Final order and findings for a parenting plan residential form
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Judgment/Ord Parenting Plan/Child Support (JDORS) - Page 1 of 6
WPF PS 15.0500 (6/2006) - RCW 26.26.375
Superior Court of Washington
County of
In re the Parenting and Support of:
Child(ren),
Petitioner,
and
Respondent.
No.
Judgment and Order Establishing
[ ] Residential Schedule/
Parenting Plan
[ ] Child Support
(JDORS)
Clerk’s action required para. 3.4, 3.7, 3.8
[ ] Law Enforcement Notification, ¶ 3.8
I. Judgment/Order Summaries
1.1 Restraining Order Summary
[ ] Does not apply. [ ] Restraining Order Summary is set forth below:
Name of person(s) restrained: . Name of person(s)
protected: . See Paragraph 3.8.
Violation of a Restraining Order in paragraph 3.8 below with actual know\
ledge of its
terms is a criminal offense under Chapter 26.50 RCW and will subject the\
violator to
arrest. RCW 26.26.590.
1.2 Money Judgment Summary
[ ] Does not apply. [ ] Judgment Summary is set forth below:
A. Judgment creditor
B. Judgment debtor
C. Total judgment amount $
D. Principal judgment amount (back support) $
From _____ to _____
E. Interest to date of judgment $
F. Attorney fees $
Judgment/Ord Parenting Plan/Child Support (JDORS) - Page 2 of 6
WPF PS 15.0500 (6/2006) - RCW 26.26.375
G. Costs $
H. Other recovery amount $
I. Principal judgment shall bear interest at __________ % per annum
J. Attorney fees, costs and other recovery amounts shall bear interest at __________ % per annum
K. Attorney for judgment creditor
L. Attorney for judgment debtor
II. Basis
This matter has come before this court, the court considered the case record and has previously entered its
findings of fact and conclusions of law.
III. Order
It is Ordered :
3.1 Jurisdiction Over the Child
The court has jurisdiction over the child(ren) as set forth in the findings of fact and conclusions of
law.
3.2 Order of Child Support
[ ] Does not apply.
[ ] _________________________ [Name] sh all pay child support as set forth in the order of
child(ren) support which was signe d by the court on ________________________ [Date].
3.3 Residential Schedule/Parenting Plan
[ ] The primary residence of th e child shall be with ______________________ [Name],
who is designated custodian solely for the purpose of other state and federal statutes.
[ ] The residential plan/parenting pl an signed by the court on __________________ [Date]
is adopted and incorporated by reference.
[ ] ______________________________ [Name] sha ll be designated the custodian of the
child, and the child sha ll reside with _______________________ [Name]
at all times.
[ ] Determination of r esidential time of ________________________________ [Name] with
the child is denied.
[ ] Other:
3.4 Judgment for Back Child Support
(Note – do not repeat this judgment in the order of child support WPF PS 01.0500.)
[ ] Does not apply.
[ ] _________________________________ [Name] is awarded a judgment against
________________________ [Name] in the amount of $__________________, for back
child support for the period from _______________ [Date] to _______________ [Date].
Judgment/Ord Parenting Plan/Child Support (JDORS) - Page 3 of 6
WPF PS 15.0500 (6/2006) - RCW 26.26.375
[ ] The unpaid support due to _________________________________ [Name] by
______________________________ [Name] is waived and will not be collected by
____________________________ [Name]. Th is does not waive any support owing to
the state as a result of payment of public assistance.
[ ] All support due under temporary court orders has been paid.
[ ] Unpaid support due under a court or administrative order is preserved for collection and
is not merged in or extinguished by this order.
[ ] Other:
[ ] Collection Limitation Against Wages:
The back child support provision above sha ll be paid at a rate of at least $__________
per month beginning __________________ [Date]. So long as the payments for current
support, back support and the judgment are timely, collection against the judgment
debtor’s wages, excluding bonuses and other lump sum payments, shall be limited to
$_______________ per month (for current support, back support and judgment). This
limitation terminates if a single payment is past due . This provision does not
limit or bar the state of Washington from using other collection remedies available to it
by law, including, but not limited to, certifica tion for collection to the Internal Revenue
Service. Payment shall be made to:
[ ] Wage Withholding Action:
[ ] Withholding action may be taken agains t wages, earnings, assets, or benefits, and
liens enforced against real and persona l property under the child support statutes
of this or any other state, without further notice to the judgment debtor at any
time after entry of an order by the court, except as limited by the Collection
Limitation Against Wages paragraph above.
[ ] Wage withholding, by notice of pa yroll deduction or other income withholding
action under Chapter 26.18 RCW or Chapter 74.20 RCW, without further not\
ice
to the judgment debtor, is delayed until a payment is past due, because:
[ ] there is good cause not to require immediate income withholding.
[ ] the parties have reached a written agreement which the court approves that provides for an alternative arrangement. (See below):
[ ] Judgment and Back Support Payments Shall Be Made to:
[ ] ____________________________________
____________________________________
[ ] Washington State Support Registry
P.O. Box 45868
Olympia, Washington 98504
Phone: 1-800-922-4306
1-800-442-5437
Judgment/Ord Parenting Plan/Child Support (JDORS) - Page 4 of 6
WPF PS 15.0500 (6/2006) - RCW 26.26.375
3.5 Judgment
(Note – do not repeat this judgment in the order of child support WPF PS 01.0500.)
[ ] Does not apply.
[ ] _______________________________________ [Name] is awarded a judgment against
_______________________________ [Name] in the amount of $_________, as follows:
[ ] $__________ for genetic testing costs.
[ ] $__________ for guardian ad litem fees.
[ ] $__________ for attorney fees.
[ ] $__________ costs.
[ ] $__________ for other fees and expenses.
[ ] $__________ other:
[ ] ___________________ [Name] shall have judgment against ____________________ [Name]
for _________________________________________ in the amount of $______________.
3.6 County Costs
[ ] Does not apply.
[ ] The Superior Court of __________________________ shall have judgment against
_____________________________ [Name] for costs of this action specified as follows:
[ ] Other:
3.7 Guardian ad Litem
[ ] Does not apply.
[ ] Any guardian ad litem appointed by the court is discharged.
[ ] Other:
3.8 Continuing Restraining Order
[ ] Does not apply.
[ ] A continuing restraining order is entered as follows:
[ ] ______________________________ [Name] is restrained and enjoined from
disturbing the peace of the other party.
[ ] _______________________________ [Name] is restrained and enjoined from
going onto the grounds of or entering the home, work place or school of the other
party, or the day care or school of the following named children:
_______________________________________________________________.
[ ] _____________________________ [Name] is restrained and enjoined from
knowingly coming within or know ingly remaining within _________________
[Distance] of
the home, work place or school of the other party, or the day care or
school of these children:
_______________________________________________________________.
Other: ________________________________________________________.
Judgment/Ord Parenting Plan/Child Support (JDORS) - Page 5 of 6
WPF PS 15.0500 (6/2006) - RCW 26.26.375
[ ] _____________________________ [Name] is restrained and enjoined from
molesting, assaulting, hara ssing or stalking _____________________ [Name].
(The following firearm restrictions appl y if this box is checked: Effective
immediately and continuing as long as this continuing restraining order is in effect,
the restrained person may not possess a firearm or ammunition. 18 U.S.C. §
922(g)(8). A violation of this federal firearms law carries a maximum possible
penalty of 10 years in prison and a $250, 000 fine. An exception exists for law
enforcement officers and military personnel when carrying
department/government-issue firearms. 18 U.S.C. § 925(a)(1).)
[ ] Other:
Violation of a restraining order in paragraph 3.8 with actual knowledge \
of its terms is a
criminal offense under Chapter 26.50 RCW and will subject the violator t\
o arrest. RCW
26.26.130.
[ ] Clerk’s Action. The clerk of the court shall forward a copy of this order, on or before
the next judicial da y, to______________________________________ [nam e of the
appropriate law enforcement agency] which sh all enter this order into any computer-
based criminal intelligence system available in this state used by law enforcement
agencies to list outstanding warrants. ( A law enforcement information sheet must be
completed by the party or the party’s atto rney and provided with this order before
this order will be entered into the law enforcement computer system.)
Service
[ ] The restrained party or attorney appeared in court or signed this order; service of this order is
not required.
[ ] The restrained party or attorney did not app ear in court; service of this order is required.
Expiration
This restraining order expires on: [Month/Day/Year]. This
restraining order supersedes all previous temporary restraining orders in this cause number.
[ ] Any temporary restraining order previously entered in this cause number is terminated. Clerk’s
Action . The clerk of the court shall forward a copy of this order, on or before the next judicial day,
to: ______________________________ law enforcement agency where Petitioner resides which
shall enter this order into any computer-based crim inal intelligence system available in this state
used by law enforcement agencies to list outstanding warrants.
Full Faith and Credit
Pursuant to 18 U.S.C. § 2265, a court in any of the 50 states, the District of Columbia, Puerto Rico,
any United States territory, and any tribal land w ithin the United States shall accord full faith and
credit to the order.
3.9 Protection Order
[ ] Does not apply.
Judgment/Ord Parenting Plan/Child Support (JDORS) - Page 6 of 6
WPF PS 15.0500 (6/2006) - RCW 26.26.375
[ ] The parties shall comply with the Order for Protection signed by the court on this date,
_____________________________ in this cause num ber. The Order for Protection signed
by the court is approved and incor porated as part of this decree.
3.10 Other
Dated: _________________________________ _____________________________________
Judge/Commissioner
Presented by: Approved for entry:
Notice of presentation waived:
_______________________________________ ________________________________\
_____
Signature of Party or Lawyer/WSBA No. Signature of Party or Lawyer/WSBA No.
_______________________________________ ________________________________\
_____
Print or Type Name Date Print or Type Name Date
_____________________________________
Approval required in Public Assistance cases. Signature of Party or Lawyer/WSBA No.
The DSHS’ Division of Child Support received
Notice required by RCW 26.23.130. This order _____________________________________
has been reviewed and approved as to: Print or Type Name Date
[ ] Current Child Support
[ ] Back Child Support
[ ] Medical Support
[ ] Other:
Deputy Prosecuting Attorney/WSBA No.
Print or Type Name Date
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