Superior Court of Washington County of In re Parentage: No. Petitioner, and Petition for Rescission of Denial of Paternity (PT) Respondent, and Respondent. Para.1.8: check box if petition is attached for: [ ] Order for protection DV (PTORPRT) [ ] Order for protection UH (PTORAH) I. Basis 1.1 Cause of Action This action affects the paternity of: (Name) ___________________________________, born on (date) __________________, a resident of _____________________________ County, Washington. The result of this proceeding will not establish or disestablish the paternity of the presumed father; it will only establish whether the Denial of Paternity may be rescinded (withdrawn). This action is brought by (name) _____________________ petitioner, the presumed father, to rescind the Denial of Paternity signed by him on (date) ____________________ and filed with the Washington State Registrar of Vital Statistics on (date) ________________________. The respondents in the action are the acknowledged father (name) _____________________ and the mother (name) __________________________, who signed the Acknowledgment of Paternity on (date) _____________________ and filed it with the Washington State Registrar of Vital Statistics on (date) ______________________________. This action is brought pursuant to RCW 26.26.330 and 340. A copy of the Denial of Paternity and the Acknowledgment of Paternity are filed with this petition under the Sealed Acknowledgment/Denial of Paternity/Birth Certificate Cover Sheet, form WPF PS 15.0150. 1.2 Effective Date of Denial of Paternity Pet for Rescission Denial of Pat (PT) - Page 1 of 4 WPF PS 12.0100 Mandatory (06/2012) - RCW 26.26.330 and .340 American LegalNet, Inc. www.FormsWorkFlow.com The effective date of the Denial of Paternity is (date) _____________________________, because. [] [] 1.3 the Denial of Paternity and the Acknowledgment of Paternity were filed with the Washington State Registrar of Vital Statistics on that date. the child was born on that date and the Denial of Paternity and the Acknowledgment of Paternity were filed with the Washington State Registrar of Vital Statistics before the child was born. Parentage Action [] [] [] 1.4 A parentage action is pending in (county) _____________________, under cause number _________________________. A parentage action will be filed by petitioner. A parentage action will not be filed by petitioner. Jurisdiction All persons who signed the Paternity Acknowledgment filed on (date) ___________________ and the Denial of Paternity filed on (date) _______________________ submitted to the jurisdiction of the court on that date pursuant to RCW 26.26.340(2); and [] no court hearing involving the petitioner has been held relating to the child and less than 60 days have passed since the effective date of the denial and acknowledgment. [] the petitioner was a minor when he signed the Denial of Paternity and this action was commenced on or before his 19th birthday. Or 1.5 Child Support [] [] 1.6 Suspension of Child Support [] [] 1.7 Does not apply. A Washington State Department of Social and Health Services Division of Child Support Administrative Child Support Order was entered on (date) ______________________. requiring (name) ________________________ to pay $______________ per month for the support of the child. Does not apply. A motion to suspend the child support order will be filed. Continuing Restraining Order [] [] [] 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. Pet for Rescission Denial of Pat (PT) - Page 2 of 4 WPF PS 12.0100 Mandatory (06/2012) - RCW 26.26.330 and .340 American LegalNet, Inc. www.FormsWorkFlow.com [] [] 1.8 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. II. Relief Requested The court is requested to enter an order and judgment that: [] [] [] [] [] [] [] [] Declares the Denial of Paternity is rescinded. Declares the Paternity Acknowledgment is void. Amends the birth certificate of the child by removing the acknowledged father as the father and adding the presumed father as the father of the child. Changes the surname of the child to (name) __________________________. Makes provision for a domestic violence protection order. Makes provision for an antiharassment protection order. Makes provision for a continuing restraining order. Awards attorney’s fees and costs to petitioner. Dated: _____________________________ __________________________________________ Signature of Petitioner or Lawyer /WSBA No. III. Declaration I declare under penalty of perjury under the laws of the state of Washington that I am the petitioner named above, that I have made the allegations contained in this petition based upon my first hand knowledge, and therefore believe that they are true. Signed at (date) ________________________, (state) ____________ on (date) __________________. Signature of Petitioner Print or Type Name Pet for Rescission Denial of Pat (PT) - Page 3 of 4 WPF PS 12.0100 Mandatory (06/2012) - RCW 26.26.330 and .340 American LegalNet, Inc. www.FormsWorkFlow.com [] Joinder [] I, (name) _______________________________, 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 [] I, (name) _______________________________, 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 Rescission Denial of Pat (PT) - Page 4 of 4 WPF PS 12.0100 Mandatory (06/2012) - RCW 26.26.330 and .340 American LegalNet, Inc. www.FormsWorkFlow.com