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I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES RELINQUISHMENT OF AN INDIAN CHILD Out-of-State Presumed Father Denies He is the Birth Father NAME OF CHILD S TRIBE ROLL NUMBER OR OTHER EVIDENCE OF TRIBAL AFFILIATION Complete upper section before sending this form to an out-of-state agency that has been requested to take...

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