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STATE OF CALIFORNIA HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES RELINQUISHMENT OF INDIAN CHILD In or Out-of-County Presumed Father Denies He is the Birth Father in California NAME OF TRIBE ROLL NUMBER OR OTHER EVIDENCE OF TRIBAL AFFILIATION Complete upper section before sending this form to an out-of-county agency that has been requested to take the annexed relinquishment. On this day of 20. the NAME OF AGENCY hereby signifies its willingness to accept the...
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