Superior Court of Washington County of In re the Domestic Partnership of: No. Decree of Dissolution (DCD) Decree of Legal Separation [] Declaration Concerning Validity (DCINMG) (Registered Domestic Partnership) [] [] Petitioner, [] [] Clerk’s action required Law Enforcement Notification, ¶ 3.8 (DCLGSP) and Respondent. I. Judgment/Summaries 1.1 Real Property Judgment Summary: [ ] Does not apply. [ ] Real Property Judgment Summary is set forth below: Name of Grantor: Name of Grantee: Assessor’s property tax parcel or account number: Or Legal description of the property awarded (including lot, block, plat, or section, township, range, county and state): See Page _________ for full legal description 1.2 Money Judgment Summary: [ ] Does not apply. [] Judgment Summary is set forth below. A. Judgment creditor B. Judgment debtor C. Principal judgment amount $ D. Interest to date of judgment $ E. Attorney fees $ F. Costs $ G. Other recovery amount $ H. Principal judgment shall bear interest at __________ % per annum I. Attorney fees, costs and other recovery amounts shall bear interest at __________ % per annum J. Attorney for judgment creditor Decree (DCD) (DCLGSP) (DCINMG) - Page 1 of 7 WPF DR 04.0405 Mandatory (06/2012) - RCW 26.09.030; .040; .070 (3) American LegalNet, Inc. www.FormsWorkFlow.com K. Attorney for judgment debtor L. Other: End of Summaries II. Basis Findings of Fact and Conclusions of Law have been entered in this case. III. Decree It is decreed that: 3.1 Status of the Domestic Partnership [] [] [] [] 3.2 The parties’ domestic partnership is dissolved. The petitioner and respondent are legally separated. The parties’ domestic partnership is invalid. The parties’ domestic partnership is valid. Property to be Awarded the Petitioner [] [] [] [] The petitioner is awarded as his or her separate property the property set forth in Exhibit _____. This exhibit is attached or filed and incorporated by reference as part of this decree. The petitioner is awarded as his or her separate property the property set forth in the separation contract or domestic partnership agreement executed by the parties on (date) ___________________ . The separation contract or domestic partnership agreement is incorporated by reference as part of this Decree. The domestic partnership agreement or, pursuant to RCW 26.09.070(5), the separation contract [ ] is [ ] is not filed with the court. The petitioner is awarded as his or her separate property the following property (list real estate, furniture, vehicles, pensions, insurance, bank accounts, etc.): Other: Decree (DCD) (DCLGSP) (DCINMG) - Page 2 of 7 WPF DR 04.0405 Mandatory (06/2012) - RCW 26.09.030; .040; .070 (3) American LegalNet, Inc. www.FormsWorkFlow.com 3.3 Property to be Awarded to the Respondent [] [] [] [] 3.4 The respondent is awarded as his or her separate property the property set forth in Exhibit _____. This exhibit is attached or filed and incorporated by reference as part of this decree. The respondent is awarded as his or her separate property the property set forth in the separation contract or domestic partnership agreement referenced above. The respondent is awarded as his or her separate property the following property (list real estate, furniture, vehicles, pensions, insurance, bank accounts, etc.): Other: Liabilities to be Paid by the Petitioner [] [] [] [] Does not apply. The petitioner shall pay the community or separate liabilities set forth in Exhibit _____. This exhibit is attached or filed and incorporated by reference as part of this decree. The petitioner shall pay the community or separate liabilities as set forth in the separation contract or domestic partnership agreement referenced above. The petitioner shall pay the following community or separate liabilities: Creditor [] Amount Other: Decree (DCD) (DCLGSP) (DCINMG) - Page 3 of 7 WPF DR 04.0405 Mandatory (06/2012) - RCW 26.09.030; .040; .070 (3) American LegalNet, Inc. www.FormsWorkFlow.com Unless otherwise provided herein, the petitioner shall pay all liabilities incurred by him or her since the date of separation. 3.5 Liabilities to be Paid by the Respondent [] [] [] [] Does not apply. The respondent shall pay the community or separate liabilities set forth in Exhibit _____. This exhibit is attached or filed and incorporated by reference as part of this decree. The respondent shall pay the community or separate liabilities as set forth in the separation contract or domestic partnership agreement referenced above. The respondent shall pay the following community or separate liabilities: Creditor [] Amount Other: Unless otherwise provided herein, the respondent shall pay all liabilities incurred by him or her since the date of separation. 3.6 Hold Harmless Provision [] [] 3.7 Each party shall hold the other party harmless from any collection action relating to separate or community liabilities set forth above, including reasonable attorney's fees and costs incurred in defending against any attempts to collect an obligation of the other party. Other: Maintenance [] [] [] [] Does not apply. The [ ] petitioner [ ] respondent shall pay maintenance as set forth in Exhibit _____. This exhibit is attached or filed and incorporated by reference as part of this decree. Maintenance shall be paid as set forth in the separation contract or domestic partnership agreement referenced above. The [ ] petitioner [ ] respondent shall pay $ _______________maintenance. Maintenance shall be paid [ ] weekly [ ] semi-monthly [ ] monthly. Decree (DCD) (DCLGSP) (DCINMG) - Page 4 of 7 WPF DR 04.0405 Mandatory (06/2012) - RCW 26.09.030; .040; .070 (3) American LegalNet, Inc. www.FormsWorkFlow.com The first maintenance payment shall be due on (date) ____________________ . The obligation to pay future maintenance is terminated upon the death of either party or the registration of a new domestic partnership of the party receiving maintenance unless otherwise specified below: Payments shall be made: [] [] [] [] [] [] 3.8 directly to the other domestic partner. to the Washington State Child Support Registry (only available if child support is ordered). to the clerk of this court as trustee for remittance to the other domestic partner (only available if there are no dependent children). If a maintenance payment is more than 15 days past due and the total of such past due payments is equal to or greater than $100, or if the obligor requests a withdrawal of accumulated contributions from the Department of Retirement Systems, the obligee may seek a mandatory benefits assignment order under Chapter 41.50 RCW without prior notice to the obligor. The Department of Retirement Systems may make a direct payment of all or part of a withdrawal of accumulated contributions pursuant to RCW 41.50.550(3). Other: Restraining Order [] [] All temporary Restraining Order(s) signed by the court under this cause number are terminated. Clerk’s Action. The clerk of the court shall forward a copy of this order, on or before the next judicial day to: ______________________________ law enforcement agency where the protected person resides which shall enter this order into any computer-based criminal intelligence system available in this state used by law enforcement agencies to list outstanding warrants. [] 3.9 No temporary personal restraining orders have been entered under this cause number. The parties shall comply with the final Restraining Order signed by the court on this date or dated _____________________________, under this cause number. The Restraining Order signed by the court is approved and incorporated as part of this decree. Protection Order [] [] 3.10 Does not apply. The parties shall comply with the [ ] domestic violence [ ] antiharassment Order for Protection signed by the court on this date or dated ____________________________, in this cause number. The Order for Protection signed by the court is approved and incorporated as part of this decree. Jurisdiction Over the Children Decree (DCD) (DCLGSP) (DCINMG) - Page 5 of 7 WPF DR 04.0405 Mandatory (06/2012) - RCW 26.09.030; .040; .070 (3) American LegalNet, Inc. www.FormsWorkFlow.com [] [] 3.11 De Facto Parent [] [] 3.12 [] Does not apply. Attorney fees, other professional fees and costs shall be paid as set forth in the separation contract or domestic partnership agreement referenced above. Attorney fees, other professional fees and costs shall be paid as follows: Name Changes [] [] [] 3.16 Does not apply. Child support shall be paid in accordance with the order of child support signed by the court on this date or dated ________________________________. This order is incorporated as part of this decree. Attorney Fees, Other Professional Fees and Costs [] [] 3.15 Does not apply. The parties shall comply with the Parenting Plan signed by the court on this date or dated ________________________________________. The Parenting Plan signed by the court is approved and incorporated as part of this decree. Child Support [] [] 3.14 Does not apply. (Name) _____________________________________________ [ ] is [ ] is not the de facto parent of (name(s) of child(ren)): Parenting Plan [] [] 3.13 Does not apply because there are no dependent children. The court has jurisdiction over the children as set forth in the Findings of Fact and Conclusions of Law. Does not apply. The petitioner's name shall be changed to: (first, middle, last) __________________________________________________. The respondent's name shall be changed to: (first, middle, last) __________________________________________________. Other Decree (DCD) (DCLGSP) (DCINMG) - Page 6 of 7 WPF DR 04.0405 Mandatory (06/2012) - RCW 26.09.030; .040; .070 (3) American LegalNet, Inc. www.FormsWorkFlow.com Dated: Judge/Commissioner Petitioner or petitioner’s lawyer: A signature below is actual notice of this order. [ ] Presented by: [ ] Approved for entry: [ ] Notice for presentation waived: Respondent or respondent’s lawyer: A signature below is actual notice of this order. [ ] Presented by: [ ] Approved for entry: [ ] Notice for presentation waived: Signature of Petitioner or Lawyer/WSBA No. Signature of Respondent or Lawyer/WSBA No. Print or Type Name Print or Type Name Date Date Decree (DCD) (DCLGSP) (DCINMG) - Page 7 of 7 WPF DR 04.0405 Mandatory (06/2012) - RCW 26.09.030; .040; .070 (3) American LegalNet, Inc. www.FormsWorkFlow.com