First and last name(s), alias(es) 

          

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  Date of birth

				
 
 
 

				

				
 
 
 

				

				

 

 

	

	

	

	

	

	
	

	

	

	

	

	

	
	

	

	

	
 
 
 

	

	
 
 
 

	

	

 

	
	
 
 
 
 
 
	

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(Name and telephone no. of natural
father or Indian custodian. State if

 
 
  unknown.)

 
(Name and telephone no. of natural
  mother or Indian custodian. State if
  unknown.)

 

 

(Name and telephone no. of ICWA 
Designated Tribal Agent. See list 
here. State if unknown.) 

 
(Use only if identity of parents,
  custodian, or tribe is unknown.
 
  attach a sheet with name(s) and  

If grandparent(s) are known, please 
 

 
 
 
 
       date(s) of birth.)
	

	

 .

 

2. This hearing will concern 

 

 removal from the home or placement in foster care. 

 termination of parental rights.

3. A copy of the petition is attached to this notice.

4. You have the absolute right to intervene in this proceeding and, absent objection by either Indian parent, you have the

1. A hearing will be held concerning the Indian child named above on  

Date and time

Location

at 

   

 

right to petition the court to have this case transferred to the Tribal court of the 

  Tribe. The Tribal court may decline the transfer.

				
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               Bureau of Indian Affairs, Midwest Regional Office 
               Norman Pointe II 
               5600 West American Blvd., Suite 500 
               Bloomington, MN 55437 
               (612) 725-4571 or 4572 
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TAKE NOTICE:

 
 
 
 
	

	
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TO:                    
                     
 
                     
 

	

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In the matter of 

STATE OF MICHIGANJUDICIAL CIRCUIT - FAMILY DIVISIONCOUNTYNOTICE OF PROCEEDINGSCONCERNING AN INDIAN CHILDCASE NO.PETITION NO.JUDGECourt addressCourt telephone no.Approved, SCAOForm JC 48, Rev. 3/2325 USC 1912, MCR 3.920(C)(1)Page 1 of 2Distribute form to:         Indian TribeCourtMichigan Department of Health and Human ServicesAdditional copies as neededJIS Code: NPINotice of Proceedings Concerning an Indian Child 
Page 2 of 2

(3/23) 

Case No. 
 

5. You may object to a transfer of this case to the Tribal court.

6. You may request an adjournment of this case for a period of up to 20 days.

7. As a parent or Indian custodian, you have the right to a court-appointed attorney if you are determined indigent. If you
intend to request a court-appointed attorney, you should contact the court immediately by telephone or in writing.
 

You are not required to attend this hearing unless this notice is accompanied by a summons or subpoena.

If you choose to attend this hearing and you require accommodations to use the court because of a disability or if you
require a foreign language interpreter to help you fully participate in court proceedings, please contact the court immediately 
to make arrangements.

USE NOTE: This notice must be sent to the parties by registered mail, return receipt requested.