DECLARATION OF BACKGROUND AND QUALIFICATIONS FOR PIERCE COUNTY SUPERIOR COURT GUARDIAN AD LITEM REGISTRY -- RCW 11.88.090 THIS IS PUBLIC INFORMATION Attached is my Written Statement of Background and Qualifications to serve as a Guardian ad Litem in Pierce County, State of Washington as required under RCW 11.88.090. I hereby certify under the penalty of perjury under the laws of the State of Washington that my statements and attachments are true and correct. Date Signed: ___________Signature: __________________________________ WSBA # and year admitted: ___________________________________________ Printed Name: __________________________________________________ Business Address: __________________________________________________ Business Telephone Number: __________________________________________ FAX Number (if any): _____________________________________________ E-mail Address: (if any) _____________________________________________ Date Training Completed and attach Certificate of Completion:_________________ Please indicate the date and location where you are scheduled for training if not completed by application closing period, March 25, 2005: _____________________ Training Sponsored by: (Name) _______________________________________ (Address) ______________________________________ (Phone) _______________________________________ All questions must be answered in the order in which they are given. Answers that only refer to a resume or vitae are not acceptable. Please return completed form to: Pierce County Superior Court Administrator Room 534, County City Building 930 Tacoma Ave S. Tacoma, WA 98402-2108 RCW 11.88 Declaration of Background and Qualifications Revised 1/31/05 American LegalNet, Inc. www.USCourtForms.com