Adoption of Indian Child
COURT This form is attached to Adoption Request (ADOPT-200).
Your name(s) (adopting parent(s)): a. b. Relationship to child:
COUNTY . . . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : : Plaintiff(s) : : :
Index No. Calendar No.
-againstYour address (skip this if you have a lawyer): Street: City: Your phone #: ( )
: Your lawyer. . . .you . . . . one):. (Name, .address, .phone. #,. and.Defendant(s) . . . . . . . . . (if . . have . . . . . . . . . . . . . . . . . . . State. Bar. #): . ... .. ..
THE PEOPLE OF THE STATE OF NEW YORK
Federal law says the State courts must send a copy of all adoption orders for an Indian child to the Secretary of the TO Interior within 30 days. The State court must also send the following information. Please complete the rest of the form. 2 Indian child's name: GREETINGS: Date of birth:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court located at County of (or tribe child is eligible for): Indian child's tribe in #: , on the day of , 20 , at o'clock if you Enrollmentroom Check herein the do noon, and at any recessed not know. or adjourned date, to testify and give evidence as a witness in this action on the part of the
Check here if tribe does not have an enrollment number.
Your failure to (name): Indian child's biological mother comply with this subpoena is punishable as a contempt of court and will make you liable to
Address: result of your failure to comply.
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
City: State: Zip: Witness, Honorable , one of the Justices of the Check here if you do not know. Court in County, day of , 20 The biological mother attaches her request that her identity remain confidential. 5 Indian child's biological father (name): Address: City: State: Attorney(s) for Check here if you do not know. The biological father attaches his request that his identity remain confidential.
Office and P.O. Address
(Attorney must sign above and type name below)
Judicial Council of California, www.courtinfo.ca.gov Rev. January 1, 2003, Mandatory Form 25 U.S.C. § 1951
Adoption of Indian
Telephone No.: Facsimile No.: E-Mail Address: Child Tel. No.: Mobile
ADOPT-220, Page 1 of 2
American LegalNet, Inc. www.USCourtForms.com
Your name(s): 6 Indian child's biological Indian grandmother(s) (name(s); include Maiden name(s) if you know them): Check here if you do not know. 7 Indian child's biological Indian grandfather(s) (names): Check here if you do not know. 8 Name of any agency with information about this adoption:
Other people with information about the Indian child's ancestry: Name a. b. c.
Relationship to Child
Parental rights: (Check all that apply) a. A court ended parental rights on (date): b. Parent(s) voluntarily agreed in writing to end their parental rights. (1) ADOPT-225 will be recorded in front of a judge and filed with the court before the adoption hearing on (date): (2) ADOPT-225 was recorded in front of a judge and is attached to ADOPT-200 (Adoption Request). (3) ADOPT-225 was signed at least 10 days after the birth date of the Indian child. A judge has certified that he or she fully explained the terms and consequences of the parent's agreement to end parental rights and that the parent(s) understood. (1) This certificate was filed with the court on (date): ; OR (2) This certificate is attached to ADOPT-200 or will be filed before the adoption hearing.
Note: The court will notify the American Indian tribe of the child's adoption.
Rev. January 1, 2003
Adoption of Indian Child
ADOPT-220, Page 2 of 2