California Adopt 220 Adoption of Indian Child
Download and Use this form if you are Adopting an Indian Child in the State of California.
Text Version of the Form
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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.
Relationship to child:
Address (skip this if you have a lawyer): Fill in court name and street address:
Street: Superior Court of California, County of
City: State: Zip:
Telephone number: ( )
Lawyer (if any): (Name, address, telephone number, and State
Bar number):
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 Indian child’s name:
Date of birth: Age:3 Indian child’s tribe (or tribe child is eligible for):
Enrollment #: Check here if you do not know.Check here if tribe does not have an
enrollment number.4 Indian child’s biological mother (name):
Street address:City: 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: State: Zip:
Check here if you do not know.
The biological father attaches his request that his identity remain confidential.Judicial Council of California, www.courts.ca.gov Adoption of Indian Child ADOPT-220, Page 1 of 2
Revised July 1, 2010, Mandatory Form
25 U.S.C. § 1951———————– Page 2———————–
Case Number:
Your name:
6 Indian child’s biological Indian grandmothers (names; include maiden names if you know them):
Check here if you do not know.
7 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 Childa.
b.
c.
10 Parental rights (check all that apply):
a. A court ended parental rights on (date):b. Parental rights were modified under a tribal customary adoption order on (date):
c. 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):(2) ADOPT-225 was recorded in front of a judge and is attached to ADOPT-200 (Adoption Request).
(3) ADOPT-225 was signed at least 10 days after the birth date of the Indian child.
d. 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.(1) This certificate was filed with the court on (date): ; OR
(2) This certificate is attached to ADOPT-200 or will be filed before the adoption hearing.
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