Parents ICWA Form {JUV-267}

SDSC JUV - 267 ( New 12 /17 ) A F ORM Page 1 of 2 SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO ICWA FORM DOB (date of birth): Petition #: Parent's ICWA Inquiry Worksheet (Indian Child Welfare Act ) Instructions: Name = full names and any maiden, married, former names, or aliases. Please complete all sections with as much information as you know. Return form to the assigned social worker, court officer, or your juvenile court attorney. Parent Your Name: Current member of a tribe? Yes No Mother Father DOB: / / Birthp Tribe(s)/Band(s): Location(s): Enrollment#/CDIB (Certificate of Degree of Indian Blood): Grandparents DOB: / / Birthp lace: DOB: / / Birthp lace: Phone: Email: Address: Phone: Email: Tribe(s)/Band(s): Location(s): Enrollment#/CDIB: Tribe(s)/Band(s): Location(s): Enrollment#/CDIB: Deceased? Yes No When? / / Where? Deceased? Yes No When? / / Where? Great Grandparents e: DOB: / / Birthp lace: DOB: / / Birthp lace: Address: Phone: Address: Phone: Tribe(s)/Band(s): Location(s): Enrollment#/CDIB: Tribe(s)/Band(s): Location(s): Enrollment#/CDIB: Deceased? Yes No When? / / Where? Deceased? Yes No When? / / Where? American LegalNet, Inc. www.FormsWorkFlow.com SDSC JUV - 267 ( New 12 /17 ) A F ORM Page 2 of 2 DOB : / / Petition #: Great Grandparents DOB: / / Birthp lace: DOB: / / Birthp lace: Address: Phone: Address: Phone: Tribe(s)/Band(s): Location(s): Enrollment#/CDIB: Tribe(s)/Band(s): Location(s): Enrollment#/CDIB: Deceased? Yes No When? / / Where? Deceased? Yes No When? / / Where? Additional Family Info Have any family members: Name, Contact Info., and Tribe(s)/Band(s) Attended an Indian School? Yes No Been t reated by an Indian Health Clinic? Yes No Lived on a reservation? Yes No Been l isted on the 1906 Final Roll? Yes No or the 1924 Roll? Yes No or the California Judgment Roll? Yes No Heritage? Yes No Name: Tribal Affiliation: Is there someone in your family who would have additional information? Name: Phone: Relationship to Child: Any Additional Information American LegalNet, Inc. www.FormsWorkFlow.com