SUPERIOR COURT OF WASHINGTON COUNTY OF _______________________ JUVENILE COURT Dependency of: No: Motion and Declaration to Publish Notice and Summons D.O.B.: (MTAF) I. Motion Based upon the following declaration, I move for an order allowing notice by publication of the [ ] dependency [ ] termination [ ] guardianship petition filed in this matter to: [ ] the mother [ ] the father [ ] anyone else claiming a parental interest in the child. Date: Signature Type or Print Name/Title/WSBA No. II. Declaration I, declare as follows: Notice and summons directed to ________________________________ [name] should be published because: [ ] the parent or guardian is a nonresident of this state; [ ] the [ ] parent [ ] guardian of the child is believed to be a resident of another county other than the county in which the petition has been filed, namely _________________________ ____________________________________ [County and State]; [ ] the name or place of residence or whereabouts of the child's parent or guardian is unknown; [ ] after due diligence, the person attempting service has been unable to serve the summons or notice and a copy has been deposited in the post office, postage prepaid, directed to the Mt/Decl to Publish (MTAF) - Page 1 of 2 WPF JU 03.0210 (11/2009) - RCW 13.34.080 American LegalNet, Inc. www.FormsWorkFlow.com child's parent or guardian at the last known place of residence: ______________________________ ___________________________________________________. The following sources were investigated or used in my attempt to serve the notice and summons: [Check applicable boxes and explain in the space below how you used that source or location. If more space is needed use an attached continuation sheet.] [ ] All known addresses: . [ ] School: _______ [ ] Telephone Book/Directory Assistance: . [ ] Relatives: . [ ] Friends/Neighbors: . [ ] Landlords/Roommates: . [ ] Law Enforcement: . [ ] Workplace/Business: . [ ] DSHS/ /DOC: . [ ] Other: . I declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Signed at ____________________________[city], Washington on _________________________ [date]. Signature Type or Print Name/Title/Agency Mt/Decl to Publish (MTAF) - Page 2 of 2 WPF JU 03.0210 (11/2009) - RCW 13.34.080 American LegalNet, Inc. www.FormsWorkFlow.com