Notice Form Designee Of Final Decree Or Order Of Adoption Of An Indian Child printable pdf download

STATE OF NORTH DAKOTA

IN DISTRICT COURT

COUNTY OF

JUDICIAL DISTRICT

IN THE INTEREST OF__________________, A CHILD

__________________________,

)

PETITIONER

)

NOTICE TO THE SECRETARY

)

OF THE INTERIOR OR HIS/HER

VS.

)

DESIGNEE OF FINAL DECREE

)

OR ORDER OF ADOPTION

__________________________,

)

OF AN INDIAN CHILD PURSUANT

RESPONDENT

)

TO 25 U.S.C. §1951

)

FILE NO. __________

Section 1951 of the Indian Child Welfare Act (25 U.S.C. §1901 et. seq. and 25 C.F.R. § 23.71) requires

that any state court entering a final decree of adoption order for any Indian child within 30 days provide the

Secretary of the Interior a copy of the decree or order, together with any information necessary to show the

following:

A Final Decree of Adoption has been entered in this matter. The minor known

as_______________________________________ Date of Birth __________________________

shall be known henceforth as _______________________________________________________

The minor’s Tribal Affiliation is _______________________ and Enrollment # is ____________

The name and addresses of the minor’s biological parents are:

________________________________________________________________________________________

_______________________________________________________________________________________

Enrollment # of mother _________________________Enrollment # of father _________________________

The names and addresses of the minor’s adoptive parents are:

________________________________________________________________________________________

The names and addresses of any agency having relevant information relating to the adoptive placement in this

matter are:

________________________________________________________________________________________

{If applicable} The biological parents have by affidavit requested that their identity remain confidential. A

copy of each affidavit is attached.

Termination of Parental Rights was:

? Voluntary --- Date __________

? Involuntary --- Date ________

Attached to this report are the Adoption Decree, Certified Copy of Original Birth Certificate, Affidavit of Anonymity

and Proof of Service of Notice.

Note: Pursuant to 25 U.S.C. §1913, any consent by the Indian parent shall not be valid unless executed in writing and recorded before

a judge and accompanied by the judge’s certificate that the terms and consequences of the consent were fully explained in detail and

were fully understood by the parent.

Notice Form Designee Of Final Decree Or Order Of Adoption Of An Indian Child

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