IDesILaytagse 1 09762081991ASDDSHS09_7624j^ K e  &,28>DJPV\bhntz6ZSubmit 6 0,H2!"6l)6$64*02509107359060832jB"@X  G[ @@@@@@ @@@@@T*BOfBOfBOfBOf*lXBT*YfBXTOfhIYfXTBTiI \I XTTI RxIiIXZxITwIG[T{IdDG[I ɫD֫D4G[G[  KbDiORY@@@  0X  Di @@@N681&@-Lp r , "  ,,,,,,,, ,׼,,,  porpsilaT porpsilaZ<E porpsilaf porpsilalDataAdefghovwxyz{|}~ArialTimes New Roman!  \;x\! D ! VV H"NT3Submit ` 09762081991BOfBO1*t`BT*hWASDB`TOfhIDSHS`T09_762TiIfXXjdVXXd'@L-?d6l6Kxthis SignatureVersion Data VersV`H$ Blue Keys*Graphics0HeaderW0P6 FieldList< Form Info` LayoutProps r DesPathInfo(x<Adov%w,x3ey:zA{H|O}V~]dkryf gh !(/6=DKRY`gnu|Cell1Cell2Cell3Cell4Cell5Cell12Cell17Cell18Cell19Cell20Cell21Cell22Cell23Cell24Cell25Cell26Cell27Cell28Cell29Cell30Cell31Cell32Cell33Cell34Cell35Cell36Cell37Cell38Cell39Cell40Cell41Cell42Cell43Cell44Cell45Cell46Cell47Cell48Cell49Cell50Cell51Cell52Cell53Cell54Cell55Cell56Cell57Cell58Cell59Cell60Cell61Cell62Cell63Cell64Cell65Cell66Cell67Cell68Cell69Cell70Cell71Cell72Cell73Cell74Cell75A}N> p0 .SUPERIOR COURT OF WASHINGTON FOR THE COUNTY OF   = p"@ dTitle  p @ JUVENILE DIVISION   i  @ ` #VOLUNTARY FOSTER CARE PLACEMENT OF:     ,Arial ($VOLUNTARY FOSTER CARE ($ PLACEMENT OF: 0  NO.     !@ eTitle   `0 $ ^PETITION FOR COURT VALIDATION OF VOLUNTARY CONSENT TO FOSTER CARE PLACEMENT OF AN INDIAN CHILD    9J  9J  9J,Arial (C!PETITION FOR COURT VALIDATION OF (C!VOLUNTARY CONSENT TO FOSTER CARE (CPLACEMENT OF AN INDIAN CHILD P H fTitle   @P An Indian Child  C 0$H gTitle  p0 Name:   H hTitle   Date of birth:  9 .P/ ~DISTRIBUTION: White - Court File Yellow - Service File Pink - Parent/Indian Custodian Goldenrod - Indian Tribe  /@0PP DSHS 09-762 (08/1991)  L/P@/0 ^PETITION FOR COURT VALIDATION OF VOLUNTARY CONSENT TO FOSTER CARE PLACEMENT OF AN INDIAN CHILD  `  I. BASIS   + p00 'I represent to the Court the following:        ,Arial (#'I represent to the Court the following:P0` 1.1   P Information about the child:  x  H vTitle    Age:   $H wTitle  p Sex:   0p$H xTitle  p0p Address:  ' 0@   y    * ` YThe child's residence/domicile is located within the reservation boundaries of the Tribe.  TE ET   TE,Arial (fOSThe child's residence/domicile is located within the reservation boundaries of the (rOTribe. #H  zTitle  @0@   {P    * ` p ]The child's residence/domicile is not located within the boundaries of an Indian reservation.    0@   |0    * @# There is not enough information available at this time to determine whether the child's residence/domicile is within an Indian reservation.  ,,zEG ,EzG TE zEG,Arial (OnThere is not enough information available at this time to determine whether the child's residence/domicile is (Owithin an Indian reservation.0` 1.2   " qThe child is or may be an Indian child as defined by the Indian Child Welfare Act, 25 U.S.C. 1903(4). The child:  17 17  17,Arial (;qThe child is or may be an Indian child as defined by the Indian Child Welfare Act, 25 U.S.C. 1903(4). The child:p0@   }p    *  p Is a member of  C  `p0H ~Title   Tribe. The tribe's address is:   $H Title  0@      *  Is eligible for membership in  |  H Title   $P 5Tribe and is the biological child of a tribal member.    The Tribe's address is:  e  p$H Title  0@      * "$P Is of Indian ancestry and may be a member of or eligible for membership in a federally recognized Indian tribe. Further efforts will be made by the petitioner to ascertain whether the child is an Indian child as defined by the Indian Child Welfare Act. The following efforts have been made to verify whether the child is Indian and to identify the tribal affiliation of the child and the parents/Indian custodian:  ffE+O fEO+ 17 E+O,Arial (OqIs of Indian ancestry and may be a member of or eligible for membership in a federally recognized Indian tribe. (OsFurther efforts will be made by the petitioner to ascertain whether the child is an Indian child as defined by the (OvIndian Child Welfare Act. The following efforts have been made to verify whether the child is Indian and to identify (OEthe tribal affiliation of the child and the parents/Indian custodian:" #$H Title  $00$` 1.3   $0$" qThe child is or may be an Indian child as defined by the Indian Child Welfare Act, 25 U.S.C. 1903(4). The child:  91Y3 193Y  91Y3,Arial (K;qThe child is or may be an Indian child as defined by the Indian Child Welfare Act, 25 U.S.C. 1903(4). The child:$%0@  %%    * %%  The child  ( %&0@  %&    * %&  The child  ( $% @  %% p    * % % is   %& @  %& p    * % & is   $ % `@   % % P    * % % is not   % & `@   % & P    * % & is not   % %$ Vthe subject of any Tribal Court custody order. A copy of each such order is attached.  u % & a ward of Tribal Court.  c &'0@  &'    * &' hThere is not enough information available at this time to determine if the child is a Tribal Court ward.   '0(` 1.4   '(P :Known information about the parent(s)/Indian custodian(s):  r1O 1rO  r1O,Arial (;:Known information about the parent(s)/Indian custodian(s):()Pp a.   ()` 1Name of consenting parent(s)/Indian custodian(s):   (p)P$H Title  )*` Address:  ' )p*P$H Title  *+` Tribal affiliation:  F *p +P$H Title  +,P !Name of non-consenting parent(s):   +`,@#H Title  ,-P Address:  ' ,`-@$H  Title  -.P Tribal affiliation:  F -` .@$H! Title  +,@p b.   /p 0$  PAGE 1 0F 2  00K  , () -(###) ###-####(000) 000-0000@@X   ' @@@@@@ @@@@@ p{*u>X? P *? P *0? p{*>0? p{2hI>p{0? p{iI  \I p{p{g{ RxIiIZxIp{wI' p{{IDdD' Dg{ ɫD֫Dt' ' qrbD! OR@@@  @@X  D ! @@@  @@X  D ! @@@   @@X  D ! @@RbD! OR@@X  D ! LBHN~=^~:B"p@#P H7 oTitle  #` # DATE ` @ Name of Indian custodian(s):   p P$H" Title   ` Address:  ' p P$H# Title    ` Tribal affiliation:  F  p P$H$ Title  Pp c.    P @%     P    *  @ ` has    P0@&    P    *   ` has not  !   ` 0consented to foster care placement of the child.     ` The Indian custodian  \  ` @ @$H' Title    ` P for the following reason(s):  1 1  1,Arial (;for the following reason(s): 0 @` 1.5     @$` xThe consenting parent/Indian custodian of the child wishes to voluntarily consent to foster care placement of the child     pP$H( Title  pP$H) Title  p  reason(s):  - 0P` 1.6   P#@ tThe consenting parent/Indian custodian of the child cannot or will not assume custody of the child for the following   `$H* Title  0`` 1.7   `P +The non-consenting parent/Indian custodian    `P@+`  pP    * `  agrees with  3 P0@,  P    * `p opposes  & `# #foster care placement of the child.   `0 ` 1.8   ` The child will be placed with:  1< 1<  1<,Arial (.;The child will be placed with:0@-       * 0 .A member of the Indian child's extended family   0@.      *  2A foster home approved by the Indian child's tribe   0@/      *  p A licensed Indian foster home   0@0      * P$0 An institution for children approved by an Indian tribe or operated by an Indian organization which has a program suitable to meet the Indian child's needs.  >>SEM >ESM 1< SEM,Arial (eOrAn institution for children approved by an Indian tribe or operated by an Indian organization which has a program (qO*suitable to meet the Indian child's needs.$H1 Title  `0 ` 1.9   ` 0 ^The child will not be placed in any of the preferred placements listed in section 1.8 because:    0 1.10     >Known information about the prospective foster care placement.    Name of care providers:  k  $H2 Title  p Address:  ' `$H3 Title   p Tribal affiliation (if any):  1 1  1,Arial (;Tribal affiliation (if any): P#H4 Title  0 1.11   p 2Agency/person that arranged foster care placement.    Name:   p#H5 Title  p Address:  ' `p$H6 Title  `  II. RELIEF REQUESTED   r  0"$ I request that the court set the matter for a validation hearing and that the court validate the voluntary consent to foster care placement, as provided in Chapter 13.34 RCW and 25 U.S.C. 1913(a).  ff+S fS+ 1 +S,Arial (#I request that the court set the matter for a validation hearing and that the court validate the voluntary consent to foster care (#Bplacement, as provided in Chapter 13.34 RCW and 25 U.S.C. 1913(a)."p@#P!H8 Title  #` #  PETITIONER *$@$!H9 Title  $ %` TITLE/AGENCY/RELATIONSHIP g%&p0 III. CERTIFICATION   ] &0(# I certify under penalty of perjury under the laws of the state of Washington that the foregoing representations are true and correct.  &&^I &^I +S ^I,Arial (p#}I certify under penalty of perjury under the laws of the state of Washington that the foregoing representations are true and (|#correct./00`@ DSHS 09-762 (08/1991)  N/`0/ ^PETITION FOR COURT VALIDATION OF VOLUNTARY CONSENT TO FOSTER CARE PLACEMENT OF AN INDIAN CHILD  / 0$  PAGE 2 0F 2  ,*p0* SERVICE WORKER B+0,@ ADDRESS #+@,@P STREET -00- CITY -0 - STATE -0-" ZIP CODE !.0/ TELEPHONE NUMBER L(0(  Signed at   wZ wZ  wZ,Arial (# Signed at (( , Washington, this  P ((p day of   (!P("0 20    '(H: Title  ' (PH; Title  'p(!H< Title  '"0($H= Title  )p *P$H> Title  * +$H? Title  ,0 -$H@ Title  - .p$HA Title  p P$H" Title   ` Address:  ' p P$H# Title    ` Tribal affiliation:  F  p P$H$ Title  Pp c.    P @%     P    *  @ ` has    P0@&    P    *   ` has not  !   ` 0consented to foster care placement of the child.     ` The Indian custodian  \  ` @ @$H' Title    ` P for the following reason(s):  1 1  1,Arial (;for the following reason(s): 0 @` 1.5     @$` xThe consenting parent/Indian custodian of the child wishes to voluntarily consent to foster care placement of the child     pP$H( Title  pP$H) Title  p  reason(s):  - 0P` 1.6   P#@ tThe consenting parent/Indian custodian of the child cannot or will not assume custody of the child for the following