Superior Court of Washington County of In re Parentage: No. Petitioner, and Respondent and Judgment and Order Determining Parentage and Granting Additional Relief (JDOEP) [ ] Clerk’s Action Required [ ] Law Enforcement Notification, ¶ 3.11 Respondent. 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 3.11. Violation of a Restraining Order in Paragraph 3.11 below with actual knowledge of its terms is a criminal offense under Chapter 26.50 RCW and will subject the violator to arrest. RCW 26.26.130. 1.2 Money Judgment Summary [ ] Does not apply. [ ] Judgment Summary is set forth below: A. Judgment creditor B. Judgment debtor C. Principal judgment amount $ D. Interest to date of judgment $ E. Attorney fees $ F. Costs $ G. Other recovery amount $ H. Principal judgment shall bear interest at __________ % per annum I. Attorney fees, costs and other recovery amounts shall bear interest at __________ % per annum Jdgmnt/Ord Determining Parentage (JDOEP) - Page 1 of 8 WPF PS 04.0200 Mandatory (6/2008) - RCW 26.26.130 .625, .630 American LegalNet, Inc. www.FormsWorkflow.com J. Attorney for judgment creditor K. Attorney for judgment debtor L. Other: End of Summaries II. Basis This matter has come before this court, the court considered the case record to date and has previously entered its findings of fact and conclusions of law. III. Order It is Ordered: 3.1 Designation of Father (Name) ____________________________ is the father of (name) _______________________, born to (name) ______________________________. Name (first/last): Birth Date: Service Address: _______________________________________________________________ (You may list an address that is not your residential address where you agree to accept legal documents.) The father must immediately file with the court and the Washington State Child Support Registry, and update as necessary, the Confidential Information form required by RCW 26.23.050. The father shall update the information required by Paragraph 3.1 promptly after any change in the information. The duty to update the information continues as long as any monthly support remains due or any unpaid support debt remains due under this judgment. [] 3.2 (Name) _________________________________ is not the father and is hereby dismissed from this action. Mother of the Child Name (first/last): Birth Date: Service Address: ______________________________________________________________ (You may list an address that is not your residential address where you agree to accept legal documents) The mother must immediately file with the court and the Washington State Child Support Registry, and update as necessary, the Confidential Information Form required by RCW 26.23.050. The mother shall update the information required by Paragraph 3.2 promptly after any change in the information. The duty to update the information continues as Jdgmnt/Ord Determining Parentage (JDOEP) - Page 2 of 8 WPF PS 04.0200 Mandatory (6/2008) - RCW 26.26.130 .625, .630 American LegalNet, Inc. www.FormsWorkflow.com long as any monthly support remains due or any unpaid support debt remains due under this judgment. 3.3 Service of Process Service of process on the father at the address required by Paragraph 3.1 or any updated address, or on the mother at the address required by Paragraph 3.2 or any updated address, may be allowed or accepted as adequate in any proceeding to establish, enforce or modify a Child Support Order between the parties by delivery of written notice to the father or mother at the last address provided. 3.4 Jurisdiction Over the Child The court has jurisdiction over the child as set forth in the Findings of Facts and Conclusions of Law. 3.5 Residential Schedule/Parenting Plan [] [] [] [] [] 3.6 Order of Child Support [] [] [] [] 3.7 The primary residence of the child(ren) shall be with (name) ______________________, who is designated custodian solely for the purpose of other state and federal statutes. The residential plan/parenting plan signed by the court on this date or dated __________________, is adopted and incorporated by reference. (Name) ______________________________ shall be designated the custodian of the child(ren), and the child(ren) shall reside with (name) _______________________ at all times. Determination of residential time of (name) ________________________________ with the child(ren) is denied. Other: Does not apply. The determination of the amount of child support is reserved for later determination by this court. (Name) ______________________________ shall pay child support as set forth in the Order of Child Support [ ] which is attached [ ] which is filed separately. Other: Judgment [] [] (Note - do not repeat this judgment in the Order of Child Support WPF PS 01.0500.) Does not apply. (Name) _______________________________ shall have judgment against (name)______________________ in the total amount of $_______________ as follows: [] $_______________ for blood testing costs. [] $_______________ for guardian ad litem fees. [] $_______________ for attorney fees. [] $_______________ costs. Jdgmnt/Ord Determining Parentage (JDOEP) - Page 3 of 8 WPF PS 04.0200 Mandatory (6/2008) - RCW 26.26.130 .625, .630 American LegalNet, Inc. www.FormsWorkflow.com [] [] [] $_______________ for other fees and expenses. Other: (Name) ____________________________ shall have judgment against (name) __________________________ for ______________________________ in the amount of $_______________. 3.8 County Costs [] [] [] 3.9 Does not apply. The Superior Court of _____________________________ shall have judgment against (name) ____________________________ for costs of this action specified as follows: Other: Birth Certificate [] [] 3.10 The Department of Health, Office of Vital Records, shall amend the birth certificate in conformity with this order. Other: Guardian ad Litem [] [] [] Does not apply. Any guardian ad litem appointed by the court is discharged. Other: 3.11 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) ___________________ _________________________________________________. (Name) _______________________________ is restrained and enjoined from going onto the grounds of or entering the home, work place or school of the protected person, 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, or the day care or school of these children: _______________________________________________________________. Other: ________________________________________________________. Jdgmnt/Ord Determining Parentage (JDOEP) - Page 4 of 8 WPF PS 04.0200 Mandatory (6/2008) - RCW 26.26.130 .625, .630 American LegalNet, Inc. www.FormsWorkflow.com [] [] (Name) _____________________________ is restrained and enjoined from molesting, assaulting, harassing or stalking (name) _______________________. (The following firearm restrictions apply if this box is checked: Effective immediately and continuing as long as this continuing restraining order is in effect, the restrained person may not possess a firearm or ammunition. 18 U.S.C. § 922(g)(8). A violation of this federal firearms law carries a maximum possible penalty of 10 years in prison and a $250,000 fine. An exception exists for law enforcement officers and military personnel when carrying department/government-issue firearms. 18 U.S.C. § 925(a)(1).) Other: Violation of a Restraining Order in Paragraph 3.11 with actual knowledge of its terms is a criminal offense under Chapter 26.50 RCW and will subject the violator to arrest. RCW 26.26.130. [] 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 the 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 [] [] 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 This restraining order expires on: (month/day/year) supersedes all previous temporary restraining orders in this cause number. [] Any temporary restraining order previously entered 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. Full Faith and Credit Pursuant to 18 U.S.C. § 2265, a court in any of the 50 states, the District of Columbia, Puerto Rico, any United States territory, and any tribal land within the United States shall accord full faith and credit to the order. 3.12 Protection Order Jdgmnt/Ord Determining Parentage (JDOEP) - Page 5 of 8 WPF PS 04.0200 Mandatory (6/2008) - RCW 26.26.130 .625, .630 American LegalNet, Inc. www.FormsWorkflow.com [] [] 3.13 Does not apply. The parties shall comply with the [ ] domestic violence [ ] antiharassment Order for Protection signed by the court on this date or dated _____________________________, in this cause number. The Order for Protection signed by the court is approved and incorporated as part of this decree. Other Provisions [] [] Does not apply. Back Child Support: (Note - Do not repeat this judgment in the Order of Child Support WPF PS 01.0500.) [] [] [] [] [] [] (Name) _______________________________ is awarded a judgment against (name) _______________________________ in the amount of $ ____________ for back child support for the period from _____________ to _______________. The unpaid support due to (name) _____________________________________ by (name) ____________________________________ is waived and will not be collected by (name) ____________________________________. This does not waive any support owing to the state as a result of payment of public assistance. All support due under temporary court orders has been paid. Unpaid support due under a court or administrative order is preserved for collection and is not merged in or extinguished by this order. Other: Collection Limitation Against Wages: The judgment in paragraph 3.6 and the back child support provision above shall be paid at a rate of at least $__________ per month beginning __________________. So long as the payments for current support, back support and the judgment are timely, collection against the judgment debtor’s wages, excluding bonuses and other lump sum payments, shall be limited to $_______________ per month (for current support, back support and judgment). This limitation terminates if a single payment is past due. This provision does not limit or bar the state of Washington from using other collection remedies available to it by law, including, but not limited to, certification for collection to the Internal Revenue Service. Payment shall be made to: [] Wage Withholding Action: [] Withholding action may be taken against wages, earnings, assets, or benefits, and liens enforced against real and personal property under the child support statutes of this or any other state, without further notice to the judgment debtor any time after entry of an order by the court, except as limited by the Collection Limitation Against Wages paragraph above. [] Wage withholding, by notice of payroll deduction or other income withholding action under Chapter 26.18 RCW or Chapter 74.20 RCW, without further notice to the judgment debtor, is delayed until a payment is past due, because: [] [] there is good cause not to require immediate income withholding. the parties have reached a written agreement which the court approves that provides for an alternative arrangement. (See below:) Jdgmnt/Ord Determining Parentage (JDOEP) - Page 6 of 8 WPF PS 04.0200 Mandatory (6/2008) - RCW 26.26.130 .625, .630 American LegalNet, Inc. www.FormsWorkflow.com [] Judgment and Back Support Payments Shall Be Made: [] To the: Washington State Support Registry P.O. Box 45868 Olympia, Washington 98504 Phone: 1-800-922-4306 1-800-442-5437 Each party shall notify the Washington State Support Registry of any change in residence address. 3.14 Other 3.15 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 5 days after learning of the move. The notice must contain the information required in RCW 26.09.440. See also form DRPSCU 07.0500, (Notice of Intended Relocation of a Child). 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. Jdgmnt/Ord Determining Parentage (JDOEP) - Page 7 of 8 WPF PS 04.0200 Mandatory (6/2008) - RCW 26.26.130 .625, .630 American LegalNet, Inc. www.FormsWorkflow.com 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. Dated: Judge/Commissioner Petitioner or petitioner’s lawyer: A signature below is actual notice of this order. [ ] Presented by: [ ] Approved for entry: [ ] Notice for presentation waived: Respondent or respondent’s lawyer: A signature below is actual notice of this order. [ ] Presented by: [ ] Approved for entry: [ ] Notice for presentation waived: Signature of Petitioner or Lawyer/WSBA No. Signature of Respondent or Lawyer/WSBA No. Print or Type Name Print or Type Name Date Date [ ] Presented by: [ ] Approved for entry: [ ] Notice for presentation waived: Signature of Party or Lawyer/WSBA No. Print or Type Name Date Jdgmnt/Ord Determining Parentage (JDOEP) - Page 8 of 8 WPF PS 04.0200 Mandatory (6/2008) - RCW 26.26.130 .625, .630 American LegalNet, Inc. www.FormsWorkflow.com