STATE OF WASHINGTON KING COUNTY DISTRICT COURT West Division, Seattle Courthouse NO. MOTION FOR WAIVER OF FEES PURSUANT TO RCW 10.14.(Ch. 117 L 2002 § 2) - HARASSMENT (MT) Petitioner vs. Respondent I. MOTION Based on the declaration below, I move the court for an order waiving filing fees, court costs and service fees that may be charged by a public agency. II. DECLARATION I am seeking protection for myself, or for a minor, from the respondent who: Stalking: intentionally and repeatedly harasses or repeatedly follows me causing me to fear the respondent intends to injure me, another person or property; and the respondent intends or reasonably should know I will be frightened, intimidated, or harassed. [See RCW 9A.46.110] Sex offense: engaged in conduct that amounts to a sex offense such as rape, child molestation, indecent liberties; family offenses, such as incest; sexual exploitation of children offenses, such as communication with a minor for immoral purpose; or attempt, solicitation or conspiracy to commit one of those crimes; or a felony that was committed in part for the offender’s sexual gratification. [See RCW 9A.44.130] Domestic violence: engaged in conduct that includes physical harm, bodily injury, assault, stalking, or inflicting fear of imminent physical harm, bodily injury or assault involving a family or household member. Check the box Spouse Former spouse Parent or child In-law that describes your relationship to the respondent: Presently Related by blood Have child in common Presently reside together Resided together in past dating Dated in past. [See RCW 26.50.010] The factual bases for this declaration are found in the statement filed with the Petition for Order for Protection and incorporated by reference. I certify under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. 08/08/2006 Dated __________________________ at ________________________________ [City], Washington. Petitioner MT FOR WAIVER OF FEES - RCW 10.14 (Ch. 117 L 2002 § 2)- HARASSMENT (MT) - Page 1 of 1 UH-02.0150 (6/2002) - RCW 10.14. (Ch. 117 L 2002 § 2) American LegalNet, Inc. www.USCourtForms.com