Fill and Sign the Welfare Affidavit 497303125 Form

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.981(a)(5), INDIAN CHILD WELFARE ACT AFFIDAVIT (11/15) When should this form be used? This form should be used in cases involving stepparent adoption of a child. This affidavit is required . This form should be typed or printed in black ink. After completing this form, you should sign the form before a notary public or deputy clerk . You should then file the original with the clerk of the circuit court in the county where the petition was fled and keep a copy for your records. IMPORTANT INFORMATION REGARDING E-FILING The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be fled electronically except in certain circumstances. Self- represented litigants may file petitions or other pleading or documents electronically; however, they are not required to do so. If you choose to fle your pleadings or other documents electronically, you must do so in accordance with Florida Rule of Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you fle. The rules and procedures should be carefully read and followed. What should I do next? A copy of this form must be mailed, e-mailed, or hand delivered to the other party in your case, if it is not served on him or her with your initial papers. IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION After the initial service of process of the petition or supplemental petition by the Sherif or certifed process server, the Florida Rules of Judicial Administration now require that all documents required or permitted to be served on the other party must be served by electronic mail (e-mail) except in certain circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial Administration. If you elect to participate in electronic service, which means serving or receiving pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review Florida Rule of Judicial Administration 2.516. You may fnd this rule at www.flcourts.org through the link to the Rules of Judicial Administration provided under either Family Law Forms: Getting Started, or Rules of Court in the A-Z Topical Index. SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the procedures must always be followed once the initial election is made. Instructions for Florida Supreme Court Approved Family Law Form 12.981(a)(5), Indian Child Welfare Act Affidavit (11/15) To serve and receive documents by e-mail, you must designate your e-mail addresses by using the Designation of Current Mailing and E-mail Address , Florida Supreme Court Approved Family Law Form 12.915, and you must provide your e-mail address on each form on which your signature appears. Please CAREFULLY read the rules and instructions for: Certificate of Service (General,, Florida Supreme Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address , Florida Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516. Where can I look for more information? Before proceeding, you should read General Information for Self- Represented Litigants found at the beginning of these forms. The words that are in bold underline in these instructions are defned there. Special notes... Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fll out these forms, that person must give you a copy of a Disclosure from Nonlawyer , Florida Family Law Rules of Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fll out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete. Instructions for Florida Supreme Court Approved Family Law Form 12.981(a)(5), Indian Child Welfare Act Affidavit (11/15) IN THE CIRCUIT COURT OF THE __________________ JUDICIAL CIRCUIT, IN AND FOR _________________________ COUNTY, FLORIDA Case No.: ____________________ Division: _____________________ IN THE MATTER OF THE ADOPTION OF ______________________________________________, {use name to be given to the minor child(ren)} Adoptee(s). INDIAN CHILD WELFARE ACT AFFIDAVIT I, {full legal name} ___________________________________, being sworn, certify that the following statements are true: Upon information and belief the child ____________________________________ {name} subject to this proceeding : {choose one only} 1. _____ is not an Indian child. The Indian Child Welfare Act does not apply to this proceeding. 2. _____ is an Indian child within the meaning of the Indian Child Welfare Act of 1978 (25 U.S.C. Section 1901 et seq.). I certify that a copy of this document was ( ) mailed ( ) faxed and mailed ( ) e-mailed ( ) hand-delivered to the person(s) listed below on {date} ____________________. Other party or his/her attorney: Name: __________________________________ Address: _________________________________ City, State, Zip: ____________________________ Fax Number: ______________________________ Designated E-mail Address(es): _______________ _________________________________________ I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this affidavit and that the punishment for knowingly making a false statement includes fines and/or imprisonment. Dated: ____________________ _______________________________________ Signature of Party Printed Name: ___________________________ Address: _______________________________ City, State, Zip: __________________________ Florida Supreme Court Approved Family Law Form 12.981(a)(5), Indian Child Welfare Act Affidavit (11/15) Telephone Number: ______________________ Fax Number: ____________________________ Designated E-mail Address(es): _____________ _______________________________________ STATE OF FLORIDA COUNTY OF _________________ Sworn to or affirmed and signed before me on __________ by __________________________________ . NOTARY PUBLIC or DEPUTY CLERK {Print, type, or stamp commissioned name of notary or clerk.} _____ Personally known _____ Produced identifcation Type of identifcation produced _________________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fll in all blanks] This form was prepared for the: {choose only one } ( ) Petitioner ( ) Respondent This form was completed with the assistance of: {name of individual} ___________________________________________________________________ , {name of business} ____________________________________________________________________ , {address} ____________________________________________________________________________ , {city} ____________________ , {state} _____ , {zip code} __________ , {telephone number} ____________. Florida Supreme Court Approved Family Law Form 12.981(a)(5), Indian Child Welfare Act Affidavit (11/15)