Superior Court of Washington County of In re: No. Petitioner, and Respondent. Summons by Publication (SMPB) To the Respondent: [Note to Publisher: Publish only those boxes which are checked.] 1. The petitioner has started an action in the above court requesting: [] [] [] [] [] [] [] 2. that your marriage be dissolved. a legal separation. that the validity of your marriage be determined. that there be a determination of parentage. the establishment or modification of a parenting plan or residential schedule. custody of the children listed in paragraph 1.3 of the Nonparental Custody Petition. that presumed paternity be disestablished. The petition also requests that the court grant the following relief: [] [] [] [] [] [] [] Provide reasonable maintenance for the [ ] husband [ ] wife. Approve a parenting plan or residential schedule for the dependent children. Approve reasonable visitation. Determine support for the dependent children pursuant to the Washington State Child Support Schedule. Order either or both parents to maintain or provide health insurance coverage for the dependent children. Approve a separation agreement. Dispose of property and liabilities. Summons by Publication (SMPB) - Page 1 of 3 WPF DRPSCU 01.0270 (6/2006) - RCW 4.28.100; CR 4.1 American LegalNet, Inc. www.USCourtForms.com [] [] [] [] [] [] [] [] Change the name of the child to: ___________________________. Change name of wife to: ______________________________. Change name of husband to: ______________________________. Order payment of court costs and reasonable fees. Enter a continuing restraining order. Enter a domestic violence protection order. Order payment of day care expenses for the children. Award the tax exemptions for the dependent children as follows: [] [] Order payment of attorney fees, other professional fees and costs. Other: 3. You must respond to this summons by serving a copy of your written response on the person signing this summons and by filing the original with the clerk of the court. If you do not serve your written response within 60 days after the date of the first publication of this summons (60 days after the ______day of ________________, 20__), the court may enter an order of default against you, and the court may, without further notice to you, enter a decree and approve or provide for other relief requested in this summons. In the case of a dissolution of marriage, the court will not enter the final decree until at least 90 days after service and filing. If you serve a notice of appearance on the undersigned person, you are entitled to notice before an order of default or a decree may be entered. 4. Your written response to the summons and petition must be on form WPF DR 01.0300, Response to Petition (Domestic Relations). Information about how to get this form may be obtained by contacting the clerk of the court, by contacting the Administrative Office of the Courts at (360) 705-5328, or from the Internet at the Washington State Courts homepage: http://www.courts.wa.gov/forms 5. If you wish to seek the advice of an attorney in this matter, you should do so promptly so that your written response, if any, may be served on time. 6. One method of serving a copy of your response on the petitioner is to send it by certified mail with return receipt requested. 7. Other: This summons is issued pursuant to RCW 4.28.100 and Superior Court Civil Rule 4.1 of the state of Washington. Dated Signature of Petitioner or Lawyer/WSBA No. Print or Type Name File Original of Your Response with Serve a Copy of Your Response on: Summons by Publication (SMPB) - Page 2 of 3 WPF DRPSCU 01.0270 (6/2006) - RCW 4.28.100; CR 4.1 American LegalNet, Inc. www.USCourtForms.com the Clerk of the Court at: [ ] Petitioner [You may list an address that is not your residential address where you agree to accept legal documents. Any time this address changes while this action is pending, you must notify the opposing parties in writing and file an updated Confidential Information Form (WPF DRPSCU 09.0200) with the court clerk.] [ ] Petitioner’s Lawyer [Name of Court] [Name] [Address] [Address] Summons by Publication (SMPB) - Page 3 of 3 WPF DRPSCU 01.0270 (6/2006) - RCW 4.28.100; CR 4.1 American LegalNet, Inc. www.USCourtForms.com