APPENDIX 1 SUPERIOR COURT OF WASHINGTON COUNTY OF JEFFERSON In Re the Marriage of: ) ) NO. , ) Petitioner, ) REQUEST FOR ENTRY OF DECREE AND ) DECLARATION OF JURISDICTIONAL FACTS and ) (DISSOLUTION OF MARRIAGE) ) , ) Respondent. ) ) REQUEST The petitioner requests immediate entry of Findings of Fact, Conclusions of Law and Decree of Dissolution of Marriage without a final hearing, and states: RESIDENCE I was a resident of the state of Washington when the petition was filed. TIME LIMITS More than 90 days have elapsed since the later of , , the date on which the Petition was filed, and , , the date: [ ] the respondent signed a joinder. [ ] the respondent signed an acceptance of service. [ ] the summons and petition were personally served upon the respondent. [ ] the summons and petition were mailed pursuant to an order for service by mail. [ ] the summons was first published pursuant to an order for service by publication. [ ] default has been taken. [ ] default has not been taken. MARRIAGE & The parties were married on , at [city, state] SEPARATION and separated on , . The marriage is now irretrievably broken. PREGNANCY The wife is not now pregnant. DEPENDENT All dependent children of the marriage are identified in the proposed Decree. CHILDREN The proposed Parenting Plan is in the children's best interest; the Child Support Worksheets are accurate. PROPERTY All property and all debts of the parties are fairly and completely divided in the & DEBTS Decree. IF DEFAULT If entry of the Decree is sought after default of the Respondent, the Decree provides for only that relief requested in the petition. PERJURY I declare under penalty of perjury under the laws of the State of Washington that DECLARATION the foregoing is true and correct. Dated:, 20. [Signed] at , Washington Petitioner Presented by: Approved, notice of presentation waived: [Signed] [Signed] Petitioner Respondent American LegalNet, Inc. www.FormsWorkFlow.com