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Ch. 26.26 RCW Mandatory Form (07/2017) FL Parentage 302 Declaration about Parentage p. 1 of 6 Superior Court of Washington, County of In re parentage: Petitioner (person who started this case) : And Respondents: ( parent / presumed parent / alleged parents) Children over age 2: No. Declaration about Parentage (DCLR) Declaration about Parentage (Fill out a separate Declaration for each child in this case.) I declare: My name is . This declaration is about the parentage of (child): , who was born on: . month / day / year 1. My relationship to this child (check all that apply): I am the birth mother. I signed a Paternity Acknowledgment. I legally adopted this child. I had this child using assisted reprstatement that I used assisted reproduction to have this child were filed with the I agreed that my spouse or domestic partner could use assisted reproduction to have this child. A valid surrogate parentage contract says I am the intended parent of this child. American LegalNet, Inc. www.FormsWorkFlow.com Ch. 26.26 RCW Mandatory Form (07/2017) FL Parentage 302 Declaration about Parentage p. 2 of 6 I was married to or registered domestic partners with the birth mother (name): when the child was born, or within the 300 days before the child was born. I believed I was in a valid marriage or registered domestic partnership with the birth mother (name): when the child was born, or within the 300 days before the child was born, even though the marriage or partnership was or could have been invalidated by a court. After the child was born, I married or became registered domestic partners with the birth mother (name): (or believed my marriage or partnership was valid, even if it was or could have been (check at least one): promised in a written or electronic record to support the child as my own. See RCW 26.26.011(23). t with the Registrar of Vital Statistics. I lived in the same home as the child and openly held him/her out as my own (List examples that show how you treated this child as if s/he were your own) I am not none of the reasons listed above apply. (name): between (startin g and ending dates): when the child was likely conceived. I am not s parent because: (name): between (starting and ending dates): when the child was likely conceived. I donated sperm for assisted reproduction with no intent to become a parent. I was excluded as a parent through genetic testing. 2. Sexual assault Does not apply. American LegalNet, Inc. www.FormsWorkFlow.com Ch. 26.26 RCW Mandatory Form (07/2017) FL Parentage 302 Declaration about Parentage p. 3 of 6 This child was born as a result of a sexual assault by (name): . See the Sexual Assault Allegation, filed separately. Important! File and serve the Sexual Assault Allegation (FL Parentage 365) together with this Declaration and your Petition or Response. 3. For each other party, write his/her namknow the status of another party, leave him/her out. Parent (someone who is already a legal parent) (Name) is a parent because (check all that apply): she is the birth mother. s/he signed a Paternity Acknowledgment. s/he legally adopted the child. statement that s/he used assisted reproduction to have this child were filed with the s/he agreed to use assisted reproduction for us to become parents. s/he signed a valid surrogate parentage contract saying s/he is the intended parent of this child. Alleged Parent/s (someone who may or may not be a genetic parent) (Name/s) may be a parent because the birth mother had sex with this person (or these people) between (starting and ending dates): when this child was likely conceived. Presumed Parent (someone who is presumed by law to be a legal parent) (Name) is a presumed parent because (check all that apply): this person and the birth mother were married or in a registered domestic partnership when this child was born, or within the 300 days before this child was born. this person and the birth mother believed they were in a valid marriage or registered domestic partnership when this child was born or within the 300 days before this child was born, even though the marriage or partnership was (or could have been) invalidated by a court. after this child was born, this person and the birth mother married or became registered domestic partners (or believed their marriage or partnership was valid, even if it was or could have been invalidated). This person willingly said s/he is (check all that apply): Promised in a written or electronic record to support this child as his/her own. See RCW 26.26.011(23). American LegalNet, Inc. www.FormsWorkFlow.com Ch. 26.26 RCW Mandatory Form (07/2017) FL Parentage 302 Declaration about Parentage p. 4 of 6 Filed a statement Vital Statistics. this person lived in the same home as this child and openly held out this child as (List examples that show how this person treated this child as if s/he were the parent): 4. Should the presumed parent continue to be a legal parent? Does not apply. There is no presumed parent. Yes, the presumed parent should be confirmed as a legal parent. No, should not (check all that apply): did not live with and did not have sex with the birth mother when this child was likely conceived, and did not openly hold out this child as his/her own child. hold out this child as his/her own child. See the requests listed in the Sexual Assault Allegation (FL Parentage 365) filed separately. 5. Was this child conceived in Washington State? Yes. During this time period (starting and ending dates): , I had sex in Washington state with (name/s): , which may have produced this child. No. 6. Was this child conceived through assisted reproduction? Yes. No. 7. During the past 5 years has the child lived: on an Indian reservation, outside Washington state, in a foreign country, or with anyone who is not a party to this case? American LegalNet, Inc. www.FormsWorkFlow.com Ch. 26.26 RCW Mandatory Form (07/2017) FL Parentage 302 Declaration about Parentage p. 5 of 6 No. (Skip to 8.) Yes. (Fill out below to show where the child has lived during the last 5 years.) Dates Child lived with In which state, Indian reservation, or foreign country From: To: Petitioner Resp. (name/s): Other (name): From: To: Petitioner Resp. (name/s): Other (name): From: T o: Petitioner Resp. (name/s): Other (name): From: To: Petitioner Resp. (name/s): Other (name): From: To: Peti tioner Resp. (name/s): Other (name): 8. Do you know of anyone besides the parties to this case who has or claims to have a legal right to spend time with this child? (Check one): No. Yes. (Name/s) has or claims to have a legal right to spend time with this child. 9. Do you know of any court cases involving this child? (Check one): No. (Skip to 10.) Yes. (Fill out below.) Kin d of case (Family Law, Criminal, Protection Order, Juvenile, Dependency, Other) County and State Case number and year American LegalNet, Inc. www.FormsWorkFlow.com Ch. 26.26 RCW Mandatory Form (07/2017) FL Parentage 302 Declaration about Parentage p. 6 of 6 10. Lawyer for the State I understand that any lawyer for the State of Washington is not my lawyer for this case. I also understand that I have the right to hire my own lawyer at any time. 11. Other information about parentage (if any): I declare under penalty of perjury under the laws of the state of Washington that the facts I have provided on this form are true. Signed at Date: city state Sign here Print name here American LegalNet, Inc. www.FormsWorkFlow.com