Superior Court of Washington County of In re Parentage: Petitioner, No. Respondent, Motion for Summary Judgment on Parentage (MTSMJG) and and Respondent, and Child(ren) over age of 2. I. Motion The undersigned moves the court for Summary Judgment against Respondent, (name) _____________ __________________________. Petitioner is entitled to this judgment as a matter of law. II. Relief Requested [] Establish that the respondent is a parent of the child (name of child) _______________________________________________. [] Order that an amended birth certificate be issued by the state registrar of vital statistics reflecting the parentage of the child(ren). [] Order that (name) _______________________________ pay $________________ per month as current support for the child(ren), commencing (date) ______________________ , and continuing on the first day of each month thereafter until further order of the court. [] Order that support be determined for the dependent child pursuant to the Washington State child support statutes and order either or both parents to maintain or provide health insurance coverage for the child and pay uninsured costs proportionate to their net income. [] Order payment of past support, medical, and other expenses incurred on behalf of the child. [] Order that (name) ______________________________ be designated as the custodian of the child(ren), and that the child(ren) shall reside with this person at all times. Mtn for Summary Jdgmnt on Parentage (MTSMJG) - Page 1 of 3 WPF PS 03.0250 (06/2012) - CR 56 American LegalNet, Inc. www.FormsWorkFlow.com [] Approve the residential schedule/parenting plan which is proposed by (name) ___________________________________. [] Order that (name) ________________________ reimburse (name) ________________________ in the amount of $_______________, for genetic test costs. [] Other: III. Statement of Undisputed Facts [] (Name) __________________________ is the child’s: [ ] alleged parent [ ] birth mother [ ] adoptive parent [ ] presumed parent [ ] parent by assisted reproduction [ ] parent by surrogacy contract [] (Name) __________________________ is the child’s: [ ] alleged parent [ ] birth mother [ ] adoptive parent [ ] presumed parent [ ] parent by assisted reproduction [ ] parent by surrogacy contract [] The mother, (name) ______________________________, had sexual intercourse with respondent during the period of conception of (name) _____________________ and the child was born as a result of that intercourse. [] Genetic tests were performed on a sample of __________________ collected from (name) ____________________________, the mother, and the child(ren) by (name) ______________________________________, which is a qualified paternity testing laboratory. The laboratory’s affidavit or declaration, dated _________________, is submitted with this motion. Based upon the results of the genetic testing, (name) reported that the probability that (name) ______________________________________ is the father of the child(ren) is ______________________ per cent. [] The petition in this case was filed or served no later than four years after the birth of the child, and for the first two years of the child’s life, (name) _________________________ resided in the same household with the child and openly held out the child as his or her own. [] [] The child(ren) [ ] is/are [ ] is/are not currently receiving Public Assistance. Other: IV. Statement of Issues Mtn for Summary Jdgmnt on Parentage (MTSMJG) - Page 2 of 3 WPF PS 03.0250 (06/2012) - CR 56 American LegalNet, Inc. www.FormsWorkFlow.com The following issues are or may be disputed: [] [] [] [] [] [] [] [] Parentage Current Support Back Support Costs Medical Support Designated Custodian of the Child(ren) Residential Provisions for the Child(ren) Other: V. Evidence Relied Upon This Motion for Summary Judgment is based upon the case record to date and upon the following supporting documents, which are submitted with this motion: [] [] [] [] [] [] [] Petition for Establishment of Parentage Declaration of Party to a Parentage Action Affidavit/Declaration of Genetic Test Expert Child Support Worksheet Response of __________________________________________________ Affidavit/Declaration Regarding Chain of Custody of samples of blood, buccal cells, or other body tissue or fluid. Other: VI. Authority This motion is brought pursuant to CR 56, to establish the parentage of the child(ren) in accordance with RCW 26.26, Washington’s version of the Uniform Parentage Act. I declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Signed at (city) _______________________, (state) ____________ on (date) _____________________. Signature of Moving Party or Lawyer/WSBA No. Print or Type Name Mtn for Summary Jdgmnt on Parentage (MTSMJG) - Page 3 of 3 WPF PS 03.0250 (06/2012) - CR 56 American LegalNet, Inc. www.FormsWorkFlow.com