ADOPT-220 Adoption of Indian Child Case Number:
✔ This form is attached to Adoption Request (ADOPT-200).
COURT
COUNTY . .
. . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
: Index No.
1 Your name(s) (adopting parent(s)):
a. : Calendar No.
b.
:
Relationship to child: Plaintiff(s) JUDICIAL SUBPOENA
-against-
Your address (skip this if you have a lawyer): :
Street: :
City: State: Zip:
:
Your phone #: ( )
Your lawyer. . . .you . . . . one):. (Name, .address, .phone. #,. and.Defendant(s) . . . . . . .
. . (if . . have . . . . . . . . . . . . . . . . . . . State. Bar. #): .
... .. ..
:
THE PEOPLE OF THE STATE OF NEW YORK
Federal law says the State courts must send a copy of all adoption orders for an Indian child to the Secretary of the
TO
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:
GREETINGS:
Date of birth: Age:
WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before
the Honorable at the Court ,
3 County of (or tribe child is eligible for):
Indian child’s tribe located at
in #:
Enrollmentroom , on the day of , 20 , at o'clock if you
Check herein the do noon, and at any recessed
not know.
or adjourned date, to testify and give evidence as a witness in this action on the part of the
Check here if tribe does not have an enrollment
number.
4 Your failure to (name):
Indian child’s biological mother comply with this subpoena is punishable as a contempt of court and will make you liable to
the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a
Address: result of your failure to comply.
City: State: Zip:
Witness, Honorable
Check here if you do not know. , one of the Justices of the
Court in County, day of , 20
The biological mother attaches her request that her identity remain confidential.
5 Indian child’s biological father (name): (Attorney must sign above and type name below)
Address:
City: State:
Attorney(s) for Zip:
Check here if you do not know.
The biological father attaches his request that his identity remain confidential.
Office and P.O. Address
Telephone No.:
Facsimile No.:
Judicial Council of California, www.courtinfo.ca.gov E-Mail Address: ADOPT-220, Page 1 of 2
Adoption of Indian Child Tel. No.:
Rev. January 1, 2003, Mandatory Form
25 U.S.C. § 1951
Mobile ➔
American LegalNet, Inc.
www.USCourtForms.com
Case Number:
Your name(s):
6 Indian child’s biological Indian grandmother(s) (name(s); include Maiden name(s) if you know them):
Check here if you do not know.
7 Indian child’s biological Indian grandfather(s) (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. Parent(s) 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.
c. A judge has certified that he or she fully explained the terms and consequences of the parent’s agreement to
end parental rights and that the parent(s) 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.
Rev. January 1, 2003
Adoption of Indian Child ADOPT-220, Page 2 of 2