Order Directing DCFS Or CPS To Release Information And Order Restricting Access
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Order Directing DCFS Or CPS To Release Information And Order Restricting Access Form. This is a Washington form and can be use in Domestic Relations Statewide.
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Tags: Order Directing DCFS Or CPS To Release Information And Order Restricting Access, CU 03.0500, Washington Statewide, Domestic Relations
Superior Court of Washington
County of
In re the Custody of:
No.
Child(ren),
Petitioner(s),
and
Respondent(s).
Order Directing DCFS/CPS to
Release Information and
Order Restricting Access
(Nonparental custody)
(ORDINFO)
Clerk’s Action Required
I. Basis
This order is entered because of a petition for nonparental custody filed by _________________________
[Names of Petitioners]. Under RCW 26.10.135, before entering a final nonparental custody order, the Court
must direct the Department of Social and Health Services (DCFS/CPS) to release information as provided
under RCW 13.50.100.
II. Order
It is Ordered that DCFS/CPS shall provide information regarding the following adults residing in the
household of the petitioners:
1. Petitioner (Last, First, Middle):
Other Names Used:
Birth date:
Counties of Residence from October 1, 1998 to present:
2. Petitioner (Last, First, Middle):
Other Names Used:
Birth date:
Counties of Residence from October 1, 1998 to present:
Order re DCFS/CPS (ORDINFO) - Page 1 of 2
WPF CU 03.0500 Mandatory (7/2007) – RCW 26.10.135, RCW 13.50.100
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3. Name (Last, First, Middle):
Other Names Used:
Birth date:
Counties of Residence from October 1, 1998 to present:
4. Name (Last, First, Middle):
Other Names Used:
Birth date:
Counties of Residence from October 1, 1998 to present:
5. Name (Last, First, Middle):
Other Names Used:
Birth date:
Counties of Residence from October 1, 1998 to present:
6. Name (Last, First, Middle):
Other Names Used:
Birth date:
Counties of Residence from October 1, 1998 to present:
The requested information should be provided to the designated recipient within two weeks of the date of
this order and shall be submitted with form WPF CU 03.0520, Cover Sheet for DCFS/CPS Investigative
Information to:
____________________________________________________________________________________
[Name of Designated Recipient at Superior Court and Mailing Address]
It is further Ordered that the information provided by DCFS/CPS, shall be maintained as confidential
and shall be protected against unauthorized disclosure, pursuant to RCW 13.50.100(5).
It is further Ordered that access to the information provided by DCFS/CPS shall be restricted to
petitioners, attorneys for petitioners, respondents, attorneys for respondents, the guardian ad litem and the
subject of the information. Absent written consent of the subject of the information, the information shall
not be further disseminated without an in camera review and court order of dissemination.
Dated:
Judge/Commissioner
Presented by:
Approved by:
Signature of Party or Lawyer/WSBA No.
Signature of Party or Lawyer/WSBA No.
Print Name
Print Name
Order re DCFS/CPS (ORDINFO) - Page 2 of 2
WPF CU 03.0500 Mandatory (7/2007) – RCW 26.10.135, RCW 13.50.100
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