Free IN THE SUPERIOR COURT FOR THE STATE OF ALASKA - Alaska

NATIVE VILLAGE OF TRIBAL COURT In the Matter of: ) ) ) ) ) ) TRIBAL COURT CASE NO. ) ) Alaska Superior ) Court Case No. ) ) ORDER RE: JURISDICTION OVER INDIAN CHILD WELFARE CASE

A minor tribal member. Date of birth:

IT IS ORDERED that: This Tribal Court ACCEPTS jurisdiction of this Child in Need of Aid proceeding that is to be transferred from the state court to this Tribal Court pursuant to Child in Need of Aid Rule 23.

This Tribal Court DECLINES jurisdiction of this Child in Need of Aid proceeding that is to be transferred from the state court to this Tribal Court pursuant to Child in Need of Aid Rule 23.

Date

Tribal Court Judge Type or Print Name

Date

Tribal Court Judge Type or Print Name

Date

Tribal Court Judge Type or Print Name

I certify that on a copy of this order was sent to: AG OCS GAL/Child Parent/Guardian/Attorney: Indian Custodian

Tribe

Tribal Court Clerk: CN-340 (1/06)(cs) TRIBAL COURT ORDER RE: JURISDICTION OVER INDIAN CHILD WELFARE CASE

CINA R. 23(c)(6) 25 U.S.C. § 1911(b); 25 U.S.C. § 1903