCW 26.10.034(1)(b), 13.38.070, 25 CFR § 23.11(e)(7), 25 USC § 1912(a) Mandatory Form (07/2017) FL Non-Parent 402 ICWA Notice (Non-Parent Custody) p. 4 of 5 Mother’s grandparents (add pages, as needed) death, if no longer living Tribe Tribal Enrollment # or other tribal ID Petitioner or Petitioner’s lawyer fills out below Petitioner or lawyer signs here Date Print name (if lawyer, also list WSBA No.) To Petitioner: You must have this Notice and a copy of the Petition served by certified mail, return receipt requested to the:  Children’s tribe/s, addressed to the agent identified by the tribe/s (tribal agents designated to receive ICWA Notices are listed in the Federal Register: www.FederalRegister.gov (search “ICWA Agent”) ),  Children’s parents,  Indian custodians (if any), and  Bureau of Indian Affairs. Fill out and file a Proof of Mailing form (FL Non-Parent 404) . (In addition to this mailing, you must have the Summons and Petition personally served on the parents and any Indian custodian.) RCW 26.10.034(1)(b), 13.38.070, 25 CFR § 23.11(e)(7), 25 USC § 1912(a) Mandatory Form (07/2017) FL Non-Parent 402 ICWA Notice (Non-Parent Custody) p. 5 of 5