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Petition for Termination of Parent-Child Relationship (PTPCR) - Page 1 of 3WPF JU 04.0100 (12/2017) - JuCR 4.1, 4.2; RCW 13.34.030, .130, .180SUPERIOR COURT OF WASHINGTONCOUNTY OF _______________________ JUVENILE COURT In Re:D.O.B.: No:Petition for Termination of Parent-Child Relationship(PTPCR)Except for the mandatory identification paragraphs, the Juvenile Referral Number text box, and the Indian Status Paragraph below, there is no pattern form petition for termination of parental rights.1.1 Identification of the Child: male femaleNameDate of BirthHome Address1.2 Identification of the Parent(s): Mother Father presumed alleged Name12Date of BirthMarital status single married other single married other Driver’s License or Identicard (# and State)Home Address Father presumed alleged Father presumed alleged Name34Date of BirthMarital status single married other single married other Driver’s License or Identicard (# and State)Home AddressFOR OFFICIAL USE ONLY Juv. Ref. No: ____________________________ Petition for Termination of Parent-Child Relationship (PTPCR) - Page 2 of 3WPF JU 04.0100 (12/2017) - JuCR 4.1, 4.2; RCW 13.34.030, .130, .1801.3 Child’s Indian status:The petitioner has made the following efforts to determine whether the child is an Indian Child: . Based upon the following, there is not a reason to know the child is an Indian child as defined in RCW 13.38.040 and 25 U.S.C. § 1903(4), and the Federal and Washington State Indian Child Welfare Acts do not apply to this proceeding: . Based upon the following, there is a reason to know the child is an Indian child as defined in RCW 13.38.040 and 25 U.S.C. § 1903(4), and the Federal and Washington State Indian Child Welfare Acts do apply to this proceeding: . The petitioner has provided notice of this proceeding as required by RCW 13.38.070 and 25 U.S.C. § 1912(a) to all tribes to which the petitioner knows or has reason to know the child may be a member or eligible for membership if the biological parent is also a member. . [The Washington Pattern Forms Committee believes that a petition to terminate a parent-child relationship should receive individualized attention due to the seriousness of the proceeding. JuCR 4.2(a) states that a termination petition shall conform to the requirements of JuCR 3.3, shall be verified and shall state the facts which underlie each of the allegations required by RCW 13.34.180. Pursuant to JuCR 3.3 the petition must: (a) identify the juvenile; (b) identify the juvenile's parent, guardian or custodian; (c) state whether the juvenile is a member of an Indian tribe; (d) state the statutory provisions that give the court jurisdiction; (e) state the facts that give the court jurisdiction; (f) request an inquiry; and (g) set forth any other information required by court rule or statute. RCW 13.34.180 provides:A petition seeking termination of a parent and child relationship may be filed in juvenile court by any party to the dependency proceedings concerning that child. Such petition shall conform to the requirements of RCW 13.34.040 and shall allege:1)That the child has been found to be a dependent child;2)That the court has entered a dispositional order pursuant to RCW 13.34.130; 3)That the child has been removed or will, at the time of the hearing, have been removed from the custody of the parent for a period of at least six months pursuant to a finding of dependency; 4)That the services ordered under RCW 13.34.136 have been expressly and understandably offered or provided and all necessary services, reasonably available, capable of correcting the parental deficiencies within the foreseeable future have been expressly and understandably offered or provided; 5) That there is little likelihood that conditions will be remedied so that the child can be returned to the parent in the near future; and6)That continuation of the parent and child relationship clearly diminishes the child's prospects for early integration into a stable and permanent home.7)In lieu of the allegations in subsections (1) through (6) the petition may allege that the child was found under such circumstances that the whereabouts of the child's parent Petition for Termination of Parent-Child Relationship (PTPCR) - Page 3 of 3WPF JU 04.0100 (12/2017) - JuCR 4.1, 4.2; RCW 13.34.030, .130, .180are unknown and no person has acknowledged paternity or maternity and requested custody of the child within two months after the child was found.8)In lieu of the allegations in subsections (2) through (6) the petition may allege that the parent has been convicted of: (a) murder in the first degree, murder in the second degree, or homicide by abuse as defined in Chapter 9A.32 RCW against another child of the parent; (b) manslaughter in the first degree or manslaughter in the second degree, as defined in Chapter 9A.32 RCW against another child of the parent;(c) attempting, conspiring, or soliciting another to commit one or more of the crimes listed in (a) or (b); or(d) assault in the first or second degree, as defined in Chapter 9A.36 RCW, against the surviving child or another child of the parent.]