SDSC D-243 (New 4/09) CONSENT TO CUSTODY OF AN INDIAN CHILD Fam. Code § 3041

Cal. Form D-243

California Superior Local Rules

MAIN ST., EL CAJON, CA NORTH COUNTY DIVISION, 325 S. MELROSE DR., VISTA, CA SOUTH COUNTY DIVISION, 500 3RD AVE., CHULA VISTA, CA PETITIONER(

S) RESPONDENT(

S) THIRD-PARTY CLAIMANT(

S) CONSENT TO CUSTODY OF AN INDIAN CHILD TO NON-PARENT AND COURT CERTIFICATION CASE NUMBER 1. Your Name: Mother Father Custodian (Check only one. Each parent/custodian must complete a separate form.) 2. Your Address: City: State: Zip Code: Telephone Number: 3. Your Name of Tribe(s)/Band(s): Your Enrollment Number: Check here if you do not know the enrollment number. 4. Name of Indian Child: Date of Birth: Age: (Note: Consent not valid unless child is at least 10 days old.) 5. Indian Tribe(s)/Band(

s) of Which Child is a Member or Eligible for Membership: Child’s Enrollment Number: Check here if you do not know the enrollment number. 6. In contemplation of the pending custody claim under California Fam.Code § 3041, I VOLUNTARILY CONSENT AND AGREE: (Check only one) a. ______________________________ shall have partial legal and/or physical custody of the child named above. (Name of Non-Parent) -OR- b. ______________________________ shall have full legal and physical custody of the child named above. (Name of Non-Parent) SDSC D-243 (New 4/09) CONSENT TO CUSTODY OF AN INDIAN CHILD Fam.

Code § 3041 TO NON-PARENT AND COURT CERTIFICATION U.S.C §1913 CASE TITLE CASE NUMBER 7. Relationship of Non-Parent to Indian Child: 8. Address of Non-Parent: City: State: Zip Code: Telephone Number: By signing below, I am certifying I know and fully understand the terms and consequences of this consent. I understand I am not waiving my rights under the Indian Child Welfare A ct (25 U.S.C. § 1901 et seq.). I understand I may withdraw and revoke my consent at any time and for any reason, and upon such withdrawal of consent, all provisions of the Indian Child Welfare Act shall apply.

Pursuant to U .S.C § 1913(b), I further understand that upon withdrawal of my consent, my child shall be returned to me as soon as is practicable. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date: Type or Print Name Signature of Indian Parent/Custodian JUDGE’S CERTIFICATION Pursuant to U.S.C § 1913(a), I, Judge/Commissioner , of the Superior Court of California, County of San Diego, hereby certify: ■ This consent was completed in writing and recorded before me. ■ I fully explained the terms and consequences of this consent to (name of parent/custodian): ■ The parent/custodian fully understood the terms and consequences of this consent. ■ The parent/custodian understands English or the hearing was interpreted into a language the parent/custodian understood.

Date: Judge/Commissioner of the Superior Court

Document details

Collection	California Superior Local Rules
Citation	Cal. Form D-243
Type	court_rule
Language	en
Format	pdf
Source	CA_LOCAL
Identifier	60d5a7998069d5642b546c04ebd99cf6a2ee76f4

Source file is stored in the law ingest library (pdf).