STATE OF NEBRASKA FORM NO. CC 17:3 3/87 NEW
CASE NUMBER
JOURNAL ENTRY
IN THE MATTER OF THE ADOPTION OF
JOURNAL ENTRY
Upon the application of
, an Indian who has
reached the age of eighteen years, and who is the subject of an adoptive placement, for information regarding his/her parent's tribal affiliation, the court provided the following information:
Tribal affiliation of Mother Tribal affiliation of Father Other
DATE:
SIGNATURE:
(Seal)
Copy to Applicant Original placed in court file