Superior Court of Washington County of In re Parentage: No. Petitioner, and Respondent and Respondent and Petition for Establishment of Parentage (PTDTP) Para.1.10: check box if petition is attached for: [ ] Order for protection DV (PTORPRT) [ ] Order for protection UH (PTORAH) Child(ren) over the age of 2. Use a separate petition for each child unless the parents or possible parents in paragraph 1.2 are the same for every child in this petition. Use this petition when there is no adjudicated parent or Paternity Acknowledgment filed with the Washington State Registrar of Vital Statistics; otherwise use form WPF PS 16.0100. I. Basis 1.1 Cause of Action This is a petition for the establishment of parentage. This action is brought on behalf of: (Name of child) _________________________________, born on (date) _______________, a resident of (name of county) _________________________ County, Washington. (Name of child) _________________________________, born on (date) _______________, a resident of (name of county) _________________________________ County, Washington. 1.2 Parties to the Action A. Petitioner, (name) ___________________________, I am the (select one): [ ] alleged parent [ ] adoptive parent [ ] parent by assisted reproduction [ ] birth mother [ ] presumed parent [ ] parent by surrogacy contract Pet for Establishment of Parentage (PTDTP) - Page 1 of 8 WPF PS 01.0100 Mandatory (06/2012) - RCW 26.26.505, .525, .530 American LegalNet, Inc. www.FormsWorkFlow.com B. Respondent is (name) ______________________________ who is: [ ] alleged parent [ ] adoptive parent [ ] parent by assisted reproduction [ ] birth mother [ ] presumed parent [ ] parent by surrogacy contract Respondent is (name) ______________________________ who is: [ ] alleged parent [ ] adoptive parent [ ] parent by assisted reproduction [ ] birth mother [ ] presumed parent [ ] parent by surrogacy contract C. Children: [] The following child(ren) are parties to this case because the child(ren) have a presumed parent and the child(ren) were born more than two years ago. (Name of child) _________________________________, Name of child) _________________________________, Petitioner requests the court to appoint a Guardian ad Litem for the child(ren) who are parties. 1.3 Presumed Parent [] Does not apply. There is no presumed parent. [] (Name) _____________________ [] is a presumed parent because: The child was born during the marriage or registered domestic partnership or within 300 days after the end of a marriage or registered domestic partnership. [] Before the child was born, this person and (name) __________________ were in a marriage or registered domestic partnership believing it was valid, even though it was or could have been declared invalid by a court. The child was born during this marriage or registered domestic partnership or within three hundred days after it ended. [] After the child was born, this person and (name) ___________________ were in a marriage or in a registered domestic partnership believing it was valid even though it was or could have been declared invalid by a court and this person voluntarily claimed to be a parent and: [] filed the claim with the state registrar of vital statistics; or [] agreed to be and is named as the child's parent on the child's birth certificate; or [] promised in a record to support the child as his or her own. [] [] This person lived in the same household with the child and openly held out the child as his or her own for the first two years of the child’s life, and this petition will be filed or served no later than four years after the birth of this child. Pet for Establishment of Parentage (PTDTP) - Page 2 of 8 WPF PS 01.0100 Mandatory (06/2012) - RCW 26.26.505, .525, .530 American LegalNet, Inc. www.FormsWorkFlow.com [] [] This person neither cohabited nor engaged in sexual intercourse with (name) _____________________ during the probable time of conception, nor held out the child as his or her own. (Name) _____________________ [] is a presumed parent because: The child was born during the marriage or registered domestic partnership or within 300 days after the end of a marriage or registered domestic partnership. [] Before the child was born, this person and (name) __________________ were in a marriage or registered domestic partnership believing it was valid, even though it was or could have been declared invalid by a court. The child was born during this marriage or registered domestic partnership or within three hundred days after it ended. [] After the child was born, this person and (name) _____________________ were in a marriage or in a registered domestic partnership believing it was valid even though it was or could have been declared invalid by a court and this person voluntarily claimed to be a parent and: [] filed the claim with the state registrar of vital statistics; or [] agreed to be and is named as the child's parent on the child's birth certificate; or [] promised in a record to support the child as his or her own. [] [] [] This person lived in the same household with the child and openly held out the child as his or her own for the first two years of the child’s life, and this petition will be filed or served no later than four years after the birth of this child. This person neither cohabited nor engaged in sexual intercourse with (name) _____________________ during the probable time of conception, nor held out the child as his or her own. [] [] 1.4 The child has a presumed parent and not more than four years have passed since the birth of the child. Other: Jurisdiction [] Jurisdiction over respondent (name) _________________________________ (check all that apply): Pet for Establishment of Parentage (PTDTP) - Page 3 of 8 WPF PS 01.0100 Mandatory (06/2012) - RCW 26.26.505, .525, .530 American LegalNet, Inc. www.FormsWorkFlow.com [] [] [] [] [] [] [] [] This person currently resides in Washington State. This person engaged in sexual intercourse in the state of Washington as a result of which the child may have been conceived. This person was personally served with summons and petition within this state. This person submits to jurisdiction of this state by consent as evidenced by joinder or consent to jurisdiction signed by respondent. This person resided with the child in this state. This person resided in this state and provided prenatal expenses or support for the child. The child resides in this state as a result of the acts or directives of this person. Other: [] [] (Name) ______________________________ is not named as a party because he or she is not subject to the jurisdiction of the court. [] 1.5 Jurisdiction over respondent (name) _________________________________ (check all that apply): [] This person currently resides in Washington State. [] This person engaged in sexual intercourse in the state of Washington as a result of which the child may have been conceived. [] This person was personally served with summons and petition within this state. [] This person submits to jurisdiction of this state by consent as evidenced by joinder or consent to jurisdiction signed by respondent. [] This person resided with the child in this state. [] This person resided in this state and provided prenatal expenses or support for the child. [] The child resides in this state as a result of the acts or directives of this person. [] Other: Other: Jurisdiction Over the Child This court has jurisdiction over the child for the reasons set forth below: [] This court has exclusive continuing jurisdiction. The court has previously made a child custody, parenting plan, residential schedule or visitation determination in this matter and retains jurisdiction under RCW 26.27.211. [] This state is the home state of the child because: [] [] [] [] the child lived in Washington with a parent or a person acting as a parent for at least six consecutive months immediately preceding the commencement of this proceeding. the child is less than six months old and has lived in Washington with a parent or a person acting as parent since birth. any absences from Washington have been only temporary. Washington was the home state of the child within six months before the commencement of this proceeding and the child is absent from the state but a parent or person acting as a parent continued to live in this state. Pet for Establishment of Parentage (PTDTP) - Page 4 of 8 WPF PS 01.0100 Mandatory (06/2012) - RCW 26.26.505, .525, .530 American LegalNet, Inc. www.FormsWorkFlow.com [] The child and the parent or the child and at least one parent or person acting as a parent have significant connection with the state other than mere physical presence, and substantial evidence is available in this state concerning the child's care, protection, training and personal relationships, and [] [] the child has no home state elsewhere. the child's home state has declined to exercise jurisdiction on the ground that this state is the more appropriate forum under RCW 26.27.261 or .271. [] All courts in the child's home state have declined to exercise jurisdiction on the ground that a court of this state is the more appropriate forum to determine the custody of the child under RCW 26.27.261 or .271. [] No other state has jurisdiction. [] This court has temporary emergency jurisdiction over this proceeding because the child is present in this state and the child has been abandoned or it is necessary in an emergency to protect the child because the child, or a sibling or parent of the child is subjected to or threatened with abuse. RCW 26.27.231. [] [] 1.6 There is a previous custody determination that is entitled to be enforced under this chapter or a child custody proceeding has been commenced in a court of a state having jurisdiction under RCW 26.27.201 through 26.27.221. The requirements of RCW 26.27.231(3) apply to this matter. This state’s jurisdiction over the child shall last until (date) _______________________________. There is no previous custody determination that is entitled to be enforced under this chapter and a child custody proceeding has not been commenced in a court of a state having jurisdiction under RCW 26.27.201 through 26.27.221. If an action is not filed in (potential home state) _____________________ by the time the child has been in Washington for six months, (date) ___________________, then Washington's jurisdiction will be final and continuing. Child Support and Residential Placement The child is entitled to financial support pursuant to the Washington State child support statutes and health insurance coverage from any parent owing a duty of child support, and it is otherwise in the child’s best interests to obtain a judicial determination of the parentage and residential placement of the child. [] 1.7 Other: Current Residence of the Child The child currently resides with (name(s)) _____________________________________. 1.8 Reimbursement [] Does not apply. Pet for Establishment of Parentage (PTDTP) - Page 5 of 8 WPF PS 01.0100 Mandatory (06/2012) - RCW 26.26.505, .525, .530 American LegalNet, Inc. www.FormsWorkFlow.com [] [] 1.9 Continuing Restraining Order [] [] [] [] [] 1.10 The state of Washington and/or ______________________________ is entitled to reimbursement for support or assistance provided to the child, for expenses incurred on behalf of the child. Other: Does not apply. A continuing restraining order should be entered which restrains or enjoins (name) _______________________________ from disturbing the peace of (name) _____________________________. A continuing restraining order should be entered which restrains or enjoins (name) _____________________________ from going onto the grounds of or entering the home, work place or school of (name) __________________________________ or the day care or school of the child. A continuing restraining order should be entered which restrains or enjoins (name) _____________________________ from knowingly coming within or knowingly remaining within (distance) _______________ of the home, work place or school of (name) ______________________________ or the day care or school of the child. Other: ___________________________________________________________. A continuing restraining order should be entered which restrains or enjoins (name) _________________________________ from molesting, assaulting, harassing, or stalking (name) _______________________________________. (If the court orders this relief, the restrained person will be prohibited from possessing a firearm or ammunition under federal law for the duration of the order. An exception exists for law enforcement officers and military personnel when carrying department/governmentissued firearms. 18 U.S.C. § 925(a)(1).) Protection Order [] [] [] Does not apply. There is a protection order between the parties filed in case number ________________, court ____________________________, which expires on (date) __________________. The court should grant the [ ] domestic violence [ ] antiharassment petition for order for protection: [ ] attached to this petition. [ ] filed separately under [ ] this case number [ ] case number _____________________. If you need immediate protection, contact the clerk/court for RCW 26.50 Domestic Violence forms or RCW 10.14 Antiharassment forms. 1.11 Other II. Relief Requested Pet for Establishment of Parentage (PTDTP) - Page 6 of 8 WPF PS 01.0100 Mandatory (06/2012) - RCW 26.26.505, .525, .530 American LegalNet, Inc. www.FormsWorkFlow.com The court is requested to enter an order and judgment that: [] (Name) __________________________________ be declared to be the parent of (name of child(ren)) __________________________________. [] (Name) _____________________________________ be declared not to be the parent of (name of child(ren)) _______________________________________________________________. [] The birth certificate of the child(ren) _________________________________________ be amended to list (name) ______________________ and (name) ___________________________ as the parents. [] Support, including medical support, be determined for the dependent child pursuant to the Washington State child support statutes. [] (Name(s))________________________________________ pay past support, medical, and other expenses incurred on behalf of the child. [] A residential plan or parenting plan for the child be adopted by the court as proposed by the parents or as the court finds to be in the child’s best interest. [] In the event no residential plan or parenting plan is proposed, the custodian and primary residential parent be the parent with whom the child currently resides and the other parent’s residential time be denied. [] Provides for a domestic violence protection order. [] Provides for an antiharassment protection order. [] Provides for a continuing restraining order. [] Court costs, genetic test costs, guardian ad litem, attorney, and other reasonable fees be awarded by the court. [] Other: Dated: Signature of Petitioner or Lawyer/WSBA No. Print or Type Name 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 Petitioner [] Print or Type Name Joinder [] I, _______________________, join in the petition. I understand that by joining in the petition, a decree or judgment and order may be entered in accordance with the relief requested in the petition unless, prior to the entry of the decree or judgment and order, a response is filed and served. [] I waive notice of entry of the decree. Pet for Establishment of Parentage (PTDTP) - Page 7 of 8 WPF PS 01.0100 Mandatory (06/2012) - RCW 26.26.505, .525, .530 American LegalNet, Inc. www.FormsWorkFlow.com [] I demand notice of all further proceedings in this matter. Further notice should be sent to the following address: (you may list an address that is not your residential address where you agree to accept legal documents.): Any time this address changes while this action is pending, you must notify the opposing parties in writing and file an updated Confidential Information Form (WPF DRPSCU 09.0200) with the court clerk. Dated: Signature of Joining Party Print or Type Name [] I, _______________________, join in the petition. I understand that by joining in the petition, a decree or judgment and order may be entered in accordance with the relief requested in the petition unless, prior to the entry of the decree or judgment and order, a response is filed and served. [] I waive notice of entry of the decree. [] I demand notice of all further proceedings in this matter. Further notice should be sent to the following address: (you may list an address that is not your residential address where you agree to accept legal documents.): Any time this address changes while this action is pending, you must notify the opposing parties in writing and file an updated Confidential Information Form (WPF DRPSCU 09.0200) with the court clerk. Dated: Signature of Joining Party Print or Type Name Pet for Establishment of Parentage (PTDTP) - Page 8 of 8 WPF PS 01.0100 Mandatory (06/2012) - RCW 26.26.505, .525, .530 American LegalNet, Inc. www.FormsWorkFlow.com