BIDesILaytags$T@ 13257092461g4j{. #$T (x¢V B &,28>DJPV\bhntz6x 0 pro6 ^5;qh proc2 putinterval 6Ftop xdf/right xdf/bottom x6$h{newpath left bottom moveto l64*40980670010765030neto cljN"X   G @@@@@@ @@@@@ \Gp"RG#\"R#\#(#( #\G"-"1 G"R4GG"R#(#\"R#( X#\" " G"R@GG"RG#(##("GpRL"Gp"R G##"MX"G"RG#"RG#"R@@#e*@@@  @@X  b G @@@n{}def /setTxMode{pop}def /gm{moveto}def /show{pop}def /gr{pN68/ *`&P0@$1&@XXjdVXXd' r ?d pV 3Submit ing/Ccedilla/ XXjdVXXd' r ?dBsis/ntilde/oac6BfSubmit e/Ou~* @,@ @ ",5s5sﺭﺭﺭzﺭ6  propalis` propalisf propalisr propalisx porpsila porpsila<EqDataTlkjihgfedArialtica0gZ@gZ@~#@gZgZ@*gZTimes New Roman????g(  ????  ????  t??? MQHH MQ?? ????? ????? ???????????????? ?????????? ?????????? ????????????????????? IMHH IM?????????????????????????????????????????? ????????? ????????? ???????? ? ? ??? ? ? ??? ? ? ?? ???? ???? ??? EIHH EI?????????????????????????????? AEHH AE????????? =AHH =A? ? ? ????????????????????? 9=HH 9=? ??? ??? ??? ??? ??? ???? ? ???? ? ???? ? ?? ??????? ???????????? ???????????? ???????????? ? ??????????????? ? ??????????????? ? ???????? 59HH 59 ????  ????  ????    ? ? ????? ? ????? ? ?????? ????????? ????????? ??????? 15HH 15?????????'?????????????? ? ????????????? ? ????????????? ? ????????$??????? ?????$??????? ?????$??????? ????? -1HH -1z????????????????????????????????? )-HH )-z??????z?????????t %)HH %)???????????????tt??? !%HH !%???????????????????????????????????????????????????????????????????????????????????????????????????????????? !HH !??????n????????????V???????????????????????????\?????????????????? HH S??????A?????? ??? ??? ??? ??? ???  HH D???P?????????P??????2??? HH P???Y??????MM??? HH  V???b????????????JV??? HH  P??????J???_???e????????????  HH  ;?????????2P??????S?????? HH &?????? ??? ???) HH h(/? ??<?? ??|??? ??~C? ???F ~J |K? xG ??F ???F ???E ??H? ````?????%pc?? <?"??"#?  ````????60p?? ````?????????? %# _?? ````?????????? i`i`i`i`?????????????????  Li`Li`Li`Li`??????  /L`/L`/L`/L`?          ?      ?  ? /`/`/`/`  ````0@@X   @@@@@@ @@@@@HThTHT70/T08p/p5Q ,T"Q p`1T/p@R Q R|TQ||RT/WT$/MT&S"/T"d/AQ|.{#A #"(S"@@@  @@X   @@@  @@X   @@@   @@X   2NTZNo{.T": AM PM   $,.YesNo/,  , : AM PM   $,.YesNo/,  , : AM PM  $,.YesNo/,  , : AM PM @,@ @ ",85s85s888;8868  propalis` propalisf propalisr propalisx porpsila porpsila<Eqa0gZ@gZ@~#@gZgZ@*gZArialN`3Submit l 1325709246"G"R##1"R##"v"##"G_" pG"RfG#\"R###G@ G`" r,, y g(,,(d'h6thisx Signature@AVersionAPAǐ Data Versǐ$ Blue Keys *Graphics 0HeaderAAǐ6 FieldList< Form Infol LayoutProps,k@~ DesPathInfo,a 9Z1`  B DEPARTMENT OF SOCIAL AND HEALTH SERVICES CHILDREN'S ADMINISTRATION  D D  D,Arial (,)DEPARTMENT OF SOCIAL AND HEALTH SERVICES (6CHILDREN'S ADMINISTRATION @P ; NOTICE TO FEDERALLY RECOGNIZED INDIAN TRIBE, BAND OR NATION  3_ 3_ D 3_,Arial (E-NOTICE TO FEDERALLY RECOGNIZED INDIAN TRIBE, (QBAND OR NATION0@@  d@P "TO: (INDIAN TRIBE, BAND OR NATION) "\)0$@  e@# DATE: "\)@0@@  fPA ADDRESS: (BOX OR STREET NUMBER) "\)0$@@  gA# DSHS CASE NUMBER: "\)V0@ @  h@P CITY: "\)0 $@  i@# LEGAL FILE NUMBER: "\)T0 @  j@ STATE: "\)0 @  k@  ZIP CODE: "\)( @ $@    l P # AN INDIAN CHILD: "\)E @ $8 ` p IN THE INTEREST OF:  m N weR ^  @$ @p# (Pursuant to the Indian Child Welfare Act of 1978, 25 U.S.C. 1901 et eq., and state law, if you are a federally recognized Indian Tribe, Band or Nation and the above named child is (a) a member of your Tribe or (b) eligible for Tribal membership you have specific rights which are described below.  G G  G,Arial ('zPursuant to the Indian Child Welfare Act of 1978, 25 U.S.C. 1901 et eq., and state law, if you are a federally recognized ('pIndian Tribe, Band or Nation and the above named child is (a) a member of your Tribe or (b) eligible for Tribal ('>membership you have specific rights which are described below.@-$P# YOU ARE HEREBY NOTIFIED THAT THE FOLLOWING LEGAL ACTION IS PENDING FOR THE ABOVE NAMED INDIAN CHILD (RCW's can be located at www.leg.wa.gov/ws/adm/rcw.htm):  883H 83H G 3H,Arial (=QYOU ARE HEREBY NOTIFIED THAT THE FOLLOWING LEGAL ACTION IS PENDING FOR THE ABOVE (=KNAMED INDIAN CHILD (RCW's can be located at www.leg.wa.gov/ws/adm/rcw.htm):@P 1.  m New R 0` 2.  m N weR  0 INFORMATION ABOUT THE HEARING:  m New R %@'` @ &  %P& DATE OF HEARING: ;L% '`@!&  % & TIME OF HEARING: J%'`$@"&  %&# LOCATION OF COURT: W'`@($@#(   'pP(!# MAILING ADDRESS OF COURT: y(@*`$@$)  (P)# TELEPHONE NUMBER OF COURT: *`@+$@%+   *pP+!# NAME OF JUDGE (IF KNOWN): u,@, ?Copies of any hearing notice entered by the court are attached.   2+ .P/P =NOTICE TO INDIAN TRIBE, BAND OR NATION DSHS 09-541 (03/2003)    ,Arial (%'NOTICE TO INDIAN TRIBE, BAND OR NATION (%DSHS 09-541 (03/2003) -p . ZDistribution: Indian Child's Tribe, Service File, Court File, Indian Child's Parent(s) 2(.!P/@$  Page 1 of 3 2)@@@@@DH0p@ p  @p AValidation of parental consent to foster care (Chapter 13.34 RCW)  ;)$ p@ p   p Dependency (Chapter 13.34 RCW)  ;) p@ p  p  Guardianship (Chapter 13.34 RCW)  ;) p@ p  p >Involuntary termination of parental rights (Chapter 13.34 RCW)  ;) p@p  p ?Voluntary relinquishment of parental rights (Chapter 26.33 RCW)  ;) p`@p  `p 2Termination of parental rights (Chapter 26.33 RCW)  ;) pp@@p  @p Adoption (Chapter 26.33 RCW)  ;) Pp @p  ` p !CHINS (Child in Need of Services)  ;) 0p@p  @p ARY (At Risk Youth)  ;)Z  p@p  0 Other:  ;) 0#pH Title  pP@p  Pp .Validation of consent to foster care placement  ;) `p0@p  p0p Shelter care hearing  ;)Z @p#@p  P# g>Fact finding or hearing on the petition. A COPY OF THE PETITION IS ATTACHED. A written response to the  )  L   0 Petition is not required.  2f p`@p  P !CHINS (Child in Need of Services)  ;f p p`@p   pP ARY (At Risk Youth)  ;fZ  p!P`@p   !PP Dependency disposition  ;fi !`p"0`@p  !p"0P Dependency review  ;fW "@p#`@p  "P#P Permanency planning  ;f` # p#`@p  #0#P Adoption  ;f' $p$@p  $$ Other:   ;f $p$#`H Title  Title  scheduling orders) entered by the court are attached.   "Y. 0 00@ fNOTICE TO INDIAN TRIE, BAND OR NATION DSHS 09-541 (00/0000) NEW REVISION TONI BENHAM 902-8342 45805    ,  Helvetica .(&NOTICE TO INDIAN TRIE, BAND OR NATION *@DSHS 09-541 (00/0000) NEW REVISION TONI BENHAM 902-8342 45805/0/ zDistribution: White - Indian Child's Tribe Yellow - Service File Pink - Court File Goldenrod - Indian Child's Parent(s)"Y/" 00$  Page 1 of 3"Y(9.@@-`$ p @ 4.   p   P 2INFORMATION ABOUT THE CHILD AND HIS/HER PARENT(S):   p$  @ @/    P  CHILD'S FULL NAME: ;$Q  $@0     # CHILD'S BIRTH DATE: ;$S @@1    P! CHILD'S ADDRESS: ;$J @2    ! CITY: ;$ @3    ! STATE: ;$ $@4    !#  ZIP CODE: ;$(@$@5   P# TRIBAL AFFILIATION OF CHILD: ;$y@@6   P! +MOTHER'S FULL NAME (including maiden name): ;$$@7   !# MOTHER'S BIRTH DATE: ;$^@@8   P MOTHER'S ADDRESS: ;$U@9    CITY: ;$@:    STATE: ;$$@;   #  ZIP CODE: ;$(@$@<   P!# MOTHER'S TRIBAL AFFILIATION: ;$~@@=   P FATHER'S FULL NAME: ;$Y$@>   # FATHER'S BIRTH DATE: ;$\@@?   P! FATHER'S ADDRESS: ;$S@@   ! CITY: ;$@A   ! STATE: ;$$@B   !#  ZIP CODE: ;$(@$@C   P# FATHER'S TRIBAL AFFILIATION: {@@D   P! ALLEGED FATHER'S FULL NAME: $@E   !# ALLEGED FATHER'S BIRTH DATE: @@F   P ALLEGED FATHER'S ADDRESS: z@G    CITY: @H    STATE: $@I   #  ZIP CODE: (@$@J   P!# &TRIBAL AFFILIATION OF ALLEGED FATHER : p` 0 5.   @ p  ADVICE OF THE TRIBE'S RIGHTS:   @ -P# >If your Tribe has court jurisdiction over this child or family, you may have exclusive jurisdiction. Please contact the social worker listed below to make proper arrangements. There is reason to believe that the child is (a) a member of your Tribe or (b) eligible for Tribal membership. Upon request, this agency will furnish case record material, reports or other documents that formed the basis for the decision to petition the court, as well as all reports and other documents that this agency intends to provide the court in support of the petition. You have the right to examine and receive copies of such other documents that may assist the Tribe in deciding whether to petition for transfer of jurisdiction to the Tribe and/or intervene in the State Court proceeding. The child's Indian Tribe has the right to intervene at any point in the court proceedings. If you wish to use this right of intervention and desire additional time to prepare, the scheduled court hearing can and will be delayed up to twenty (20) days upon your request if the proceeding involves dependency, guardianship, or termination of parental rights. The most effective way to intervene and/or request a continuance is to fill out the attached Notice of Intervention and Request for Continuance (DSHS 09-542) and return it as soon as possible to the Court address listed on this notice. The Tribe may also intervene by personally appearing at the next scheduled hearing or by sending a written request for continuance and/or notice of intervention to the Court.        5.1  @ !" 5.2  @ %& 5.3  @ (( 5.4  @ - .0 ZDistribution: Indian Child's Tribe, Service File, Court File, Indian Child's Parent(s) @(.!p/$@  Page 2 of 3 @)pp@ 3.   @ p` THE LEGAL ACTION MAY RESULT IN:   @ p`p@&p  ``  Dependency  ;8 @` @@'@  P` 0 New  ; P@ @@(@  `P 0 Ongoing  & `p0p@)p  p0`  Guardianship  ; @p@*p  P *Foster Care or other out of home placement    p`@+p  0P !Permanent loss of parental rights    p @,p     Adoption  '  p @-p     Other:     ` #PH. Title  .@/@ =NOTICE TO INDIAN TRIBE, BAND OR NATION DSHS 09-541 (03/2003)    ,Arial ($'NOTICE TO INDIAN TRIBE, BAND OR NATION ($DSHS 09-541 (03/2003)  Title   0 p  p $ wDependency Guardianship Foster Care or Other Out of Home Placement Permanent Loss of Parental Rights Adoption Other:   PP43Y 34Y @8 43Y, Helvetica (H= Dependency(r= Guardianship(=*Foster Care or Other Out of Home Placement(=!Permanent Loss of Parental Rights(=Adoption(=Other:`  New Ongoing  AFp FAp 43Y AFp, Helvetica (UPNew(cPOngoing  %  %  !Permanent Loss of Parental Rights  " vlteci P@NP  ` New  " lvetic PPP `@OP  ``P P Ongoing  " vlteci&   @P     Adoption  " lvetic'    d"Y -p.  5.6   d"Y 0P0` fNOTICE TO INDIAN TRIE, BAND OR NATION DSHS 09-541 (00/0000) NEW REVISION TONI BENHAM 902-8342 45805    ,  Helvetica .(&NOTICE TO INDIAN TRIE, BAND OR NATION *@DSHS 09-541 (00/0000) NEW REVISION TONI BENHAM 902-8342 45805/ / zDistribution: White - Indian Child's Tribe Yellow - Service File Pink - Court File Goldenrod - Indian Child's Parent(s)d"Y/"00%P  Page 2 of 3d"Y(3¢<Td&.6>Fe6=f DKRYg`gnu|hi$j$+29@GNU\ck*jqxl0NCell1Cell2Cell3Cell4Cell5Cell6Cell7Cell8Cell9Cell28Cell29Cell30Cell31Cell32Cell33Cell41Cell42Cell43Cell44Cell45Cell46Cell47Cell48Cell49Cell50Cell51Cell52Cell53Cell54Cell55Cell56Cell57Cell58Cell59Cell60Cell61Cell62Cell63Cell64Cell65Cell66Cell67Cell68Cell69Cell71Cell72Cell73Cell74Cell75Cell76Cell77Cell78Cell79Cell80Cell81Cell82Cell83Cell84Cell85Cell86Cell87Cell88Cell89Cell90Cell91Cell92Cell93Cell94Cell95Cell96Cell97Cell98Cell99Cell100Cell101Cell102Cell103Cell104Cell105Cell106Cell107Cell108Cell109Cell110NAME OF SOCIA"#@@($ p # To locate the nearest Tribe or Indian organization consult the Indian Child Welfare Program Manager at (360) 902-7982, Children's Administration, Division of Program and Policy Development, PO BOX 45710, Olympia, WA. 98504-5710.  G G  G,Arial ('mTo locate the nearest Tribe or Indian organization consult the Indian Child Welfare Program Manager at (360) ('l902-7982, Children's Administration, Division of Program and Policy Development, PO BOX 45710, Olympia, WA. (' 98504-5710. 0p APlease keep the information contained in this Notice Confidential   p4  @$@K  0P# NAME OF SOCIAL WORKER: ;4m@ @L0  P1 AGENCY ADDRESS: ;4M @M0  1 CITY: ;4 @N0  1 STATE: ;4 $@O0  1#  ZIP CODE: ;4( @ @P  0P !SOCIAL WORKER'S TELEPHONE NUMBER: ;4  $@Q  00# SOCIAL WORKER'S FAX NUMBER: ;4@ $@R0  P1# PASSISTANT ATTORNEY GENERAL/PROSECUTING ATTORNEY ASSIGNED TO THE CASE (if known): ;4z @$@S  0P# CASSISTANT ATTORNEY GENERAL/PROSECUTING ATTORNEY'S TELEPHONE NUMBER: ;4P@ $@T0  P1# <ASSISTANT ATTORNEY GENERAL/PROSECUTING ATORNEY'S FAX NUMBER: ;4*@ p" >If the above hearing is a fact finding, or hearing on the petition, attach a copy of the petition. Send to the Tribe by registered mail, return receipt requested, and marked Confidential. The following forms are attached:  d    `&#` [DSHS 09-542, Notice of Intervention and Request for Continuance. Any court orders. DSHS 04-220, Family Ancestry Chart. Petition DSHS 15-209, Individual Service and Safety Plan (ISSP) DSHS 09-547, Motion and Order to Transfer Jurisdiction to Tribal Court DSHS 09-548, Motion and Order For the Tribal Court to Accept Jurisdiction under 25USC1911(b)  ^^|k@ ^|@k  |k@,Arial (ADSHS 09-542, Notice of Intervention and Request for Continuance. (!Any court orders. (-$DSHS 04-220, Family Ancestry Chart. (9 Petition (E8DSHS 15-209, Individual Service and Safety Plan (ISSP) (QGDSHS 09-547, Motion and Order to Transfer Jurisdiction to Tribal Court (]\DSHS 09-548, Motion and Order For the Tribal Court to Accept Jurisdiction under 25USC1911(b) `&0 1. 2, 3. 4. 5. 6. 7.  lk lk |k@ lk,Arial (v1. (!v2, (-v3. (9v4. (Ev5. (Qv6. (]v7.- p- ^Distribution: Indian Child's Tribe, Service File, Court File, Indian Child's Parent(s) p1.!p/0$@  Page 3 of 3 p) # >You have the right to petition the Court to transfer the proceeding to the jurisdiction of the Tribe. If you wish to request a transfer, please file a transfer petition as soon as possible after receiving notice. Unnecessary delay may result in denial of the request for transfer. To request a transfer of jurisdiction, you may fill out the Motion and Order to Transfer Jurisdiction to Tribal Court (DSHS 09-547) and return it as soon as possible to the court address indicated on this notice. The Tribe may also request transfer of jurisdiction at the next scheduled court hearing or by sending a written request for transfer to the Superior Court. You may wish to contact another Tribe or off-reservation Indian organization for referral, consultation and/or possible intervention.      p 5.5  p  5.6  p  P $ P $.p@/0 =NOTICE TO INDIAN TRIBE, BAND OR NATION DSHS 09-541 (03/2003)   lk ,Arial ($'NOTICE TO INDIAN TRIBE, BAND OR NATION ($DSHS 09-541 (03/2003)  p  P $ P $ ` `% ..$3S 3$S wj $3S, Helvetica (6=}You have the right to petition the Court to transfer the proceeding to the jurisdiction of the Tribe. If you wish to request(B=xa transfer, please file a transfer petition as soon as possible after receiving notice. Unnecessary delay may result in(N=%denial of the request for transfer. (NXTo request a transfer of jurisdiction, you may fill out the Motion and Order to Transfer(Z=sJurisdiction to Tribal Court (DSHS 09-547) and return it as soon as possible to the court address indicated on this(f=notice.(fZq The Tribe may also request transfer of jurisdiction at the next scheduled court hearing or by sending a written(r=+request for transfer to the Superior Court.(=wYou may wish to contact another Tribe or off-reservation Indian organization for referral, consultation and/or possible(= intervention.0`` 5.5  4G  0` 5.6    ^ b% ` `%VH    4 HH   HH \ HH \ HH \ HH  HH . HH 1 HH 4 HH R HH  HH  HH  HH X HH L HH L HH I HH L HH I HH F HH F HH = HH @ HH . HH " HH F HH U HH  HH  HH  HH  HH @ HH C HH R HH  HH  HH  HH  HH  HH  HH  HH  HH x HH x HH x HH x HH u HH \ HH \ HH b HH b HH b HH b HH b HH b HH b HH b HH b HH b HH b HH b HH b HH h HH ^ HH a HH a HH  HH  HH  HH  HH  HH  HH  HH  HH  HH  HH  HH  HH j HH j HH j HH j HH ^ HH v HH  HH  HH  HH  HH p HH j HH d HH m HH  HH  HH  HH  HH  HH  HH  ~HH ~ }~HH }~z |}HH |}z {|HH {|z z{HH z{z yzHH yzk xyHH xy\ wxHH wx\ vwHH vw\ uvHH uv\ tuHH tu\ stHH st\ rsHH rs\ qrHH qr\ pqHH pq\ opHH op\ noHH no\ mnHH mn\ lmHH lm\ klHH kl\ jkHH jk\ ijHH ijb hiHH hib ghHH ghq fgHH fgq efHH efq deHH dee cdHH cd bcHH bcX abHH ab `aHH `a _`HH _` ^_HH ^_ ]^HH ]^ \]HH \] [\HH [\ Z[HH Z[ YZHH YZd XYHH XY_ WXHH WXe VWHH VW\ UVHH UV\ TUHH TU STHH STw RSHH RS QRHH QR7 PQHH PQ OPHH OP NOHH NO MNHH MN LMHH LM KLHH KL JKHH JKt IJHH IJn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