Superior Court of Washington County of In re the Custody of: No. Child(ren), Petitioner(s), Nonparental Custody Decree (DCC) and [ ] Clerk’s action required [ ] Law Enforcement Notification, ¶ 3.5 Respondent(s). I. Judgment/Order Summaries 1.1 Restraining Order Summary [ ] Does not apply. [ ] Restraining Order Summary is set forth below: Name of person(s) restrained: ____________________________________________. Name of person(s) protected: ___________________________________________________. See paragraph 3.5 Violation of a Restraining Order in Paragraph 3.5 below with actual knowledge of its terms is a criminal offense under Chapter 26.50 RCW and will subject the violator to arrest. RCW 26.10.040. 1.2 Money Judgment Summary [ ] Does not apply. A. B. C. D. E. F. [ ] The judgment summary is as follows: Judgment creditor Judgment debtor Principal judgment amount (back child support) from (date)_______________ to (date)_______________ Interest to date of judgment Attorney fees Costs $ $ $ $ Nonparental Custody Decree (DCC) - Page 1 of 6 WPF CU 02.0200 Mandatory (6/2008) - RCW 26.10.040 American LegalNet, Inc. www.FormsWorkflow.com G. H. I. J. K. L. Other recovery amount $ Principal judgment shall bear interest at __________ % per annum Attorney fees, costs and other recovery amounts shall bear interest at __________ % per annum Attorney for judgment creditor Attorney for judgment debtor Other: II. Basis The findings of fact and conclusions of law have been entered in this case. III. Decree It is Decreed: 3.1 Jurisdiction Over the Children The court has jurisdiction over the children as set forth in the Findings of Fact and Conclusions of Law. 3.2 Custody The petition is granted. The petitioner(s) (name(s))__________________________________ is/are granted custody of the following children: 3.3 Visitation Respondent (name) ________________________________: Visitation shall be [ ] as set forth in the Residential Schedule signed by the court on this date or dated ___________________; or [ ] as follows: Respondent (name) _________________________________: Visitation shall be [ ] as set forth in the Residential Schedule signed by the court on this date or dated ___________________; or [ ] as follows: [] Other: Nonparental Custody Decree (DCC) - Page 2 of 6 WPF CU 02.0200 Mandatory (6/2008) - RCW 26.10.040 American LegalNet, Inc. www.FormsWorkflow.com 3.4 Child Support [] 3.5 Child support shall be paid in accordance with the Order of Child Support, which was signed by the court on this date or dated _______________________, and incorporated as part of this decree. Continuing Restraining Order [] [] Does not apply. A continuing restraining order is entered as follows: [] [] [] [] [] (Name) ______________________________________ is restrained and enjoined from disturbing the peace of (name of the protected person(s)) ____________________________________________________________. (Name) _______________________________________ is restrained and enjoined from going onto the grounds of or entering the home, work place or school of the protected person(s) or the day care or school of the following named children:________________________________________________ (Name) _______________________________________ is restrained and enjoined from knowingly coming within or knowingly remaining within (distance) _____________ of the home, work place or school of the protected person(s); or the day care or school of these children:_____________________ ________________________________________________________________ other: ___________________________________________________________ (Name) _______________________________ is restrained and enjoined from molesting, assaulting, harassing, or stalking (name) _____________________. Other: Violation of a restraining order in paragraph 3.5 with actual knowledge of its terms is a criminal offense under Chapter 26.50 RCW and will subject the violator to arrest. RCW 26.10.040. [] Clerk’s Action. The clerk of the court shall forward a copy of this order, on or before the next judicial day, to: (name of appropriate law enforcement agency) _____________________________ 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. (A law enforcement information sheet must be completed by the party or the party’s attorney and provided with this order before this order will be entered into the law enforcement computer system.) Service Nonparental Custody Decree (DCC) - Page 3 of 6 WPF CU 02.0200 Mandatory (6/2008) - RCW 26.10.040 American LegalNet, Inc. www.FormsWorkflow.com [] The restrained party or attorney appeared in court or signed this order; service of this order is not required. The restrained party or attorney did not appear in court; service of this order is required. The protected party must arrange for service of this order on the restrained party. File the original Return of Service with the clerk and provide a copy to the law enforcement agency listed above. [] Expiration This restraining order expires on: (month/day/year) . This restraining order supersedes all previous temporary restraining orders in this cause number. Any temporary restraining order signed by the court in this cause number is 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 Petitioner 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. [] 3.6 Attorney Fees, Other Professional Fees and Costs [] [] Does not apply. Attorney fees, other professional fees and costs shall be paid as follows: 3.7 Other 3.8 Summary of RCW 26.09.430 - .480, Regarding Relocation of a Child This is a summary only. For the full text, please see RCW 26.09.430 through 26.09.480. If the person with whom the child resides a majority of the time plans to move, that person shall give notice to every person entitled to court ordered time with the child. If the move is outside the child’s school district, the relocating person must give notice by personal service or by mail requiring a return receipt. This notice must be at least 60 days before the intended move. If the relocating person could not have known about the move in time to give 60 days’ notice, that person must give notice within five days after learning of the move. The notice must contain the information required in RCW 26.09.260. See also form DRPSCU 07.0500 (Notice of Intended Relocation of A Child). Nonparental Custody Decree (DCC) - Page 4 of 6 WPF CU 02.0200 Mandatory (6/2008) - RCW 26.10.040 American LegalNet, Inc. www.FormsWorkflow.com If the move is within the same school district, the relocating person must provide actual notice by any reasonable means. A person entitled to time with the child may not object to the move but may ask for modification under RCW 26.09.260. Notice may be delayed for 21 days if the relocating person is entering a domestic violence shelter or is moving to avoid a clear, immediate and unreasonable risk to health and safety. If information is protected under a court order or the address confidentiality program, it may be withheld from the notice. A relocating person may ask the court to waive any notice requirements that may put the health and safety of a person or a child at risk. Failure to give the required notice may be grounds for sanctions, including contempt. If no objection is filed within 30 days after service of the notice of intended relocation, the relocation will be permitted and the proposed revised residential schedule may be confirmed. A person entitled to time with a child under a court order can file an objection to the child’s relocation whether or not he or she received proper notice. An objection may be filed by using the mandatory pattern form WPF DRPSCU 07.0700 (Objection to Relocation/Petition for Modification of Custody Decree/Parenting Plan/Residential Schedule). The objection must be served on all persons entitled to time with the child. The relocating person shall not move the child during the time for objection unless: (a) the delayed notice provisions apply; or (b) a court order allows the move. If the objecting person schedules a hearing for a date within 15 days of timely service of the objection, the relocating person shall not move the child before the hearing unless there is a clear, immediate and unreasonable risk to the health or safety of a person or a child. Warning: Violation of residential provisions of this order with actual knowledge of its terms is punishable by contempt of court and may be a criminal offense under RCW 9A.40.060(2) or RCW 9A.40.070(2). Violation of this order may subject a violator to arrest. Dated: ________________________________ _______________________________________ Judge/Commissioner Petitioner or petitioner’s attorney: A signature below is actual notice of this order. [ ] Presented by: [ ] Approved by: [ ] Notice for presentation waived: Respondent or respondent’s attorney: A signature below is actual notice of this order. [ ] Presented by: [ ] Approved by: [ ] Notice for presentation waived: _______________________________________ Signature of Party or Lawyer/WSBA No. _______________________________________ Signature of Party or Lawyer/WSBA No. _______________________________________ Print or Type Name Date ______________________________________ Print or Type Name Date A signature below is acted notice of the order. A signature below is acted notice of the order. [ ] Presented by: [ ] Presented by: Nonparental Custody Decree (DCC) - Page 5 of 6 WPF CU 02.0200 Mandatory (6/2008) - RCW 26.10.040 American LegalNet, Inc. www.FormsWorkflow.com [ ] Approved by: [ ] Notice for presentation waived: [ ] Approved by: [ ] Notice for presentation waived: _______________________________________ Signature of Party or Lawyer/WSBA No. _______________________________________ Signature of Party or Lawyer/WSBA No. _______________________________________ Print or Type Name Date ______________________________________ Print or Type Name Date A signature below is acted notice of the order. A signature below is acted notice of the order. [ ] Presented by: [ ] Approved by: [ ] Notice for presentation waived: [ ] Presented by: [ ] Approved by: [ ] Notice for presentation waived: _______________________________________ Signature of Party or Lawyer/WSBA No. _______________________________________ Signature of Party or Lawyer/WSBA No. _______________________________________ Print or Type Name Date ______________________________________ Print or Type Name Date Nonparental Custody Decree (DCC) - Page 6 of 6 WPF CU 02.0200 Mandatory (6/2008) - RCW 26.10.040 American LegalNet, Inc. www.FormsWorkflow.com