Superior Court of Washington, County of In re parentage: Petitioner (person who started this case): No. Final Order and Findings on Petition to Withdraw (Rescind) Paternity Acknowledgment or Denial (JORWD) Clerk's action required: 1, 14 And Respondent/s: (other person/s who signed the Acknowledgment or Denial) Final Order and Findings on Petition to Withdraw (Rescind) Paternity Acknowledgment or Denial 1. Money Judgment Summary No money judgment is ordered. Summarize any money judgment from section 14 in the table below. Judgment for Debtor's name (person who must pay money) Creditor's name (person who must be paid) Amount Interest Lawyer fees Guardian ad litem (GAL) fees Court costs Other fees and expenses (specify): Yearly Interest Rate: ____% (12% unless otherwise listed) Lawyer (name): Lawyer (name): represents (name): represents (name): $ $ $ $ $ $ RCW 26.26.330, 340 Mandatory Form (05/2016) FL Parentage 343 Final Order and Findings on Pet. to Withdraw Paternity Ackn. or Denial p. 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com  Findings & Conclusions 2. Court findings based on (check all that apply): Parties' agreement Default order (date): Court hearing on (date): The following people were at the hearing (list parties, lawyers, and any GALs): 3. Notice and jurisdiction over parents (check all that apply): All people with a right to receive notice of this case were served with the Summons and Petition. Each party agreed to personal jurisdiction in Washington by signing a Paternity Acknowledgment or Denial of Paternity that was filed with the Washington State Registrar of Vital Statistics. Other (specify): 4. Child This case is about a Paternity Acknowledgment (and Denial, if any) for the following child: Child's name Birth date (month / day / year) The Acknowledgment (and Denial, if any) was filed with the Washington State Registrar of Vital Statistics on (date): 5. Effective Date The Paternity Acknowledgment (and Denial, if any) became effective on (date): . This is either the date the child was born, or the date the Paternity Acknowledgment (and Denial, if any) was filed with the Washington State Registrar of Vital Statistics, whichever happened later. 6. Withdrawal Deadline This case was started (check one): before the deadline for withdrawing (rescinding) the Paternity Acknowledgment (and Denial, if any) because (check one): the Petitioner was under 18 when s/he signed the Acknowledgment or Denial, and this Petition was filed or served on or before the Petitioner's 19th birthday. RCW 26.26.330, 340 Mandatory Form (05/2016) FL Parentage 343 Final Order and Findings on Pet. to Withdraw Paternity Ackn. or Denial p. 2 of 6 American LegalNet, Inc. www.FormsWorkFlow.com the Petition was filed or served: within 60 days of the Effective Date listed above, and before there were any court hearings involving this child in any case that the Petitioner was a party to. after the deadline for withdrawing (rescinding) the Paternity Acknowledgment (and Denial, if any) because (check one): the Petitioner was under 18 when s/he signed the Acknowledgment or Denial, but this Petition was not filed or served until after the Petitioner's 19th birthday. the Petition was filed and served (check all that apply): 60 days or more after the Effective Date listed above. after there was a court hearing involving this child in a case the Petitioner was a party to. 7. Parentage Petition A Petition to Decide Parentage has been filed. A Petition to Decide Parentage has not been filed. 8. Child's Name No one requested a name change. The Court finds there are not good reasons to change this child's last name. The Court finds good reasons to change this child's last name to: . 9. Protection Order Does not apply. The court signed an Order for Protection filed separately today or on (date): Other findings: . 10. Restraining Order Does not apply. The court signed a Restraining Order filed separately today or on (date): Other findings: . 11. Fees and Costs Does not apply. (Name): should pay court costs, guardian ad litem costs, lawyer fees, and other reasonable costs. (Money Judgment in 14, below.) Other: RCW 26.26.330, 340 Mandatory Form (05/2016) FL Parentage 343 Final Order and Findings on Pet. to Withdraw Paternity Ackn. or Denial p. 3 of 6 American LegalNet, Inc. www.FormsWorkFlow.com 12. Other findings, if any Court Orders 13. Decision ­ The Petition is (check one): Denied. The Paternity Acknowledgment and Denial, if any, are still valid. Granted. (Check all that apply): Acknowledgment / Denial of Paternity The Paternity Acknowledgment is withdrawn (rescinded). Any related Denial of Paternity is cancelled (void). The Denial of Paternity is withdrawn (rescinded). The related Paternity Acknowledgment is cancelled (void). Child's Name and Birth Certificate Upon receipt of a certified copy of this Order, the State Registrar of Vital Statistics must amend the child's birth certificate as follows: removing (acknowledged father's name): as a parent. adding (presumed parent's name): as a parent. changing the last name of the child to: Note ­ The court does not forward this Order to Vital Statistics. To amend the birth certificate, a party must provide a certified copy of this Order and pay a filing fee to the State Registrar of Vital Statistics (360-236-4347). You may order a copy of the amended birth certificate for an additional fee. Protection or Restraining Order Does not apply. The court signed the following orders, filed separately: Order for Protection. Restraining Order. Check this box if the court previously signed a temporary Restraining Order and is not signing a final Restraining Order in this case. Also check the "Clerk's action required" box in the caption on page 1. Name of law enforcement agency where the Protected Person lived when the Restraining Order was issued: To the Clerk: Provide a copy of this Order to the agency listed above within 1 court day. The law enforcement agency must remove the temporary Restraining Order from the state's database. . RCW 26.26.330, 340 Mandatory Form (05/2016) FL Parentage 343 Final Order and Findings on Pet. to Withdraw Paternity Ackn. or Denial p. 4 of 6 American LegalNet, Inc. www.FormsWorkFlow.com 14. Money Judgment for fees and costs (summarized on page 1) No money judgment is ordered. The court orders a money judgment for fees and costs as follows: Judgment for Debtor's name (person who must pay money) Creditor's name (person who must be paid) A