Fill and Sign the Declaration About Parentage Form

Ch. 26.26 RCW Mandatory Form (07/2017) FL Parentage 302 Declaration about Parentage p. 1 of 6 Superior Court of Washington, County of In re parentage: Petitioner (person who started this case) : And Respondents: (parent / presumed parent / alleged parents) Children over age 2: No. Declaration about Parentage (DCLR) Declaration about Parentage (Fill out a separate Declaration for each child in this case.) I declare: My name is . This declaration is about the parentage of (child): , who was born on: . month / day / year 1. My relationship to this child (check all that apply): I am this child’s parent because: I am the birth mother. I signed a Paternity Acknowledgment . I legally adopted this child. I had this child using assisted repr oduction. The physician’s certificate and my statement that I used assisted reproduction to have this child were filed with the Washington State Registrar of Vital Statistics within ten days of thi s child’s birth. I agreed that my spouse or domestic partner could use assisted reproduction to have this child. A valid surrogate parentage contract says I am the intended parent of this child. Ch. 26.26 RCW Mandatory Form (07/2017) FL Parentage 302 Declaration about Parentage p. 2 of 6 I am presumed by law to be this child’s parent because: I was married to or registered domestic partners with the birth mother (name): when the child was born, or within the 300 days before the child was born. I believed I was in a valid marriage or registered domestic partnership with the birth mother (name): when the child was born, or within the 300 days before the child was born, even though the marriage or partnership was or could have been invalidated by a court. After the child was born, I married or became registered domestic partners with the birth mother (name): (or believed my marriage or partnership was valid, even if it was or could have been invalidated). I willingly said I was the child’s parent and I (check at least one): promised in a written or electronic record to suppo rt the child as my own. See RCW 26.26.011(23). agreed to be and am listed as the parent on the chil d’s birth certificate. filed a statement claiming I was the child’s paren t with the Registrar of Vital Statistics. I lived in the same home as the child and openly held him/her out as my own child for the first 2 years of the child’s life. (List examples that show how you treated this child as if s/he were your own) I am not presumed by law to be this child’s parent because none of the reasons listed above apply. I may be this child’s parent because I had sex with the child’s birth mother (name): between (starting and ending dates): when the child was likely conceived. I agree I am this child’s parent and should be legally declared a parent. I don’t know if I am this child’s parent. I am not this child’ s parent because: I did not have sex with the child’s birth mother (name): between (starting and ending dates): when the child was likely conceived. I donated sperm for assisted reproduction with no intent to become a parent. I was excluded as a parent through genetic testing. 2. Sexual assault Does not apply. Ch. 26.26 RCW Mandatory Form (07/2017) FL Parentage 302 Declaration about Parentage p. 3 of 6 This child was born as a result of a sexual assault by (name): . See the Sexual Assault Allegation , filed separately. Important! File and serve the Sexual Assault Allegation (FL Parentage 365) together with this Declaration and your Petition or Response. 3. Other parties’ relationship to this child For each other party, write his/her nam e in the category below that applies. If you don’t know the status of another party, leave him/her out . Parent (someone who is already a legal parent) (Name) is a parent because (check all that apply): she is the birth mother. s/he signed a Paternity Acknowledgment . s/he legally adopted the child. s/he had this child using assisted reproduction, and a physician’s certificate and a statement that s/he used assisted reproduction to have this child were filed with the Washington State Registrar of Vital Statistics within ten days of thi s child’s birth. s/he agreed to use assisted reproduction for us to become parents. s/he signed a valid surrogate parentage contract saying s/he is the intended pa rent of this child . Alleged Parent/s (someone who may or may not be a genetic parent) (Name/s ) may be a parent because the birth mother had sex with this person (or these peopl e) between (starting and ending dates): when this child was likely conceived. Presumed Parent (someone who is presumed by law to be a legal parent) (Name) is a presumed parent because (check all that apply): this person and the birth mother were married or in a registered domestic partnership when this child was born, or within the 300 days before this child was born. this person and the birth mother believed they were in a valid marriage or registered domestic partnership when this child was born or within the 300 days before this child was born, even though the marriage or partnership was (or could have been) invalidated by a court. after this child was born, this person and the birth mother married or became registered domestic partners (or believed their marriage or partnership was valid, even if it was or could have been invalidated). This person willingly said s/he i s this child’s parent and (check all that apply): Promised in a written or electronic record to suppo rt this child as his/her own. See RCW 26.26.011(23). Agreed to be and is listed as the parent on this chi ld’s birth certificate. Ch. 26.26 RCW Mandatory Form (07/2017) FL Parentage 302 Declaration about Parentage p. 4 of 6 Filed a statement claiming s/he was this child’s parent with the Regist rar of Vital Statistics. this person lived in the same home as this child and openly held out this child as his/her own child for the first 2 years of the child’s life. (List examples that show how this person treated this child as if s/he were the parent): 4. Should the presumed parent continue to be a legal parent? Does not apply. There is no presumed parent. Yes, the presumed parent should be confirmed as a legal parent. No, (Presumed parent’s name): should not be this child’s legal parent because s/he is not a biological parent and (check all that apply): did not live with and did not have sex with the birth mother when this child was likely conceived, and did not openly hold out this child as his/her own child. did not live with this child for the first 2 years of the child’s life, and did not openly hold out this child as his/her own child. I don’t know if the presumed parent should continue to be a legal parent. See the requests listed in the Sexual Assault Allegation (FL Parentage 365) filed separately. 5. Was this child conceived in Washingt on State? Yes. During this time period (starting and ending dates): , I had sex in Washington state with (name/s): , which may have produced this child. No. I don’t know. 6. Was this child conceived through assisted reproduction? Yes. No. I don’t know. 7. Child’s Home/s During the past 5 years has the child lived:  on an Indian reservation,  outside Washington state,  in a foreign country, or  with anyone who is not a party to this case? Ch. 26.26 RCW Mandatory Form (07/2017) FL Parentage 302 Declaration about Parentage p. 5 of 6 No. (Skip to 8.) Yes. (Fill out below to show where the child has lived during the last 5 years.) Dates Child lived with In which state, Indian reservation, or foreign country From: To: Petitioner Resp. (name/s): Other (name): From: To: Petitioner Resp. (name/s): Other (name): From: To: Petitioner Resp. (name/s): Other (name): From: To: Petitioner Resp. (name/s): Other (name): From: To: Petitioner Resp. (name/s): Other (name): 8. Do you know of anyone besides the parties to this case who has or claims to have a legal right to spend time with this child? (Check one): No. Yes. (Name/s) has or claims to have a legal right to spend time with this child. 9. Do you know of any court cases involving this child? (Check one): No. (Skip to 10.) Yes. (Fill out below.) Kind of case (Family Law, Criminal, Protection Order, Juvenile, Dependency, Other) County and State Case number and year Ch. 26.26 RCW Mandatory Form (07/2017) FL Parentage 302 Declaration about Parentage p. 6 of 6 10. Lawyer for the State I understand that any lawyer for the State of Washington is not my lawy er for this case. I also understand that I have the right to hire my own lawyer at any time. 11. Other information about parentage (if any): I declare under penalty of perjury under the laws of the state of Washington that the facts I have provided on this form are true. Signed at Date: city state Sign here Print name here