Fla. Fam. Law R.P. Form 12.981(a)(5)

Florida Statutes

Florida Family Law Rules of Procedure

Section II. Family Law Forms, Commentary, and Instructions


Form 12.981(a)(5). Indian Child Welfare Act Affidavit


IN THE CIRCUIT COURT OF THE __________ JUDICIAL CIRCUIT, IN AND FOR __________

COUNTY, FLORIDA


                                    Case No.: _________________________

                                    Division: _________________________


IN THE MATTER OF THE ADOPTION OF


__________________________________,

                       Adoptee(s).


INDIAN CHILD WELFARE ACT AFFIDAVIT

I, {full legal name} ____________________, being sworn, certify that the following statements are true:


1.    Upon information and belief the child ____________________ {name} subject

       to this proceeding:

[<<SYM>> one only]


___   is not an Indian child. The Indian Child Welfare Act does not apply to

       this proceeding.


___   is an Indian child within the meaning of the Indian Child Welfare Act of

       1978 (25 U.S.C. § 1901 et seq.).


I certify that a copy of this document was [<<SYM>> one only] ( ) mailed  ( ) faxed and mailed ( ) hand delivered to the person(s) listed below on  {date} __________.


Other party or his/her attorney:

Name: __________________________

Address: _______________________

City, State, Zip: ______________

Fax Number: ____________________


I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this affidavit and that the punishment for knowingly making a false statement includes fines and/or imprisonment.


Dated: ____________________________  ___________________________________

                                    Signature of Party

                                    Printed Name: _____________________

                                    Address: __________________________

                                    City, State, Zip: _________________

                                    Telephone Number: _________________

                                    Fax Number: _______________________


STATE OF FLORIDA


COUNTY OF __________


Sworn to or affirmed and signed before me on __________ by __________.


                                        ______________________________________

                                        NOTARY PUBLIC or DEPUTY CLERK

                                        ______________________________________

                                        [Print, type, or stamp commissioned

                                          name of notary or clerk.]

___  Personally known

___  Produced identification

    Type of identification produced ____________________


IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:  [<<PencilInHand>> fill in all blanks]


I, {full legal name and trade name of nonlawyer} _____________________________, a nonlawyer, located at {street} ____________________, {city} _______________, {state} __________, {phone} __________, helped {name} __________, who is the [<<SYM>> one only] ___ petitioner or ___ respondent, fill out this form.


INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.981(a)(5),

INDIAN CHILD WELFARE ACT AFFIDAVIT

When should this form be used?

This form should be used in cases involving stepparent adoption of a child.  This affidavit is required.


This form should be typed or printed in black ink.  After completing this form, you should sign the form before a notary public or deputy clerk.  You should then file the original with the clerk of the circuit court in the county where the petition was filed and keep a copy for your records.


What should I do next?

A copy of this form must be mailed or hand delivered to the other party in your case, if it is not served on him or her with your initial papers.


Where can I look for more information?

Before proceeding, you should read "General Information for Self-Represented Litigants" found at the beginning of these forms.  The words that are in "bold underline" in these instructions are defined there.


Special notes ...

Remember, a person who is NOT an attorney is called a nonlawyer.  If a nonlawyer helps you fill out these forms, that person must give you a copy of a Disclosure from Nonlawyer, <<pencil>> <<SYM>> Florida Family Law Rules of Procedure Form 12.900 (a), before he or she helps you.  A nonlawyer helping you fill out these forms also must put his or her name, address, and telephone number on the bottom of the last page of every form he or she helps you complete.

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