Or on Threshold Hearing (ORDSM/ORH) - Page 1 of 3 WPF JU 04.0700 (07/2018) - RCW 13.34.215 Superior Court of Washington County of Juvenile Court In Re: D.O.B.: No: Order on Threshold Hearing (Petition for Reinstatement of Terminated Parental Rights) Dismiss Petition (ORDSM) Set Hearing (ORH) Clerk222s Action Required: Paragraphs 3.1, 3.2 I. Basis 1.1 The court held a threshold hearing in this matter on [date]. 1.2 The following persons were present: Child Child's Lawyer Child's Guardian ad Litem Guardian ad Litem's Lawyer Mother Mother's Lawyer Father Father's Lawyer DCYF DCYF222s Lawyer Tribal Representative Current Caregiver Interpreter for mother father Other other II. Findings 2.1 The court has jurisdiction over the parties and the subject matter. 2.2 Proper notice of this hearing was was not given. 2.3 The court has received and considered evidence relating to the apparent fitness of [name(s)] and of his or her interest in reinstatement of his or her parental rights. American LegalNet, Inc. www.FormsWorkFlow.com Or on Threshold Hearing (ORDSM/ORH) - Page 2 of 3 WPF JU 04.0700 (07/2018) - RCW 13.34.215 2.4 The court does does not find, by a preponderance of the evidence, that the best interests of the child may be served by reinstatement of parental rights. 2.5 Other III. Order 3.1 The petition for reinstatement of terminated parental rights is dismissed. 3.2 The court has scheduled a hearing on the merits: On: [date] at a.m./p.m. At: Court, Room/Department: Address: 3.3 DCYF shall provide the court with information relating to efforts to achieve the permanency plan, including efforts to achieve adoption or permanent guardianship, days prior to the hearing set in paragraph 3.2. Dated: Judge/Commissioner Presented by: Signature Print Name/Title WSBA No. Copy Received; Approved for Entry; Notice of Presentation Waived: Signature of Child Signature of Child222s Lawyer Print Name WSBA No. Signature of Child222s Guardian ad Litem Signature of Lawyer for the Guardian ad Litem Print Name Print Name WSBA No. American LegalNet, Inc. www.FormsWorkFlow.com Or on Threshold Hearing (ORDSM/ORH) - Page 3 of 3 WPF JU 04.0700 (07/2018) - RCW 13.34.215 Signature of Mother Signature of Mother222s Lawyer Print Name WSBA No. Signature of Father Signature of Father222s Lawyer Print Name WSBA No. Signature of DCYF Representative Signature of DCYF Representative222s Lawyer Print Name Print Name WSBA No. Signature of Tribal Representative Signature Print Name Print Name WSBA No. Lawyer for American LegalNet, Inc. www.FormsWorkFlow.com