In the Superior Court for the State of Alaska

IN THE SUPERIOR COURT FOR THE STATE OF ALASKA

(A) JUDICAL DISTRICT AT (B)

In the Matter of the )

) Case No. (E)

(C) )

)

D.O.B. (D) )

) NOTICE OF INTERVENTION

A Minor Native Child. ) (NO MANDATORY FORM) ______)

COMES NOW the Native Village (F) , through its non-attorney representative, (G) , and requests that this Court recognize the Intervention of the Native Village of (H) in this matter, a child custody proceeding involving and Indian child as defined by the Indian Child Welfare Act of 1978, 25 U.S. C. § 1903(1). As grounds for this Intervention, the Tribe states:

1. The above child is an “Indian Child” as defined by the Indian Child Welfare Act of 1978, 25 U.S.C. §1903(4), in that the child is under eighteen and is either a member of the (I) Tribe or eligible for membership in the (J) Tribe and is the biological child of (K) , who is a member of (L) Tribe.

2. The (M) Tribe is an Indian Tribe as defined by the Indian Child Welfare Act of 1978, 25 U.S.C. §1903(8).

3. The (N) Tribe is the “Indian Child’s Tribe” as defined by the Indian Child Welfare Act of 1978, 25 U.S.C§1903(5), in that the child is a member of or eligible for membership in the (N) Tribe.

4. The Indian Child Welfare Act of 1978, 25 U.S.C. § 1911(c) gives the Indian child’s tribe the right to intervene at any point in a State court proceeding for the foster care placement or adoption of, or termination of parental rights to an Indian child.

WHEREFORE, the (O) Tribe prays the Court to accept this Intervention in the above-captioned proceeding. We request that all further documents, pleadings and notices in this matter be provided to our designated representative, (P), at the address provided below. The official Designation of Tribal Representative document is attached.

(Q)______

(R), Tribal Council Native Village of (S)

P.O. Box (T)

(T) , Alaska 995 (T)

(907) (T) Phone

(907) (T) Fax

Email: ______

ACCEPTANCE AND ACKNOWLEDGMENT

Based on the foregoing, the court hereby accepts this intervention and acknowledges the Tribe as a party in this matter.

Date ______

Judicial Officer

ICWA Intervention form