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FORM 12.981(a)(5),: INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED (Florida)

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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.981(a)(5),
INDIAN CHILD WELFARE ACT AFFIDAVIT (11/15)
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.
IMPORTANT INFORMATION REGARDING E-FILING
The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or
other pleading or documents electronically; however, they are not required to do so. If you choose to
file your pleadings or other documents electronically, you must do so in accordance with Florida Rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read andfollowed.
What should I do next?
A copy of this form must be mailed, e-mailed, or hand delivered to the other party in your case, if it is not
served on him or her with your initial papers.
IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION
After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of
Judicial Administration. If you elect to participate in electronic service, which means serving or receiving
pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review
Florida Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link
to the Rules of Judicial Administration provided under either Family Law Forms: Getting Started, or Rules
of Court in the A-Z Topical Index.
SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.
To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears.
Please CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme
Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida
Instructions for Florida Supreme Court Approved Family Law Form 12.981(a)(5), Indian Child Welfare Act
Affidavit (11/15)
Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration2.516.
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 definedthere.
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, 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.
Instructions for Florida Supreme Court Approved Family Law Form 12.981(a)(5), Indian Child Welfare Act
Affidavit (11/15)
_________________________________________
_______________________________________
IN THE CIRCUIT COURT OF THE __________________ JUDICIAL CIRCUIT,
IN AND FOR _________________________ COUNTY, FLORIDA
Case No.: ____________________
Division: _____________________
IN THE MATTER OF THE ADOPTION OF
______________________________________________,
{use name to be given to the minor child(ren)} Adoptee(s).
INDIAN CHILD WELFARE ACT AFFIDAVIT
I, {full legal name} ___________________________________, being sworn, certify that the following
statements are true:
Upon information and belief the child ____________________________________ {name} subject to
this proceeding: {choose one only}
1. _____ is not an Indian child. The Indian Child Welfare Act does not apply to thisproceeding.
2. _____ is an Indian child within the meaning of the Indian Child Welfare Act of 1978 (25 U.S.C.
Section 1901 et seq.).
I certify that a copy of this document was ( ) mailed ( ) faxed and mailed ( ) e-mailed ( ) hand-
delivered to the person(s) listed below on {date} ____________________.
Other party or his/her attorney:
Name: __________________________________
Address: _________________________________
City, State, Zip: ____________________________
Fax Number: ______________________________
Designated E-mail Address(es): _______________
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: ____________________________
Designated E-mail Address(es): _____________
Florida Supreme Court Approved Family Law Form 12.981(a)(5), Indian Child Welfare Act Affidavit
(11/15)
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:
[fill in all blanks] This form was prepared for the: {choose only one} ( ) Petitioner ( ) Respondent
This form was completed with the assistance of:
{name of individual} ___________________________________________________________________,
{name of business} ____________________________________________________________________,
{address} ____________________________________________________________________________,
{city} ____________________, {state} _____, {zip code} __________, {telephone number} ____________.
Florida Supreme Court Approved Family Law Form 12.981(a)(5), Indian Child Welfare Act Affidavit
(11/15)
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FORM 12.981(a)(5),: INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED (Florida)

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Completed 10 January 2021

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