SUPERIOR COURT OF WASHINGTON COUNTY OF In re the Parenting and Support of: NO. Child(ren), PETITION FOR Petitioner, [ ] RESIDENTIAL SCHEDULE/ PARENTING PLAN [ ] CHILD SUPPORT (PT) and Respondent. I. BASIS 1.1 CAUSE OF ACTION. This action is brought pursuant to RCW 26.26.375 by _________________________ [Name], petitioner, for a [ ] residential schedule/parenting plan [ ] child support order for __________________________ [Name], _______________ [Age], residing with __________________________ [Name] in ________________ County, Washington. __________________________ [Name], _______________ [Age], residing with __________________________ [Name] in ________________ County, Washington. __________________________ [Name], _______________ [Age], residing with __________________________ [Name] in ________________ County, Washington. 1.2 ACKNOWLEDGMENT OF PATERNITY AND DENIAL OF PATERNITY. PET FOR RES SCHED/PAR. PLAN AND CHILD SUPPORT (PT) - Page 1 of 7 WPF PS 15.0100 (6/2005) - RCW 26.26.375 American LegalNet, Inc. www.USCourtForms.com ____________________________ [Name] is the child’s acknowledged father and _______________________ [Name] is the mother of the child. Both parents signed the Acknowledgment of Paternity, which was filed with the Washington State Registrar of Vital Statistics on _______________ [Date]. A copy of the Acknowledgment of Paternity is filed with this petition. [] _________________________ [Name] signed a Denial of Paternity, which was filed with the Washington State Registrar of Vital Statistics on ________________________ [Date]. A copy of the Denial of Paternity is filed with this petition. 1.3 JURISDICTION. The court has jurisdiction over the parties because more than 60 days have passed since the effective date of the acknowledgment of paternity and [check all that apply]: [] [] [] [] [] [] [] The mother and acknowledged father engaged in sexual intercourse in the state of Washington as a result of which the child was conceived. Respondent was personally served with summons and petition within this state. Respondent submits to jurisdiction of this state by consent as evidenced by joinder or consent to jurisdiction signed by respondent. Respondent resided with the child in this state. Respondent 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 the respondent. Other: and the following parties are presently residing in the state of Washington: [ ] Mother. [ ] Acknowledged Father. 1.4 PERIOD FOR CHALLENGE TO THE ACKNOWLEDGMENT OR DENIAL OF PATERNITY. (Pick only one.) [] A period of two years or more has passed since the date the acknowledgment [ ] and denial of paternity was filed with the Washington State Registrar of Vital Statistics. [] Less than two years has passed since the date the acknowledgment [ ] or denial of paternity was filed with the Washington State Registrar of Vital Statistics, and petitioner specifically alleges: a) No man other than the acknowledged father is the father of the child; and b) No proceeding to adjudicate the parentage of the child is currently pending; and c) No other man is an adjudicated father of the child; and d) Notice of this proceeding has been provided to all other men who have claimed parentage of the child. 1.5 JURISDICTION OVER THE CHILD. PET FOR RES SCHED/PAR. PLAN AND CHILD SUPPORT (PT) - Page 2 of 7 WPF PS 15.0100 (6/2005) - RCW 26.26.375 American LegalNet, Inc. www.USCourtForms.com This court has jurisdiction over the child for the reasons set forth below. [] [] [] [] [] [] [] 1.6 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 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 only been 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 continues to live in this state. 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. [] 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 children 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. Other: CHILD SUPPORT. PET FOR RES SCHED/PAR. PLAN AND CHILD SUPPORT (PT) - Page 3 of 7 WPF PS 15.0100 (6/2005) - RCW 26.26.375 American LegalNet, Inc. www.USCourtForms.com Support and health insurance coverage for the minor child: [] [] 1.7 has been determined administratively by the Division of Child Support and the petitioner [ ] does [ ] does not want the court to address child support. has not been determined administratively by the Division of Child Support and the petitioner [ ] does [ ] does not want the court to address child support. RESIDENTIAL PLACEMENT. [] [] Does not apply. It is in the child’s best interests to enter the residential schedule/parenting plan proposed by _______________________ [Name]. If residential placement is requested: During the last five years, the child has lived: [] [] in no place other than the state of Washington and with no person other than the declarant or a named party. in the following places with the following persons (list each place the child lived, including the state of Washington, the dates the child lived there and the names of the persons with whom the child lived. The present addresses of those persons must be listed in the required Confidential Information form.): Claims to custody or visitation. [] [] I do not know of any person other than a named party who has physical custody of, or claims to have custody or visitation rights to the child. The following persons have physical custody of, or claim to have custody or visitation rights to the child (list their names and the child(ren) concerned below and list their present addresses in the Confidential Information Form. Do not list the responding party.): Involvement in any other proceeding concerning the child: [] [] I have not been involved in any other proceeding regarding the child. I have been involved in the following proceedings regarding the child (list the court, the case number, and the date of the judgment or order): Other legal proceedings concerning the child: [] I do not know of any other legal proceedings concerning the child. PET FOR RES SCHED/PAR. PLAN AND CHILD SUPPORT (PT) - Page 4 of 7 WPF PS 15.0100 (6/2005) - RCW 26.26.375 American LegalNet, Inc. www.USCourtForms.com [] 1.8 REIMBURSEMENT. [] [] 1.9 Does not apply. The state of Washington or ____________________ [Name] is entitled to reimbursement for support or assistance provided to the child, for expenses incurred on behalf of the child. CONTINUING RESTRAINING ORDER. [] [] [] [] [] 1.10 I know of the following legal proceedings which concern the child (list the child concerned, the court, case number and the kind of proceeding): 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. A domestic violence protection order should be entered protecting __________________________ [Name] from __________________________ [Name] because ____________________________ [Name] has committed domestic violence as defined by 26.50 RCW against ____________________________ [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).) PET FOR RES SCHED/PAR. PLAN AND CHILD SUPPORT (PT) - Page 5 of 7 WPF PS 15.0100 (6/2005) - RCW 26.26.375 American LegalNet, Inc. www.USCourtForms.com If you need immediate protection, contact the clerk/court for RCW 26.50 Domestic Violence forms. 1.11 OTHER: II. RELIEF REQUESTED The court is requested to enter an order that: [] [] [] [] [] determines support for the dependent child pursuant to the Washington State Support Schedule and either or both parents be ordered to maintain or provide health insurance coverage for the child and pay extraordinary uninsured costs proportionate to their income. orders the [ ] acknowledged father [ ] mother to pay past support, medical, and other expenses incurred on behalf of the child. adopts the residential schedule/parenting plan for the child as proposed by petitioner. awards court costs, guardian ad litem, attorney, and other reasonable fees. makes provision for a domestic violence protection order. makes provision for a continuing restraining order. [] Other: [] Dated: Petitioner or Lawyer for Petitioner/WSBA No. III. DECLARATION I declare under penalty of perjury under the laws of the state of Washington that I am the petitioner hereinabove named, 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 ________________________, [City] __________ [State] on ____________________ [Date]. Signature of Petitioner Print or Type Name PET FOR RES SCHED/PAR. PLAN AND CHILD SUPPORT (PT) - Page 6 of 7 WPF PS 15.0100 (6/2005) - RCW 26.26.375 American LegalNet, Inc. www.USCourtForms.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.]: Dated: ____________________________ _____________________________________ Signature of Joining Party _____________________________________ Print or Type Name PET FOR RES SCHED/PAR. PLAN AND CHILD SUPPORT (PT) - Page 7 of 7 WPF PS 15.0100 (6/2005) - RCW 26.26.375 American LegalNet, Inc. www.USCourtForms.com