Fresno — (ICWA-030) Notice of Child Custody Proceedings for Indian Child

Source: https://www.courts.ca.gov/documents/icwa030.pdf

CONFIDENTIAL ICWA-030 ATTORNEY OR PARTY WITHOUT ATTORNEY STATE BAR NUMBER: FOR COURT USE ONLY NAME: FIRM NAME: STREET ADDRESS: CITY: STATE: ZIP CODE: TELEPHONE NO.: FAX NO.: E-MAIL ADDRESS: ATTORNEY FOR (name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:

CASE NAME:

NOTICE OF CHILD CUSTODY PROCEEDING FOR INDIAN CHILD (check all that apply): CASE NUMBER: JUVENILE Dependency Delinquency ADOPTION CONSERVATORSHIP CUSTODY (Fam. Code, § 3041) HEARING DATE: DEPT.: DECLARATION OF FREEDOM FROM CONTROL OF PARENT GUARDIANSHIP TERMINATION OF PARENTAL RIGHTS VOLUNTARY RELINQUISHMENT OF CHILD BY PARENT

NOTICE TO (check all that apply): Parents or Legal Guardians Tribes Indian Custodians Sacramento Area Director, BIA

1. NOTICE is given that based on the petition, a copy of which is attached to this notice, a child custody proceeding under the Indian Child Welfare Act (25 U.S.C. § 1901 et seq.) has been initiated for the following child (a separate notice must be filed for each child):

Name Date of Birth Place of Birth a. Date: Time: Dept.: Room: Type of hearing:

b. Address and telephone number of court same as noted above is (specify):

3. The child is or may be eligible for membership in the following Indian tribes (list each):

*Use this form in a conservatorship only if the proposed conservatee is a formerly married minor.

Form Adopted for Mandatory Use 25 U.S.C. § 1901 et seq.;Judicial Council of California NOTICE OF CHILD CUSTODY PROCEEDING FOR INDIAN CHILD Welfare & Institutions Code, §§ 224.2, 224.3; ICWA-030 [Rev. January 1, 2021] (Indian Child Welfare Act) Probate Code, §§ 1449, 1459.5; 1460.2; Cal. Rules of Court, rules 5.480–5.487 and 7.1015 www.courts.ca.gov

ICWA-030 CASE NAME: CASE NUMBER:

4. Under the Indian Child Welfare Act (ICWA) and California law: a. The child's parents, Indian custodian, and the child's tribe have the right to be present at all hearings. b. The child's Indian custodian and the child's tribe have the right to intervene in the proceedings when ICWA applies. c. The child's parent, Indian custodian, or tribe may petition the court to transfer the case to the tribal court of the Indian child's tribe. The child's parent or tribe also have the right to refuse to have the case transferred to the tribal court. d. With the limited exceptions of the detention hearing in juvenile cases and the jurisdiction and disposition hearings in delinquency cases as identified in rule 5.482, the court will give up to 20 additional days from the time of the scheduled hearing if the child's parent, Indian custodian, or tribe request such time to prepare for the hearing. e. The proceedings could lead to the removal of the child from the custody of the parent or Indian custodian and possible termination of parental rights and adoption of the child. f. If the child's parents or Indian custodian have a right to be represented by a lawyer and if they cannot afford to hire one, a lawyer will be appointed for them. g. The information contained in this notice and all attachments is confidential. Any tribal representative or agent or any other person or entity receiving this information must maintain the confidentiality of this information and not reveal it to anyone who does not need the information in order to exercise the tribe's rights under the Indian Child Welfare Act (25 U.S.C. § 1901 et seq.). h. An Indian custodian is any Indian person who has legal custody of the child under tribal law or custom or state law, or to whom temporary physical custody, care, and control of the child has been transferred by a parent.

5. INFORMATION ON THE CHILD NAMED IN 1 a. A copy of the petition initiating this case is attached. b. The child's birth certificate is attached unavailable. c. A copy of the tribal registration card of the child the parent is attached. d. Biological relative information is listed below. (Indicate if any of the information requested below is unknown or does not apply. Do not use the abbreviation "N/A".) (Required by Fam. Code, § 180; Prob. Code, § 1460.2; and Welf. & Inst. Code, § 224.3.) e. If the chart does not represent the gender identities of the individuals in the child's family tree, please attach an appropriate equivalent. Biological Mother Biological Father Name (include maiden, married, and former names or aliases): Name (include former names or aliases):

   Current address: Current address:

   Former address: Former address:

Birthdate and place: Birthdate and place:

Tribe or band, and location: Tribe or band, and location:

Tribal membership or enrollment number, if known: Tribal membership or enrollment number, if known:

If deceased, date and place of death: If deceased, date and place of death:

Additional information: Additional information:

Page 2 of 10ICWA-030 [Rev. January 1, 2021] NOTICE OF CHILD CUSTODY PROCEEDING FOR INDIAN CHILD
(Indian Child Welfare Act)

ICWA-030 CASE NAME: CASE NUMBER:

5. f. INFORMATION ON THE CHILD NAMED IN 1 (Indicate if any of the information requested below is unknown or does not apply; do not use the abbreviation "N/A".)

   Mother's Biological Mother Father's Biological Mother
   (Child's Maternal Grandmother) (Child's Paternal Grandmother)

Name (include maiden, married, and former names or aliases): Name (include maiden, married, and former names or aliases):

Current address: Current address:

Former address: Former address:

Birthdate and place: Birthdate and place:

Tribe or band, and location: Tribe or band, and location:

Tribal membership or enrollment number, if known: Tribal membership or enrollment number, if known:

If deceased, date and place of death: If deceased, date and place of death:

Mother's Biological Father Father's Biological Father
(Child's Maternal Grandfather) (Child's Paternal Grandfather)

Name (include former names or aliases): Name (include former names or aliases):

Current address: Current address:

Former address: Former address:

Birthdate and place: Birthdate and place:

Tribe or band, and location: Tribe or band, and location:

Tribal membership or enrollment number, if known: Tribal membership or enrollment number, if known:

If deceased, date and place of death: If deceased, date and place of death:

ICWA-030 [Rev. January 1, 2021] NOTICE OF CHILD CUSTODY PROCEEDING FOR INDIAN CHILD Page 3 of 10 (Indian Child Welfare Act)

ICWA-030 CASE NAME: CASE NUMBER:

5. g. INFORMATION ON THE CHILD NAMED IN 1 (Indicate if any of the information requested below is unknown or does not apply; do not use the abbreviation "N/A".) Mother's Biological Grandmother Mother's Biological Grandmother (Child's Maternal Great-grandmother) (Child's Maternal Great-grandmother)

Name (include maiden, married, and former names or aliases): Name (include maiden, married, and former names or aliases):

Current address: Current address:

Former address: Former address:

Birthdate and place: Birthdate and place:

Tribe or band, and location: Tribe or band, and location:

Tribal membership or enrollment number, if known: Tribal membership or enrollment number, if known:

If deceased, date and place of death: If deceased, date and place of death:

Mother's Biological Grandfather Mother's Biological Grandfather
(Child's Maternal Great-grandfather) (Child's Maternal Great-grandfather)

Name (include former names or aliases): Name (include former names or aliases):

Current address: Current address:

Former address: Former address:

Birthdate and place: Birthdate and place:

Tribe or band, and location: Tribe or band, and location:

Tribal membership or enrollment number, if known: Tribal membership or enrollment number, if known:

If deceased, date and place of death: If deceased, date and place of death:

ICWA-030 [Rev. January 1, 2021] NOTICE OF CHILD CUSTODY PROCEEDING FOR INDIAN CHILD Page 4 of 10 (Indian Child Welfare Act)

ICWA-030 CASE NAME: CASE NUMBER:

5. h. INFORMATION ON THE CHILD NAMED IN 1 (Indicate if any of the information requested below is unknown or does not apply; do not use the abbreviation "N/A".) Father's Biological Grandmother Father's Biological Grandmother (Child's Paternal Great-grandmother) (Child's Paternal Great-grandmother)

Name (include maiden, married, and former names or aliases): Name (include maiden, married, and former names or aliases):

Current address: Current address:

Former address: Former address:

Birthdate and place: Birthdate and place:

Tribe or band, and location: Tribe or band, and location:

Tribal membership or enrollment number, if known: Tribal membership or enrollment number, if known:

If deceased, date and place of death: If deceased, date and place of death:

Father's Biological Grandfather Father's Biological Grandfather
(Child's Paternal Great-grandfather) (Child's Paternal Great-grandfather)

Name (include former names or aliases): Name (include former names or aliases):

Current address: Current address:

Former address: Former address:

Birthdate and place: Birthdate and place:

Tribe or band, and location: Tribe or band, and location:

Tribal membership or enrollment number, if known: Tribal membership or enrollment number, if known:

If deceased, date and place of death: If deceased, date and place of death:

ICWA-030 [Rev. January 1, 2021] NOTICE OF CHILD CUSTODY PROCEEDING FOR INDIAN CHILD Page 5 of 10 (Indian Child Welfare Act)

ICWA-030 CASE NAME: CASE NUMBER:

5. i. INFORMATION ON THE CHILD NAMED IN 1 (Indicate if any of the information requested below is unknown or does not apply; do not use the abbreviation "N/A")

   Information on Indian Ancestry of Information on Indian Ancestry of
   Other Lineal Biological Ancestors Other Lineal Biological Ancestors

Name (include maiden, married, and former names or aliases): Name (include maiden, married, and former names or aliases):

Current address: Current address:

Former address: Former address:

Birthdate and place: Birthdate and place:

Tribe or band, and location: Tribe or band, and location:

Tribal membership or enrollment number, if known: Tribal membership or enrollment number, if known:

If deceased, date and place of death: If deceased, date and place of death:

More information on lineal biological ancestors is attached on a separate sheet.

5. j. INFORMATION ON THE CHILD NAMED IN 1 (Indicate if any of the information requested below is unknown or does not apply; do not use the abbreviation "N/A".)

   Indian Custodian Information Indian Custodian Information

Name (include maiden, married, and former names or aliases): Name (include maiden, married, and former names or aliases):

Current address: Current address:

Former address: Former address:

Birthdate and place: Birthdate and place:

Tribe or band, and location: Tribe or band, and location:

Tribal membership or enrollment number, if known: Tribal membership or enrollment number, if known:

ICWA-030 [Rev. January 1, 2021] NOTICE OF CHILD CUSTODY PROCEEDING FOR INDIAN CHILD Page 6 of 10 (Indian Child Welfare Act)

ICWA-030 CASE NAME: CASE NUMBER:

6. ADDITIONAL INFORMATION ON THE CHILD NAMED IN 1 (Indicate if any of the information requested below is unknown.) a. Biological father is named on birth certificate. Unknown b. Biological father has acknowledged parentage. Unknown c. There has been a judicial declaration of parentage. Unknown d. Other alleged father (name each):

   Unknown

The following optional questions may be helpful in tracing the ancestry of the child named in 1.

7. Has the child named in 1 or any members of the child's family ever (if "yes," provide the information requested below): a. Attended an Indian school? Yes No Unknown

   Name/relationship to child Type of school Dates attended Name and location of school

   b. Received medical treatment at an Indian health clinic or U.S. Public Health Service hospital? Yes No Unknown

   Name/relationship to child Type of treatment Dates of treatment Location where treatment given

   c. Lived on federal trust land, a reservation, rancheria, an allotment or in an Alaska Native village or other tribal trust land? Yes No Unknown

   Name/relationship to child Name/description of property and address Dates of residence

   d. Other relative information (e.g., aunts, uncles, siblings, first and second cousins, stepparents, etc.)

   Name/relationship to child Current and former address Birthdate and place Tribe, band, and location

8. Tribal affiliation and location of child named in 1 (check all that apply):

   a. 1906 Final Roll Name of relative listed on roll: Relationship to child named in 1: b. Roll of 1924 Name of relative listed on roll: Relationship to child named in 1: c. California Judgment Roll. Name of relative listed on roll: Relationship to child named in 1:

ICWA-030 [Rev. January 1, 2021] NOTICE OF CHILD CUSTODY PROCEEDING FOR INDIAN CHILD Page 7 of 10 (Indian Child Welfare Act)

ICWA-030 CASE NAME: CASE NUMBER:

9. Additional party information (list the name, mailing address, and telephone number of all parties notified):

Name Mailing Address Telephone Number

DECLARATION

(To be completed, dated, and signed in all cases by each petitioner named in companion petition.)

I am the petitioner or we are all of the petitioners in this proceeding. In response to items 5–9 of this form, I/we have given all information I/we have about the relatives and, if applicable, the Indian custodian, of the child named in item 1 of this form.

I/We declare under penalty of perjury under the laws of the State of California that the foregoing and all attachments are true and correct.

Date:

(TYPE OR PRINT NAME) (SIGNATURE)

Date:

(TYPE OR PRINT NAME) (SIGNATURE)

Date:

(TYPE OR PRINT NAME) (SIGNATURE)

ICWA-030 [Rev. January 1, 2021] NOTICE OF CHILD CUSTODY PROCEEDING FOR INDIAN CHILD Page 8 of 10 (Indian Child Welfare Act)

ICWA-030 CASE NAME: CASE NUMBER:

CERTIFICATE OF MAILING—JUVENILE COURT PROCEEDINGS (To be completed by social worker or probation officer.)

I certify that a copy of the Notice of Child Custody Proceeding for Indian Child, with a copy of the petition identified on page 1 of this form, was mailed as follows. Each copy was enclosed in an envelope with postage for registered or certified mail, return receipt requested, fully prepaid. The envelopes were addressed to each person, tribe, or agency as indicated below. (Except that the telephone numbers shown below were not placed on the envelopes. They are shown below because they must be disclosed in the Notice under Family Code section 180, Probate Code section 1460.2, and Welfare and Institutions Code section 224.3.) Each envelope was sealed and deposited with the United States Postal Service at (place): on (date): .

Date: Title: Department:

(TYPE OR PRINT NAME) (SIGNATURE)

DECLARATION OF MAILING—ADOPTION, FAMILY LAW, AND PROBATE PROCEEDINGS
(To be completed by the attorney for Petitioner if Petitioner is represented.)
I am an attorney at law, admitted to practice in the courts of the State of California, and attorney for Petitioner in this matter.
I declare that a copy of the Notice of Child Custody Proceeding for Indian Child, with a copy of the petition identified on page 1 of
this form, was mailed as follows. Each copy was enclosed in an envelope with postage for registered or certified mail, return
receipt requested, fully prepaid. The envelopes were addressed to each person, tribe, or agency as indicated below. (Except that
the telephone numbers shown below were not placed on the envelopes. They are shown below because they must be disclosed
in the Notice under Family Code section 180, Probate Code section 1460.2, and Welfare and Institutions Code section 224.3.)
Each envelope was sealed and deposited with the United States Postal Service at (place):
on (date): .

I declare under penalty of perjury under the laws of the State of California that the foregoing and all attachments are true and correct. Date:

(TYPE OR PRINT NAME) (SIGNATURE)

CERTIFICATE OF MAILING—PROBATE PROCEEDINGS
(To be completed by the clerk of the court if Petitioner is unrepresented.)

I certify that a copy of the Notice of Child Custody Proceeding for Indian Child, with a copy of the petition, was mailed as follows. Each copy was enclosed in an envelope with postage for registered or certified mail, return receipt requested, fully prepaid. The envelopes were addressed to each person, tribe, or agency as indicated below. (Except that the telephone numbers shown below were not placed on the envelopes. They are shown below because they must be disclosed in the Notice under Family Code section 180, Probate Code section 1460.2, and Welfare and Institutions Code section 224.3.) Each envelope was sealed and deposited with the United States Postal Service at (place): on (date): .

Date: Title: Department:

(TYPE OR PRINT NAME) (SIGNATURE)

This form and all return receipts must be filed with the court.

ICWA-030 [Rev. January 1, 2021] NOTICE OF CHILD CUSTODY PROCEEDING FOR INDIAN CHILD Page 9 of 10 (Indian Child Welfare Act)

ICWA-030 CASE NAME: CASE NUMBER:

NAMES, ADDRESSES, AND TELEPHONE NUMBERS OF ALL PERSONS, TRIBES, OR AGENCIES TO WHOM NOTICE WAS MAILED

1. Parent (Name): 2. Parent (Name):
   Street address: Street address:
   Mailing address: Mailing address:

   City, state, and zip code: City, state, and zip code: Telephone number: Telephone number:

2. Guardian (Name): 4. Guardian (Name):
   Street address: Street address:
   Mailing address: Mailing address:

   City, state, and zip code: City, state, and zip code: Telephone number: Telephone number:

3. Indian Custodian 6. Indian Custodian
   (Name): (Name):
   Street address: Street address:
   Mailing address: Mailing address:

   City, state, and zip code: City, state, and zip code: Telephone number: Telephone number:

4. Sacramento Regional Director 8. Tribe (Name):
   Bureau of Indian Affairs, Federal Office Building Addressee (Name):
   Street address: 2800 Cottage Way Title:

   City, state, and zip code: Sacramento, CA 95825 Street address: Telephone number: Mailing address: City, state, and zip code: Telephone number:

5. Tribe (Name): 10. Tribe (Name):
   Addressee (Name): Addressee (Name):
   Title: Title:
   Street address: Street address:
   Mailing address: Mailing address:

   City, state, and zip code: City, state, and zip code: Telephone number: Telephone number:

6. Tribe (Name): 12. Tribe (Name):

   Addressee (Name): Addressee (Name): Title: Title: Street address: Street address: Mailing address: Mailing address: City, state, and zip code: City, state, and zip code: Telephone number: Telephone number:

   Note: Notice to the tribe must be sent to the tribal chairperson or designated authorized agent for service.

   Additional tribes served listed on attached form ICWA-030(A)

   Page 10 of 10ICWA-030 [Rev. January 1, 2021] NOTICE OF CHILD CUSTODY PROCEEDING FOR INDIAN CHILD
   (Indian Child Welfare Act)

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