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RCW 26. 10 .115 Mandatory Form (07/201 9) FL Non -Parent 424 Temporary Non -Parent Custody Order p. 1 of 5 Superior Court of Washington, County of _______________ In re custody of : Children : Petitioner /s (person /s who started this case ): Respondents (parent s and any guardian or custodian ): No. Temporary Non -Parent Custody Order (T CO / TNPO ) [ ] Clerk’s action required : 1, 8, 9 Temporary Non -Parent Custody Order Use this form in non -parent custody cases only. For other cases, use FL Divorce 224, FL Parentage 324, or FL Modify 624, depending on the type of case . 1. Money Judgment Summary [ ] No money judgment is ordered . [ ] Summarize any money judgment s from section 8 in the table below. Judgment for Debtor’s name (person who must pay money) Creditor’s name (person who must be paid) Amount Interest Lawyer’s fees $ $ Other fees and cos ts $ $ Other amounts (describe) : $ $ Yearly Interest Rate : ___% (12% unless otherwise listed) Lawyer (name): represents (name): Lawyer (name): represents (name): RCW 26. 10 .115 Mandatory Form (07/201 9) FL Non -Parent 424 Temporary Non -Parent Custody Order p. 2 of 5 2. Basis for order The (check one): [ ] Petitioner [ ] Respondent (name ): made a Motion for Temporary Non -Parent Custody Order (form FL Non -Parent 423 ) or a Motion for Immediate Restraining Order – Non -Parent Custody (form FL Non -Parent 421 ) and the court finds there is reason to approve this order. [ ] Specific findings : 3. Adequate Cause [ ] The court approved an Order on Adequate Cause for Non -Parent Custody (form FL Non -Parent 417 ) on (date): . [ ] Petitioner/s must file a Motion for Adequate Cause Decision (form FL Non -Parent 41 6) and schedule a hearing by (date): . [ ] Other: 4. Indian Child ren (An Indian child is a child who is a member of an Indian tribe, or who is the biological child of an Indian tribe member and eligible for membership. Indian Child Welfare Act, 25 USC 1903. ) [ ] None of the ch ildren are Indian children . The state and federal Indian Child Welfare Acts do not apply to this case. [ ] These children are or may be Indian children (name/s) : The federal and state Indian Child Welfare Acts apply to this case. Jurisdiction – The court [ ] has [ ] does not have jurisdiction over the Indian children. Notice to tribes – The Petitioner (check one): [ ] provided the Indian Child Welfare Act Notice (form FL Non -Parent 4 02 ) and a copy of the Petition to all of the tribes, people , and agencies entitled to notice . [ ] did not provide the Indian Child Welfare Act Notice and a copy of the Petition to all of the tribes, people , and agencies entitled to notice . Order – Petitioners must provide the Indian Child Welfare Act No tice (form FL Non -Parent 4 02 ) and a copy of the Petition to the: [ ] children’s tribes or possible tribes [ ] Indian custodian [ ] children’s parents [ ] Bureau of Indian Affairs [ ] The court does not have enough information to decide whether any of the children are Indian children. Order – Petitioners must make a good faith effort to find out if any of the children are Indian children and provide the Indian Child Welfare Act Notice (form FL Non -Parent 402 ) and a copy of the Petition to all of the tribes, people or agencies entitled to notice. Good faith efforts are defined in RCW 13.38.050. RCW 26. 10 .115 Mandatory Form (07/201 9) FL Non -Parent 424 Temporary Non -Parent Custody Order p. 3 of 5 5. Active duty military (The federal Servicemembers Civil Relief Act covers:  Army, Navy, Air Force, Marine Corps, and Coast Guard members on active duty;  National Guard or Reserve members under a call to active service for more than 30 days in a row; and  commissioned corps of the Public Health Service and NOAA. The state Service Members’ Civil Relief Act covers those service members listed above who are ei ther stationed in or residents of Washington state, and their dependents, except for the commissioned corps of the Public Health Service and NOAA. ) [ ] None of the parties are covered by the state or federal Service Members ’ Civil Relief Act , OR no party covered by the Acts has asked for a stay. [ ] One or more of the parties is covered by the state or federal Service Members ’ Civil Relief Acts and has not appeared in this case , or has asked for a stay. (Check one): [ ] The court signed the Order r e Service Members ’ Civil Relief Act (form FL All Family 170) filed separately. [ ] The court’s order about the service member’s rights is in section 10 below. [ ] Other Findings:  The Court Orders 6. Care and safety of children [ ] No request ma de . [ ] Request denied. [ ] (Name/s) is/are granted temporary custody of these children: Child’s name Age Child’s name Age 1. 4. 2. 5. 3. 6. [ ] The temporary Residential Schedule is signed by the court and filed separately. [ ] (Name/s ): must not take the children out of Washington state. [ ] The court will appoint the person below to investigate and report on issues affecting the children (check one): [ ] Guardian ad Litem (GAL) . The court signed the Order Appointing Guardi an ad Litem for a Child (form FL All Family 146) filed separately. [ ] Evaluator /Investigator. The court signed the Order Appointing Parenting Evaluator/Investigator (form FL All Family 148) filed separately. [ ] Other: RCW 26. 10 .115 Mandatory Form (07/201 9) FL Non -Parent 424 Temporary Non -Parent Custody Order p. 4 of 5 Important! Attach Summa ry of the Law about Moving with Children (form FL Relocate 736) if residential time is included in this order instead of a temporary Residential Schedule . 7. Support , insurance and taxes [ ] No request made . [ ] Request denied. [ ] The court signed the temporary Child Support Order and Worksheets filed separately. [ ] The parents must pay for health insurance, uninsured medical, day care, or other necessary expenses (check one): [ ] as listed on the Child Support Order signed by the court and f iled separately. [ ] as follows (specify): [ ] (Name/s): may claim the children as dependents on tax forms. [ ] Other: 8. Fees and costs [ ] No request made . [ ] Request denied. [ ] Request reserved . [ ] (Name): must : [ ] Pay the other party’s lawyer fees . Amount: $ Make payments to (name): by (date): [ ] Pay other fees and costs . Amount: $ Make payments to (name): by (date): for: Money Judgment (check one): [ ] The amount/s listed above must be paid, but the court is not entering a money judgment at this time. [ ] The amount/s listed above shall be entered as a money judgment. (Summarize the money judgment in section 1 above). The interest rate is 12% unless another amount is listed here . [ ] The interest rate is % because (explain): [ ] Other: RCW 26. 10 .115 Mandatory Form (07/201 9) FL Non -Parent 424 Temporary Non -Parent Custody Order p. 5 of 5 9. Restraining order [ ] No request made . [ ] Request denied. [ ] The court signed the temporary Restraining Order (form FL All Family 150 ) filed separately in this case number. (Check one): [ ] No bond or security is required. [ ] (Name): must file a bond or post security. Amount: $ by (date): [ ] Any earlier Restraining Order that restrains ( name ) signed by the court in this case number is terminated . (If you check this box, also check the “Clerk’s action required” box on page 1.) Name of law enforcement agency where the Protected Person lived when the Restraining Order was issued : Clerk’s Action . The court clerk must p rovide a copy of this Temporary Family Law Order to the agency li sted above within one court day. The law enforcement agency must remove the earlier Restraining Order from the state’s database as described above . 10. Other temporary orders (if any) Date Judge or Commissioner Parties or t heir lawyers fill out below. This order (check any that apply) : This order (check any that apply) : [ ] is an agreement of the parties [ ] is an agreement of the parties [ ] is presented by me [ ] is presented by me [ ] may be signed by the court w ithout notice to me [ ] may be signed by the court without notice to me Petitioner signs here or lawyer signs here + WSBA # Respondent signs here or lawyer signs here + WSBA # Print Name Date Print Name Date This order (check any that apply) : Th is order (check any that apply) : [ ] is an agreement of the parties [ ] is an agreement of the parties [ ] is presented by me [ ] is presented by me [ ] may be signed by the court without notice to me [ ] may be signed by the court without notice to me Other party or lawyer signs here + WSBA # Other party or Guardian ad Litem signs here + WSBA # Print Name Date Print Name Date