Form D-243 "Consent to Custody of an Indian Child to Non-parent and Court Certification" - County of San Diego, California

Form D-243 Printable Pdf
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What Is Form D-243?

This is a legal form that was released by the Superior Court - County of San Diego, California - a government authority operating within California. The form may be used strictly within County of San Diego. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2009;
  • The latest edition provided by the Superior Court - County of San Diego, California;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form D-243 by clicking the link below or browse more documents and templates provided by the Superior Court - County of San Diego, California.

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Download Form D-243 "Consent to Custody of an Indian Child to Non-parent and Court Certification" - County of San Diego, California

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ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
FOR COURT USE ONLY
TELEPHONE NO.:
FAX NO.(Optional):
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO
CENTRAL DIVISION, CENTRAL COURTHOUSE, 1100 UNION ST., SAN DIEGO, CA 92101
CENTRAL DIVISION, FAMILY COURT, 1555 6TH AVE., SAN DIEGO, CA 92101
CENTRAL DIVISION, MADGE BRADLEY, 1409 4TH AVE., SAN DIEGO, CA 92101
EAST COUNTY DIVISION, 250 E. MAIN ST., EL CAJON, CA 92020
NORTH COUNTY DIVISION, 325 S. MELROSE DR., VISTA, CA 92081
SOUTH COUNTY DIVISION, 500 3RD AVE., CHULA VISTA, CA 91910
PETITIONER(S)
RESPONDENT(S)
THIRD-PARTY CLAIMANT(S)
CASE NUMBER
CONSENT TO CUSTODY OF AN INDIAN CHILD TO NON-PARENT
AND COURT CERTIFICATION
1. Your Name:
Mother
Father
Custodian
(Check only one. Each parent/custodian must complete a separate form.)
2. Your Address:
City:
State:
Zip Code:
Telephone Number:
3. Your Name of Tribe(s)/Band(s):
Your Enrollment Number:
Check here if you do not know the enrollment number.
4. Name of Indian Child:
Date of Birth:
Age:
(Note: Consent not valid unless child is at least 10 days old.)
5. Indian Tribe(s)/Band(s) of Which Child is a Member or Eligible for Membership:
Child’s Enrollment Number:
Check here if you do not know the enrollment number.
6. In contemplation of the pending custody claim under California Fam.Code § 3041,
I VOLUNTARILY CONSENT AND AGREE:
(Check only one)
a.
______________________________ shall have partial legal and/or physical custody of the child named above.
(Name of Non-Parent)
-OR-
b.
______________________________ shall have full legal and physical custody of the child named above.
(Name of Non-Parent)
CONSENT TO CUSTODY OF AN INDIAN CHILD
SDSC D-243 (New 4/09)
Fam. Code § 3041
TO NON-PARENT AND COURT CERTIFICATION
25 U.S.C §1913
Page 1 of 2
For your protection and privacy, press the Clear This Form button on the last page after printing.
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
FOR COURT USE ONLY
TELEPHONE NO.:
FAX NO.(Optional):
E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO
CENTRAL DIVISION, CENTRAL COURTHOUSE, 1100 UNION ST., SAN DIEGO, CA 92101
CENTRAL DIVISION, FAMILY COURT, 1555 6TH AVE., SAN DIEGO, CA 92101
CENTRAL DIVISION, MADGE BRADLEY, 1409 4TH AVE., SAN DIEGO, CA 92101
EAST COUNTY DIVISION, 250 E. MAIN ST., EL CAJON, CA 92020
NORTH COUNTY DIVISION, 325 S. MELROSE DR., VISTA, CA 92081
SOUTH COUNTY DIVISION, 500 3RD AVE., CHULA VISTA, CA 91910
PETITIONER(S)
RESPONDENT(S)
THIRD-PARTY CLAIMANT(S)
CASE NUMBER
CONSENT TO CUSTODY OF AN INDIAN CHILD TO NON-PARENT
AND COURT CERTIFICATION
1. Your Name:
Mother
Father
Custodian
(Check only one. Each parent/custodian must complete a separate form.)
2. Your Address:
City:
State:
Zip Code:
Telephone Number:
3. Your Name of Tribe(s)/Band(s):
Your Enrollment Number:
Check here if you do not know the enrollment number.
4. Name of Indian Child:
Date of Birth:
Age:
(Note: Consent not valid unless child is at least 10 days old.)
5. Indian Tribe(s)/Band(s) of Which Child is a Member or Eligible for Membership:
Child’s Enrollment Number:
Check here if you do not know the enrollment number.
6. In contemplation of the pending custody claim under California Fam.Code § 3041,
I VOLUNTARILY CONSENT AND AGREE:
(Check only one)
a.
______________________________ shall have partial legal and/or physical custody of the child named above.
(Name of Non-Parent)
-OR-
b.
______________________________ shall have full legal and physical custody of the child named above.
(Name of Non-Parent)
CONSENT TO CUSTODY OF AN INDIAN CHILD
SDSC D-243 (New 4/09)
Fam. Code § 3041
TO NON-PARENT AND COURT CERTIFICATION
25 U.S.C §1913
Page 1 of 2
CASE TITLE
CASE NUMBER
7. Relationship of Non-Parent to Indian Child:
8. Address of Non-Parent:
City:
State:
Zip Code:
Telephone Number:
By signing below, I am certifying I know and fully understand the terms and consequences of this consent.
I understand I am not waiving my rights under the Indian Child Welfare Act (25 U.S.C. § 1901 et seq.).
I understand I may withdraw and revoke my consent at any time and for any reason, and upon such withdrawal of
consent, all provisions of the Indian Child Welfare Act shall apply. Pursuant to 25 U.S.C § 1913(b), I further understand
that upon withdrawal of my consent, my child shall be returned to me as soon as is practicable.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date:
Type or Print Name
Signature of Indian Parent/Custodian
JUDGE’S CERTIFICATION
Pursuant to 25 U.S.C § 1913(a), I, Judge/Commissioner
, of the
Superior Court of California, County of San Diego, hereby certify:
■ This consent was completed in writing and recorded before me.
■ I fully explained the terms and consequences of this consent to (name of parent/custodian):
■ The parent/custodian fully understood the terms and consequences of this consent.
■ The parent/custodian understands English or the hearing was interpreted into a language the parent/custodian
understood.
Date:
Judge/Commissioner of the Superior Court
CONSENT TO CUSTODY OF AN INDIAN CHILD
SDSC D-243 (New 4/09)
Fam. Code § 3041
TO NON-PARENT AND COURT CERTIFICATION
25 U.S.C §1913
Page 2 of 2
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