Superior Court of Washington County of: In re Parentage: No. Petitioner, and Respondent, and Child(ren) over the age of 2, if applicable. Petition to Disestablish Parentage Based on Presumption (Optional Use) (PTDP) Para. 1.9: 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 is brought to disprove a presumption of parentage which arose pursuant to RCW 26.26.116(3) and RCW 26.26.500 through RCW 26.26.630. This action affects the parentage of: (Child’s name) ___________________________________, born on (date) _________________, a resident of __________________________ County, Washington. (Child’s name) ___________________________________, born on (date) _________________, a resident of _______________________________________ County, Washington. 1.2 Parties to the Action A. Petitioner, (name) _______________________________, I am the (select one): [ ] birth mother [ ] adoptive parent [ ] presumed parent [ ] parent by assisted reproduction [ ] parent by surrogacy contract [ ] acknowledged father Pet Disestab Par (PTDP) – Page 1 of 6 WPF PS 17.0100 Mandatory (06/2012) – RCW 26.26.116 and 26.26.500 – 26.26.630 American LegalNet, Inc. www.FormsWorkFlow.com B. Respondent is (name) ___________________________ who is the (select one): [ [ [ [ ] birth mother ] adoptive parent ] parent by assisted reproduction ] parent by surrogacy contract [ ] presumed parent [ ] acknowledged father Respondent is (name) _____________________________ who is the (select one): [ [ [ [ C. ] birth mother ] adoptive parent ] parent by assisted reproduction ] parent by surrogacy contract [ ] presumed parent [ ] acknowledged father Children: [] These children: (Name of child) _________________________________________, (Name of child) __________________________________________, are parties to this action because :  the presumed parent and the other parent neither cohabited nor engaged in sexual intercourse during the probable time of conception, and  the presumed parent never held out the child(ren) as his or her own, and  the child(ren) were born more than two years ago. Petitioner asks the court to appoint a Guardian ad Litem for the child(ren) who are parties. 1.3 Basis for Presumed Parentage (Name) ___________________________ is a presumed parent of the child 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. Pet Disestab Par (PTDP) – Page 2 of 6 WPF PS 17.0100 Mandatory (06/2012) – RCW 26.26.116 and 26.26.500 – 26.26.630 American LegalNet, Inc. www.FormsWorkFlow.com (Name) ____________________________ is a presumed parent of the child because: [] [] [] [] 1.4 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. Basis For Disproving the Presumption of Parentage I want to disprove the parent-child relationship between the presumed parent and the child because [ ] I am not or may not be [ ] the respondent is not or may not be the parent of the child and: [ ] The child is under four years of age. Or [ ] [ ] 1.5 The presumed parent 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. For the first two years of this child’s life, the presumed parent did not reside in the same household with the child and did not openly hold out the child as his or her own. Jurisdiction [] Jurisdiction over respondent (name) _________________________________ (check all that apply) [] This person is presently residing in the state of Washington. [] 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 the presumed parent. [] 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: [] Jurisdiction over respondent (name) __________________________________ (check all that apply) Pet Disestab Par (PTDP) – Page 3 of 6 WPF PS 17.0100 Mandatory (06/2012) – RCW 26.26.116 and 26.26.500 – 26.26.630 American LegalNet, Inc. www.FormsWorkFlow.com [] [] [] [] [] [] [] 1.6 This person is presently residing in the state of Washington. 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 the presumed parent. 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: Guardian Ad Litem I [ ] do [ ] do not request that the court appoint a Guardian Ad Litem. 1.7 Genetic Testing [] [] 1.8 Continuing Restraining Order [] [] [] [] [] 1.9 I request that paternity genetic tests be performed. Paternity genetic tests have already been performed. 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 ________________, in _________________________ court, which expires on (date) ___________________. Pet Disestab Par (PTDP) – Page 4 of 6 WPF PS 17.0100 Mandatory (06/2012) – RCW 26.26.116 and 26.26.500 – 26.26.630 American LegalNet, Inc. www.FormsWorkFlow.com [] 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. 1.10 Other II. Relief Requested The petitioner asks the court to enter an order and judgment that: [] [] [] [] [] [] [] Declares the nonexistence of the parent and child relationship between the presumed parent and the child. Amends the birth certificate by removing the presumed parent as the parent of the child. Changes the surname of the child to (surname) _______________________________. Makes provision for a domestic violence protection order. Makes provisions for an antiharassment protection order. Makes provision for a continuing restraining order. Awards court costs, genetic test costs, guardian ad litem, attorney and other reasonable fees. [] Other: Dated: ____________________________ ______________________________________ Signature of Petitioner or Lawyer/WSBA No. ______________________________________ Print or Type Name III. Declaration Pet Disestab Par (PTDP) – Page 5 of 6 WPF PS 17.0100 Mandatory (06/2012) – RCW 26.26.116 and 26.26.500 – 26.26.630 American LegalNet, Inc. www.FormsWorkFlow.com 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 (city) ______________________, (state) ___________ on (date) _______________________. Signature of Petitioner [] Print or Type Name 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 Pet Disestab Par (PTDP) – Page 6 of 6 WPF PS 17.0100 Mandatory (06/2012) – RCW 26.26.116 and 26.26.500 – 26.26.630 American LegalNet, Inc. www.FormsWorkFlow.com