Superior Court of Washington County of In re: No. Petitioner, Motion/Declaration for Default (Child Support Modification) (MTDFL) and Respondent. I. Motion (Name of requesting party) ________________________________________ moves the court for an order of default against (name of other party to be defaulted) ___________________________________. Venue of this action is proper as set forth in the declaration below. Dated: Signature of Requesting Party or Lawyer/WSBA No. Print Name II. Declaration 2.1 Proper Venue Venue is proper in this court. [] The most recent support order was entered in this county. The petitioner resides in (county and state only) _______________________________________. The child(ren) reside(s) in (county and state only) ______________________________________. Respondent resides in (county and state only) _________________________________________. [] Other: Mot/Decl for Default (Child Suppt Mod)([MTDFL) - Page 1 of 3 WPF DRPSCU 06.0400 Mandatory (6/2008) - CR 55 (a); RCW 26.09.175 American LegalNet, Inc. www.FormsWorkFlow.com 2.2 Jurisdiction Over Parties. This court has jurisdiction over the parties because: [] [] [] 2.3 There is a Washington Order of Child Support. Both parties presently reside in the state of Washington. Other: Service of Process The affidavit of service on file with the court shows that the other party was served with summons, petition and child support worksheet. 2.4 Time Elapsed Since Service of Process [] [] [] [] [] 2.5 The other party was served within the state of Washington and more than 20 days have elapsed since the date of service. The other party was served outside the state of Washington and more than 60 days have elapsed since the date of service. The other party was served by mail in lieu of publication and more than 90 days have elapsed since the date of mailing. The other party was served by publication and more than 60 days have passed since the date of first publication. Other: Appearance of the Parties The other party has failed to appear, or if appeared, has failed to otherwise defend this action. 2.6 Servicemembers Civil Relief Act Statement 2.6.1 A. Service member status -- (name of other party) ________________________________: [ ] is not a service member; [ ] is on active duty in the U.S. armed forces (excluding National Guard and reserves); [ ] is on active duty and is a National Guard member or a Reservist residing in Washington; [ ] is not on active duty in the U.S. armed forces (excluding National Guard and reserves); [ ] is not on active duty and is a National Guard member or a Reservist residing in Washington; [ ] I am unable to determine whether the other party is or is not on active duty as a National Guard member or a Reservist residing in Washington; [ ] I am unable to determine whether the other party is or is not on active duty in the U.S. armed forces. B. Factual basis: [ ] See the attached Defense Man Power Data Center Report obtained from https://www.dmdc.osd.mil/scra/owa/home. [ ] Other factual basis: Mot/Decl for Default (Child Suppt Mod)([MTDFL) - Page 2 of 3 WPF DRPSCU 06.0400 Mandatory (6/2008) - CR 55 (a); RCW 26.09.175 American LegalNet, Inc. www.FormsWorkFlow.com C. [ ] As indicated above, the other party is on active duty and (check all that apply): [ ] The other party is represented by an attorney. [ ] The court has appointed an attorney to represent the other party. [ ] A stay of these proceedings [ ] has [ ] has not been entered by the court. 2.6.2 A. Dependent of a service member status -- (name of other party) _________________ ______________________________: [ ] is not a dependent of a resident of Washington who is on active duty and is a National Guard member or a Reservist; [ ] is a dependent of a resident of Washington who is on active duty and is a National Guard member or a Reservist; [ ] I am unable to determine whether the other party is a dependent of a resident of Washington who is on active duty and is a National Guard member or a Reservist. B. Factual basis: [ ] The other party failed to respond to a notice to him or her as a dependent of a person in Military Service that was [ ] served on [ ] mailed by first class mail on (date) ________________________________________, therefore he or she should be presumed not a dependent of a resident of Washington who is on active duty and is a National Guard member or a Reservist. [ ] Other factual basis: C. [ ] As indicated above, the other party is a dependent of a resident of Washington who is on active duty and is a National Guard member or a Reservist and (check all that apply): [ ] The other party is represented by an attorney. [ ] The court has appointed an attorney to represent the other party. [ ] A stay of these proceedings [ ] has [ ] has not been entered by the court. 2.7 Mailing of Documents [] [] Does not apply because the other party has failed to appear or otherwise defend. Copies of the following documents were mailed on (date) ________________________ to: 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 of Requesting Party Print Name Mot/Decl for Default (Child Suppt Mod)([MTDFL) - Page 3 of 3 WPF DRPSCU 06.0400 Mandatory (6/2008) - CR 55 (a); RCW 26.09.175 American LegalNet, Inc. www.FormsWorkFlow.com