Superior Court of Washington County of In re: No. Petitioner, and Declaration re: Service Members Civil Relief Act (Optional Use) (AFSCR) Respondent. I ______________________________ [Name] Declare that: 1. A. Service member status --- _____________________________ [name of nonmoving party]: [] [] [] [] [] is not a service member; is on active duty in the U.S. armed forces (excluding National Guard and reserves); is on active duty and is a National Guard member or a Reservist residing in Washington; is not on active duty in the U.S. armed forces (excluding National Guard and reserves); is not on active duty and is a National Guard member or a Reservist residing in Washington; [ ] I am unable to determine whether the nonmoving party is or is not on active duty in the U.S. armed forces; [ ] I am unable to determine whether the nonmoving party is or is not on active duty as a National Guard member or a Reservist residing in Washington. B. Factual basis: [ ] See the attached Department of Defense Manpower Data Center Status Report Pursuant to Servicemembers Civil Relief Act (SCRA) obtained from https://www.dmdc.osd.mil/appj/scra/. (You must have the person’s social security number to search in this site.) [ ] Other factual basis: C. [ ] As indicated above, the nonmoving party is on active duty and (check all that apply): Decl re Service Member’s Civil Relief Act (AFSCR) - Page 1 of 2 WPF All Cases 01.0200 (06/2012) RCW 38.42.050 American LegalNet, Inc. www.FormsWorkFlow.com [ ] The nonmoving party is represented by an attorney. [ ] The court has appointed an attorney to represent the nonmoving party. [ ] A stay of these proceedings [ ] has [ ] has not been entered by the court. 2. A. Dependent of a service member status --- __________________________________ [name of nonmoving party]: [ ] is not a dependent of a resident of Washington who is on active duty and is a National Guard member or a Reservist; [ ] is a dependent of a resident of Washington who is on active duty and is a National Guard member or a Reservist; [ ] I am unable to determine whether the nonmoving party is a dependent of a resident of Washington who is on active duty and is a National Guard member or a Reservist. B. Factual basis: [ ] The nonmoving party failed to respond to a notice to him or her as a dependent of a person in Military Service that was [ ] served on [ ] mailed by first class mail on ________________________________________ [Date], therefore he or she should be presumed not a dependent of a resident of Washington who is on active duty and is a National Guard member or a Reservist. [ ] Other factual basis: C. [ ] As indicated above, the nonmoving party is a dependent of a resident of Washington who is on active duty and is a National Guard member or a Reservist and (check all that apply): [ ] The nonmoving party is represented by an attorney. [ ] The court has appointed an attorney to represent the nonmoving party. [ ] A stay of these proceedings [ ] has [ ] has not been entered by the court. 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 or Lawyer/WSBA No. Print Name Decl re Service Member’s Civil Relief Act (AFSCR) - Page 2 of 2 WPF All Cases 01.0200 (06/2012) RCW 38.42.050 American LegalNet, Inc. www.FormsWorkFlow.com