IN THE DISTRICT COURT OF THE CHEROKEE NATION
IN THE MATTER OF THE
GUARDIANSHIP OF:
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Case No. CVGD-________________
AFFIDAVIT AND PETITION FOR GUARDIANSHIP
COMES NOW, _____________________________________________, being of sound mind
and body, and on this ____ day of _______________________________, 20____, and being under oath,
hereby affirms, deposes, and swears as follows:
(1) The full names, birthdates, sex, and tribal affiliation of the child(ren) who is/are subjects of
this proceeding are:
NAME
DOB
SEX
TRIBAL
AFFILIATION
CURRENT
RESIDENCE
(2) The natural mother of the child(ren) is __________________________________________.
(3) The natural mother’s address is ____________________________________________,
and the natural mother’s telephone number is _______________________________________
(4) The natural father of the child(ren) is __________________________________________.
(5) The natural father’s address is ____________________________________________,
and the natural father’s telephone number is _______________________________________.
(6) The relationship of the mother and father of the child at this time is:
(check all that may apply)
married ______
divorced
parents never married and father’s whereabouts are known
parents never married and father’s whereabouts are unknown
parents never married and mother’s whereabouts are known
parents never married and mother’s whereabouts are unknown
father is unknown
(7) _____ Other than the parents named above, there is no one else who can assert custody to
the child or who would require notice of the guardianship hearing.
OR
_____ In addition to the parents named above, the following individual(s) may also be entitled
to custody of the child(ren).
NAME
ADDRESS
____________________________________
______________________________________
____________________________________
______________________________________
(8) To the best of my knowledge, information, and belief, neither the Cherokee Nation nor any
state including the State of Oklahoma (DHS), have an open investigation concerning the
welfare of this child.
YES or
NO
*If yes,
explain._____________________________________________________________________
(9) To the best of my knowledge, information, and belief, neither the Cherokee Nation nor any
state including the State of Oklahoma (DHS), have custody of or are seeking custody of this
child.
YES
or
NO
*If yes,
explain._____________________________________________________________________
(10) The child(ren) who are the subjects of this guardianship are Cherokee Indian.
YES
or
NO
(11) I, the Petitioner for Guardianship, am a Cherokee Indian.
YES
or
NO
(12) To the best of my knowledge, information, and belief the parents of the child(ren) are in
agreement with guardianship over the child(ren) being awarded to me.
YES or
NO
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(13) The parents of the child(ren) are willing to testify that guardianship of the child(ren)
should be given to me.
YES or
NO
(14) The parents of the children have signed before a Notary Public their consent to the
guardianship and waiver of any further notice to them of hearing.
YES or
NO
(15) The parents of the child(ren) have been notified that I am seeking guardianship of the
child(ren)
.
YES or
NO
*If yes,
explain._____________________________________________________________________
(16)
Petitioners Full
Name
DOB
Physical Address
Tribal Affiliation
My telephone number is ________________________________
My present physical address is within the jurisdictional boundaries of the Cherokee Nation, and
I have resided within the jurisdictional boundaries of the Cherokee Nation for more than one
year.
YES or
NO
*If no,
explain._____________________________________________________________________
(17) My relationship to the child(ren) is _______________________________________.
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(18) The child(ren) currently resides in my home.
YES or
NO
*If YES, list the dates since child(ren) have resided in home from _________________ until
present. If NO, list with whom they reside.________________________________________
(19) List all adults (18 years of age or older) full name and date of birth, whom are residing in
the home.
(19) List the detailed reasons this guardianship is being sought:
(20)
1. I am a minor, incapacitated or partially incapacitated persons,
YES or
NO
*If yes, explain___________________________________________________________
2. I am a convicted felon
YES
or
NO
*If yes,explain_____________________________________________________________
3. I am bankrupt, insolvent or under any financial obligation to the Prospective Ward or
subject to a conflict of interest which would preclude or be substantially detrimental to
their ability to act in the best interest of the Prospective Ward.
YES or
NO
*If yes,explain_____________________________________________________________
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(21) I have information of any custody proceeding pending in a court of this Nation or any
state or other jurisdiction concerning a child subject in this affidavit and petition; I do not know
of any other person not named in this document who has physical custody or claims to have
custody or visitation rights with respect to a child subject to this proceeding
YES
or
NO
*If yes,explain_____________________________________________________________
(22) The children posses real or personal property and, therefore, a bond is necessary.
YES
or
NO
*If yes,explain_____________________________________________________________
list real property, if any, and any personal property (not including any personal clothing or
toys), such as trust funds, bank accounts, Social Security income,
etc.:_________________________________________________________
Valued at approximately $___________ (no bond if under $40,000.00, or if parent,
grandparent, brother or sister
WHEREFORE, premises considered, Petitioner respectfully prays: That this matter be set for
hearing and such Summons and Notice be given as required by law; That upon such trial, guardianship
over the above-named child or children be placed with Petitioner; and for such other and further relief as
this Court may deem appropriate and in the best interests of the child.
PETITIONER SIGNATURE
CHEROKEE NATION
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ss.
The undersigned, being of lawful age, and being first duly sworn, states that she has read the
above and foregoing Affidavit and Petition for Guardianship, and that the statements contained therein are
true and correct to the best of her information and belief.
PETITIONER
Subscribed and sworn to before me this _____ day of ___________________________, 20____.
NOTARY PUBLIC
My Commission Expires: __________________
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