Free PG-623 - Alaska

IN THE SUPERIOR COURT FOR THE STATE OF ALASKA AT In the Matter of the Protective Proceeding of ) ) ) ) ) )

CASE NO. CERTIFICATE OF SERVICE BY CERTIFIED MAIL (Guardianship of Indian Child)

Minor Date of Birth:

I certify that the following facts are true: 1. On , I mailed by certified mail the Notice of Guardianship Hearing for Indian Child (PG-621) and Petition for Guardianship to the above-named child's Mother Name: Mailing Address: Request to BIA (PG-622) to (name & address): Father Indian Custodian Tribe BIA

2. The receipt (green card) showing that the person received the document(s) is attached below.

Attach green card here with signature side up.

Date Print Name:
PG-623 (4/07)(cs) CERTIFICATE OF SERVICE BY CERTIFIED MAIL (Guardianship of Indian Child)

Signature of Petitioner
Civil Rule 4(h) & (f) AS 13.06.100, AS 13.26.135(b)