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ADOPT-220 Adoption of Indian Child 

Clerk stamps date here when form is filed.

This form is attached to Adoption Request (ADOPT-200).

1

Your name (adopting parent):

a.

b.

Street:

Relationship to child:

Address (skip this if you have a lawyer):

City:
Telephone number: (
Lawyer (if any): (Name, address, telephone number, and State 
Bar number):

State:

Zip:

)

Fill in court name and street address:

Superior Court of California, County of

Fill in case number if known:
Case 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

3

4

Indian child’s name:
Date of birth:

Age:

Indian child’s tribe (or tribe child is eligible for):
Enrollment #:

Indian child’s biological mother (name):
Street address:

City:

Check here if  you do not know.

Check here if tribe does not have an 
enrollment number.

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:

Check here if  you do not know.
The biological father attaches his request that his identity remain confidential.

State:

Zip:

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, Page 1 of 2

Indian child’s biological Indian grandmothers (names; include maiden names if you know them):

Case Number:

Your name:

6

7

Check here if  you do not know.

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.

b.

c.

d.

10

Parental rights (check all that apply):
a.

A court ended parental rights on (date):

Parental rights were modified under a tribal customary adoption order on  (date):

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):

ADOPT-225 was recorded in front of a judge and is attached to ADOPT-200 (Adoption Request). 

ADOPT-225 was signed at least 10 days after the birth date of the Indian child.

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.

This certificate was filed with the court on (date):
This certificate is attached to ADOPT-200 or will be filed before the adoption hearing.

; OR

(2)

(3)

(1)

(2)

11

Note: The court will notify the American Indian tribe of the child’s adoption.

Revised July 1, 2010

Adoption of Indian Child

ADOPT-220, Page 2 of 2

Adoption of Indian Child

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the California state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from selfhelp.courts.ca.gov (2023-03)
Page(s): 2
Fields(s): 55
Average fields per page: 27
Reading Level: Grade 6
LIST Grouping(s): FA-00-00-00-00.

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Adoption of Indian Child

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02