Superior Court of Washington County of In re: No. Child(ren) Petitioner(s), and Respondent(s). Notice of Intended Relocation of Children (NTRELOC) Clerk's Action Required This document will be filed in a restricted access court file. I. Notice 1.1 On ________________________________ (Date), I intend to relocate the following children: Name (first/last)___________________________________________ Age _____________ Name (first/last)___________________________________________ Age _____________ Name (first/last)___________________________________________ Age _____________ Name (first/last)___________________________________________ Age _____________ Name (first/last)___________________________________________ Age _____________ Name (first/last)___________________________________________ Age _____________ 1.2 Notification to other parties: [ ] This notice is being served 60 days before the date of the intended relocation of the children. [ ] This notice is being served no more than five days after the date I learned the information below and I did not know nor could I have reasonably known the information in enough time to give the 60 days’ notice and it is not reasonable to delay the move. [ ] This notice was delayed 21 days because [ ] I entered a domestic violence shelter [ ] I am relocating to avoid a clear, immediate and unreasonable risk to the health and safety of myself or the children. Notice of Intended Relocation (NTRELOC) - Page 1 of 3 WPF DRPSCU 07.0500 (6/2006) - RCW 26.09.440., 460 American LegalNet, Inc. www.USCourtForms.com II. Reasons for the Intended Relocation of the Children I intend to move the children for the following reasons: III. 3.1 Objection to Relocation or Proposed Residential Schedule An objection to the intended move of the children, or to the proposed revised residential schedule filed with this notice, must be filed with the court and served within 30 days after you receive this notice. The relocation of the children will be permitted and the proposed revised residential schedule may be confirmed unless, within 30 days, you file a petition and motion with the court to block the relocation or object to the proposed revised residential schedule and serve the petition and motion on the person proposing relocation and all other persons entitled by court order to residential time or visitation with the children. 3.2 Your objection must be served on the relocating person at the following address: (Street Address, Apartment Number) (City, State, Zip Code) (Serve all other persons entitled to time with the children under court order at their mailing addresses.) Notice of Intended Relocation (NTRELOC) - Page 2 of 3 WPF DRPSCU 07.0500 (6/2006) - RCW 26.09.440., 460 American LegalNet, Inc. www.USCourtForms.com IV. Information Regarding Proposed Relocation if known 4.1 New Residential Address (street 4.2 New Mailing Address (if different from address, city, county, state, zip code): the new residential address): 4.3 New Home Telephone Number ( ) 4.4 Name and Address of the Child’s New School and Day Care Facility (Some or all of this information may be withheld if the relocating person is a participant in the Washington State Address Confidentiality Program or if there is an existing court order that allows some or all of this information to be kept confidential. A relocating person also may seek an ex parte court order allowing information to be withheld upon a showing that providing the information would create unreasonable risk to a person’s or a child’s health and safety. RCW 26.09.460.) 4.5 Parenting Plan or Residential Schedule [ ] The parenting plan/residential schedule should not be changed. [ ] The relocating person’s proposed parenting plan or residential schedule is attached. (Use Washington State mandatory pattern forms.) I declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Signed at ________________________, [City] [State] on [Date]. Signature Print or Type Name Notice of Intended Relocation (NTRELOC) - Page 3 of 3 WPF DRPSCU 07.0500 (6/2006) - RCW 26.09.440., 460 American LegalNet, Inc. www.USCourtForms.com