Dependency Petition (DPP) 226 Page 1 of 3 WPF JU 03.0100 (07/2018) 226 JuCR 3.3; RCW 13.34.030, .040 Superior Court of Washington County of Juvenile Court Dependency of: D.O.B.: No : Dependency Petition (DPP) I. Basis I represent to the court the following: 1.1 Petitioner DSHS/Supervising Agency by (name) . (Name) . 1.2 Child alleged to be dependent: male female Name Date of Birth Home Address 1.3 Parent(s) or Legal Guardian(s): Mother Father presumed alleged Name 1 2 Date of Birth Marital status single married other single married other Driver222s License or Identicard (# and State) Home Address Father presumed alleged Custodian/Legal Guardian Name 3 4 Date of Birth Marital status single married other Driver222s License or Identicard (# and State) Home Address FOR OFFICIAL USE ONLY Juv. Ref. No: American LegalNet, Inc. www.FormsWorkFlow.com Dependency Petition (DPP) 226 Page 2 of 3 WPF JU 03.0100 (07/2018) 226 JuCR 3.3; RCW 13.34.030, .040 1.4 Child222s Indian Status: Based upon the following, the petitioner does not have reason to know the child is an Indian child as defined in RCW 13.38.040 and 25 U.S.C. 247 1903(4), and the Federal and Washington State Indian Child Welfare Acts do not apply to this proceeding: . Based upon the following, the petitioner knows or has reason to know the child is an Indian child as defined in RCW 13.38.040 and 25 U.S.C. 247 1903(4), and the Federal and Washington State Indian Child Welfare Acts do apply to this proceeding: . The petitioner has made the following preliminary efforts to provide notice of this proceeding to all tribes to which the petitioner knows or has reason to know the child may be (1) a member or (2) eligible for membership if the biological parent is also a member: . 1.5 Dependency: The child should be declared dependent according to RCW13.34.030(6) as follows: (a) the child has been abandoned as defined in RCW 13.34.030; (b) the child is abused or neglected as defined in chapter 26.44 RCW; or (c) the child has no parent, guardian or custodian capable of adequately caring for the child, such that the child is in circumstances which constitute a danger of substantial damage to the child222s psychological or physical development. 1.6 Allegations: The allegation of Dependency is based on the following facts: . American LegalNet, Inc. www.FormsWorkFlow.com Dependency Petition (DPP) 226 Page 3 of 3 WPF JU 03.0100 (07/2018) 226 JuCR 3.3; RCW 13.34.030, .040 1.7 Educational Liaison The child meets the criteria for appointment of an educational liaison. DSHS/Supervising Agency recommends that the court appoint an educational liaison. II. Relief Requested The petitioner requests that the court find the child dependent, enter an order of dependency, and grant the relief below: enter a disposition order that includes placement, parent-child and sibling visitation, and services. appoint an educational liaison. order a parent to cooperate with the establishment of paternity. order a parent to sign releases for information. Other: Dated: Petitioner Type or Print Name/Title WSBA No. III. Certification I declare under penalty of perjury under the laws of the State of Washington that the foregoing representations are true and correct. Signed at (City), Washington on (Date). Signature Print Name American LegalNet, Inc. www.FormsWorkFlow.com