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Return of Service (RTS) – Page 1 of 2 XR 112 (07/ 2019 ) _________________ Court of Washington For _____________________ , County _______________________________________ Petitioner vs. _______________________________________ Respondent No . ___________________ Return of Service –Extreme Risk (RTS) 1. Identification of Server : My name is . I am [ ] a peace officer [ ] 18 years of age or older and not the petitioner or the respondent. 2. Able to personally serve : [ ] I served (name of person served) on ___________________________ (date) at _______________ (time) at this address: _________________________________ _______________________________, with the documents checked in paragraph 3. 3. Document list : (Server: Check the box before the title of each document you serve. Write in the title for any document you serve that is not already listed below.) [ ] Petition for an Extreme Risk Protection Order [ ] Temporary Extreme Risk Protection Order - Without Notice [ ] Order Transferring Case and Setting Hearing - Extreme Risk *Document list is continued on next page. [ ] Motion to Renew Extreme Risk Protection Order [ ] Order on Motion to Renew Extreme Risk Protection Order [ ] Extreme Risk Protection Order/Renewal [ ] Petition for an Extreme Risk Protection Order – Respondent Under 18 Years Return of Service (RTS) – Page 2 of 2 XR 112 (07/ 2019 ) Document list (continued): [ ] Order Reissuing Temporary Extreme Risk Protection Order - Without Notice [ ] Extreme Risk Protection Order [ ] Temporary Extreme Risk Protection Order - Without Notice – Respondent Under 18 Years [ ] Extreme Risk Protection Order – Respondent Under 18 Years [ ] Other: 4. Not able to personally serve : [ ] I was unable to make personal service on the respondent. [ ] I notified the petitioner that the respondent was not served. [ ] I was unable to make personal service on the petitioner. [ ] I notified the respondent that petitioner was not served. [ ] I was unable to make personal service on the minor respondent’s parent or guardian. [ ] I notified the petitioner that the respo ndent’s parent or guardian was not served. [ ] I was unable to make personal service on the Department of Children, Youth, and Families (DCYF). [ ] I notified the petitioner that DCYF was not served. [ ] Personal service was attempted on the followin g date(s) [ ] No service was attempted because: 5. Other information about service that I want the court to consider : _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________. I declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and correc t. Dated: at , Washington. Fees: Service ______________ ____________________________________ Mileage ______________ Signature of Server ____________________________________ Print or Type Name Total ______________ ____________________________________ Law Enforcement Agency