CASE NAME:

CASE NUMBER:

ICWA-030(A)

ATTACHMENT TO NOTICE OF CHILD CUSTODY PROCEEDING FOR INDIAN CHILD

(This attachment may be used with form ICWA-030 to show additional tribes or bands served with the Notice)

NAMES, ADDRESSES, AND TELEPHONE NUMBERS  OF ALL PERSONS, TRIBES, 

OR AGENCIES TO WHOM NOTICE WAS MAILED (Continued)

Tribe (Name):

 Addressee (Name):
Title:
Street address:
Mailing address:
City, state and zip code:
Telephone number:

Tribe (Name):

 Addressee (Name):
Title:
Street address:
Mailing address:
City, state and zip code:
Telephone number:

Tribe (Name):

 Addressee (Name):
Title:
Street address:
Mailing address:
City, state and zip code:
Telephone number:

Tribe (Name):

 Addressee (Name):
Title:
Street address:
Mailing address:
City, state and zip code:
Telephone number:

Tribe (Name):

 Addressee (Name):
Title:
Street address:
Mailing address:
City, state and zip code:
Telephone number:

Tribe (Name):

 Addressee (Name):
Title:
Street address:
Mailing address:
City, state and zip code:
Telephone number:

Tribe (Name):

 Addressee (Name):
Title:
Street address:
Mailing address:
City, state and zip code:
Telephone number:

Tribe (Name):

 Addressee (Name):
Title:
Street address:
Mailing address:
City, state and zip code:
Telephone number:

Form Approved for Optional Use 
Judicial Council of California
ICWA-030(A) [New January 1, 2008]

ATTACHMENT TO NOTICE OF CHILD CUSTODY 
PROCEEDING FOR INDIAN CHILD
(Indian Child Welfare Act)

Page

25 U.S.C. § 1901 et seq.;
Family Code, § 180;
Welfare and Institutions Code, §§ 224.2, 224.3;
Probate Code, §§  1449, 1459.5, 1460.2;
Cal. Rules of Court, rules 5.480–5.487 and 7.1015
www.courtinfo.ca.gov