Fill and Sign the Motion Modification Form

SUPERIOR COURT OF WASHINGTON COUNTY OF _______________________ JUVENILE COURT STATE OF WASHINGTON v. Respondent(s). D.O.B.: NO: MOTION AND DECLARATION FOR HEARING ON MODIFICATION OF COURT ORDER (MTAF) I. MOTION The undersigned moves the court for an order modifying the Order of Disposition __________________. (Date) _____________________________________________ Signature _____________________________________________ Type or Print Name/Title/Agency II. DECLARATION I, ___________________________________________, hereby declare as follows: 2.1 I am __________________________________________ and am responsible for informing the court of violations of court orders. I make this declaration of personal knowledge and could and would competently testify to its contents. 2.2 The respondent violated the court order of ______________________________________ (Date)  by failing to:  Perform community restitution between ________________ and ___________________________________ in the amount of __________ hours.  Pay restitution between _________________________________________ and ____________________________ in the amount of $____________________. MTN/DECL FOR HRG ON MOD. OF COURT ORDER (MTAF) - Page 1 of 2 WPF JU 07.1000 (6/2002) - RCW 13.40.200  Pay a fine between __________________________________________ and ____________________________ in the amount of $_____________________.  Pay a penalty assessment or costs between _____________________________ and ____________________________ in the amount of $_________________.  Serve confinement between ______________________________________ and __________________________________________.  Comply with the written terms of community supervision in that the respondent: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________  By committing the offense(s) of _____________________________________________ ______________________________________________________________________; A copy of the Information is attached and incorporated by reference. 2.3 A hearing should be scheduled. I declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct. Signed at ___________________________________, Washington on ___________________________. (Place) (Date) _____________________________________________ Declarant _____________________________________________ Type or Print Name/Title/Bar Number MTN/DECL FOR HRG ON MOD. OF COURT ORDER (MTAF) - Page 2 of 2 WPF JU 07.1000 (6/2002) - RCW 13.40.200