ADOPT-220 Adoption of Indian Child

ADOPT-220
Adoption of Indian Child
Your name (adopting parent):
Relationship to child:
Address (skip this if you have a lawyer):
Street:
State: Zip:
City:
ADOPT-220, Page 1 of 2
a.
b.
Lawyer (if any): (Name, address, telephone number, and State
Bar number):
Telephone number:
()
Clerk stamps date here when form is filed.
Fill in court name and street address:
Superior Court of Californ ia, County of
Case Number:
Fill in case number if known:
1
This form is attached to Adoption Request (ADOPT-200).
Federal law says the state courts must send a copy of all adoption orders for an Indian child to the Secretary of the
Interior within 30 days. The state court must also send the following information Please complete the rest of the
form.
Indian child’s name:
Date of birth:
Age:
Indian child’s tribe (or tribe child is eligible for):
Enrollment #:
Check here if you do not know.
Check here if tribe does not have an
enrollment number.
Indian child’s biological mother (name):
Street address:
Zip:State:City:
Check here if you do not know.
The biological mother attaches her request that her identity remain confidential.
Indian child’s biological father (name):
Street address:
Zip:
State:City:
Check here if you do not know.
The biological father attaches his request that his identity remain confidential.
2
3
4
5
Adoption of Indian Child
Judicial Council of California, www.courts.ca.gov
Revised July 1, 2010, Mandatory Form
25 U.S.C. § 1951
To keep other people from
seeing what you entered on
your form, please press the
Clear This Form button at the
end of the form when finished.
Page 1/2
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