SUPERIOR COURT OF WASHINGTON COUNTY OF _______________________ JUVENILE COURT Dependency of: No: Motion and Declaration for Order Dismissing Dependency (MTAF) D.O.B. I. Basis ________________________________ (name) or DSHS/Supervising Agency asks the court for an order dismissing the dependency. This motion is based upon the following declaration. Dated: ________________________________ ______________________________________ Signature _______________________________________ Print Name WSBA No. II. Declaration The undersigned declares: Dependency has not been established, and the petition should be dismissed. Dependency was established, and should be dismissed because (check only one): The youth is 18 and is not eligible, or 18 to 21years of age and is no longer eligible for extended foster care. The youth is 18 years of age and has not requested extended foster care. The youth is in extended foster care and he or she requests dismissal. The permanent plan of return home to the mother father has been achieved and court supervision is no longer needed. A parenting plan/residential schedule signed by the court has been entered in cause number ____________________________. The permanency plan of third party custody was achieved and court supervision is no longer needed. The child was adopted on (date) ________________________________. A Title 13 RCW guardianship was established as to the child. The child is deceased. Other: I declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Signed at ________________________ (city), Washington, on ________________________(date). ________________________________________ Signature MTAF for Or dismissing Dependency (MTAF) - Page 1 of 1 WPF JU 03.0600 (072013) ­ RCW 13.34.237, 13.34.267 American LegalNet, Inc. www.FormsWorkFlow.com ____________________________________ Print Name