ADOPT-220 - Adoption of Indian Child

Summary

Adoption of Indian Child

Text

Form ID: ADOPT-220
Title: Adoption of Indian Child
Effective Date: 2010-07-01
Mandatory Form: yes
Info Page: https://selfhelp.courts.ca.gov/jcc-form/ADOPT-220
Primary Download URL: https://www.courts.ca.gov/documents/adopt220.pdf
Form Detail Page:
Adoption of Indian Child
(ADOPT-220)
Tells the court that the child who is being adopted is an Indian Child, with Native American ancestry. Once completed, this form must be attached to the Adoption Request (ADOPT-200).
Get form ADOPT-220
Effective: July 1, 2010
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PDF Text:
Judicial Council of California, www.courts.ca.gov 
Revised July 1, 2010, Mandatory Form 
25 U.S.C. § 1951
Adoption of Indian Child
ADOPT-220 Adoption Expenses
Clerk stamps date here when form is filed.
Fill in court name and street address:
Superior Court of California, County of
Fill in case number if known:
Case Number:
This form is attached to Adoption Request (ADOPT-200).
1 Your name (adopting parent):
a.
b.
Relationship to child:
Address (skip this if you have a lawyer):
Street:
City: State: Zip:
Telephone number:
Lawyer (if any): (Name, address, telephone number, and State 
Bar number):
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.
2 Indian child’s name:
Date of birth: Age:
3 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.
4 Indian child’s biological mother (name):
Street address:
City: State: Zip:
Check here if you do not know.
The biological mother attaches her request that her identity remain confidential.
5 Indian child’s biological father (name):
Street address:
City: State: Zip:
Check here if you do not know.
The biological father attaches his request that his identity remain confidential.
ADOPT-220, Page 1 of 2

For your protection and privacy, please press the Clear 
button after you have printed the form.
Revised July 1, 2010
Adoption of Indian Child
Your name:
Case Number:
6 Indian child’s biological Indian grandmothers (names; include maiden names if you know them):
Check here if you do not know.
7 Indian child’s biological Indian grandfathers (names):
Check here if you do not know.
8 Name of any agency with information about this adoption:
9 Other people with information about the Indian child’s ancestry:
Name Relationship to Child
a.
b.
c.
10 Parental rights (check all that apply):
a. A court ended parental rights on (date):
b. Parental rights were modified under a tribal customary adoption order on (date):
c. Parents 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.
d. A judge has certified that he or she fully explained the terms and consequences of the parents’ agreement 
to end parental rights and that the parents 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.
11 Note: The court will notify the American Indian tribe of the child’s adoption.
ADOPT-220, Page 2 of 2

Retrieval chunks

• #1

  Form ID: ADOPT-220 Title: Adoption of Indian Child Effective Date: 2010-07-01 Mandatory Form: yes Info Page: https://selfhelp.courts.ca.gov/jcc-form/ADOPT-220 Primary Download URL: https://www.courts.ca.gov/documents/adopt220.pdf Form Detail Page: Adoption of Indian Child (ADOPT-220) Tells the court that the …

• #2

  8 Name of any agency with information about this adoption: 9 Other people with information about the Indian child’s ancestry: Name Relationship to Child a. b. c. 10 Parental rights (check all that apply): a. A court ended parental rights on (date): b. Parental rights were modified under a tribal customary adop…