Fill and Sign the Petition for De Facto Parentage Form

RCW 26.26A.440 (07 /2019) FL Parentage 341 Petition for De Facto Parent age p. 1 of 10 Superior Court of Washington, County of In re parentage: Petitioner (person who started this case) : And Respondents: (parent / presumed parent / legal guardian/s ) No. Petition for De Facto Parentage (PTDFP ) Petition for De Facto Parentage Use this form to ask the court to find you to be a de facto parent only if all of these are true :  You lived with the child as a regular member of the child's household for a significant period;  You engaged in consistent caretaking of the child and underto ok full and permanent responsibilities of a parent of the child without expectation of financial compensation;  You held the child out as your child;  You established a bonded and dependent relationship with the child which is parental in nature;  Another par ent of the child fostered or supported the bo nded and dependent relationship; and  Continuing the relationship between you and the child is in the best interest of the child.  Parties, Jurisdiction , and Venue 1. Child Petition er asks the court to order tha t Petitioner is the de facto parent of: Child’s name (first, middle, last) Born (month/day/year) Lives in (county and state) Important! Don’t list more than one child unless they have all the same parents or possible parents. If they have (or ma y have ) different parents, fill out a separate Petition for each c hild. If multiple children are listed, change “child” to “children” in this form as needed. RCW 26.26A.440 (07 /2019) FL Parentage 341 Petition for De Facto Parent age p. 2 of 10 2. Petitioner’s Information My name is: I live in (county and state only): If there is anot her Petitioner in this case, put the other Petitioner’s information below. My name is: I live in (county and state only): 3. Respondent/s ’ Information Important! You must name all parents and legal guardians /non -parent custodians. Parents include a person who:  gave birth to the child (except as a surrogate)  is a parent by court order (from a parentage, adoption or divorce case )  is presumed to be a parent by marriage or state registered domestic partners hip  is presumed to be a parent because s/he li ved in the same household with the child for the first four years of the child’s life, including any period of temporary absence, and openly held out the child as his/her child. (See RCW 26.26A.204(b).)  signed an Acknowledgment of Parentage Parents do no t include any person who a court has ordered is not a parent. Respondent’s Name (first, middle, last) Relationship Lives in (county and state) 4. Child ’s Home/s During the past 5 years has the child lived:  on an Indian reservation,  outs ide Washington state,  in a foreign country, or  with anyone other than Petitioner/s and/or Respondent/s? [ ] No. (Skip to 5.) [ ] Yes. (Fill out below to show where the child has lived during the last 5 years.) Dates Lived with In which state, Indi an reservation, or foreign country From: To: [ ] Petitioner/s [ ] Resp. (name/s): [ ] Other (name): From: To: [ ] Petitioner/s [ ] Resp. (name/s): [ ] Other (name): RCW 26.26A.440 (07 /2019) FL Parentage 341 Petition for De Facto Parent age p. 3 of 10 Dates Lived with In which state, Indi an reservation, or foreign country From: To: [ ] Petitioner/s [ ] Resp. (name/s): [ ] Other (name): From: To: [ ] Petitioner/s [ ] Resp. (name/s): [ ] Other (name): 5. Other people with a legal right to spend time with the child Do you know of anyone besides yourself and Respondent/s who has or claims to have a legal right to spe nd time with the child? [ ] No. [ ] Yes. (Name/s) has or claims to have a legal right to spend time with this child because: 6. Other court cases involving the child Do you know of any court cases involving the child ? (Check one): [ ] No. (Skip to 7.) [ ] Yes. (Fill out below.) Kind of case (Family Law such as Divorce, Criminal, Protection Order, Juvenile, Dependency, Other) County and State Case number and year 7. Jurisdiction over the child (RCW 26.27.201 – .221, .231, .261, .271) [ ] The court can decide a Parenting Plan or Residential Schedule for the child and decide who the child should live with most of the time because (check all that apply) : [ ] Exclusive, continuing jurisdiction – A Washington court has a lready made a custody order or parenting plan for the child, and the court still has authority to make other orders for the child. RCW 26.26A.440 (07 /2019) FL Parentage 341 Petition for De Facto Parent age p. 4 of 10 [ ] Home state jurisdiction – Washington is the child ’s home state because (check all that apply): [ ] The child lived in Washington with a parent or someone acting as a parent for at least the 6 months just before this case was filed, or if the child is less than 6 months old, the child has lived in Washington with a parent or someone acting as a parent since birth. [ ] Th ere were times the child was not in Washington in the 6 months just before this case was filed (or since birth if they are less than 6 months old), but those were temporary absences. [ ] The child do es not live in Washington right now, but Washington was the child’s home state some time in the 6 months just before this case was filed, and a p arent or someone ac ting as a parent of the child still lives in Washington. [ ] The child do es not have another home state. [ ] No home state or home state declined – No court of any other state (or tribe) has the ju risdiction to make decisions for the child , or a court in the children’s home state (or tribe) decided it is better to have this case in Washington and:  The child and a parent or someone acting as a parent has ties to Washington beyond just living here; and  There is a lot of information (substant ial evidence) about the child ’s care, protection, education and relationships in this state. [ ] Other state declined – The courts in other states (or tribes) that might be the child ’s home state have refused to take this case because it is better to have this case in Washington . [ ] Temporary emergency jurisdiction – The court can make decisions for the child because the child is in this state now and was abandoned here or needs emergency protection because the child (or the children’s parent, brother , or sister) was abused or threatened with abuse. ( Check one): [ ] A cust ody case involving the child was file d in the child ’s home state (name of state or tribe): . Washington should take temporary emergenc y jurisdiction over the child until the Petitioner can get a court order from the child ’s home state (or tribe) . [ ] There is no valid custody order or o pen custody case in the child ’s home state (name of state o r tribe): . If no case is filed in the child’s home state (or tribe) by the time the children have been in Washington for 6 months, (date): , Washington should have final jurisdiction over the children. [ ] Other reason (specify): [ ] [ ] The cour t cannot decide a Parenting Plan or Residential Schedule for the child or decide who the child should live with most of the time because the court does not hav e jurisdiction over the child . 8. Personal Jurisdiction Fill out below to say if a Washington s tate court has personal jurisdiction (authority to make decisions) over each Respondent. (Add columns if needed for more Respondents.) RCW 26.26A.440 (07 /2019) FL Parentage 341 Petition for De Facto Parent age p. 5 of 10 Basis for Personal Jurisdiction (check all that apply) Respondent’s Name: Other Respondent’s Name: Will be served in Washington [ ] [ ] Lives in Washington now [ ] [ ] Lived in Washington with child [ ] [ ] Lived in Washington and paid pregnancy costs or support for child [ ] [ ] Caused child to live in Washington [ ] [ ] Had sex in Washington that may have produced the child [ ] [ ] Agrees to Washington deciding [ ] [ ] None of the above [ ] [ ] 9. Co rrect County (Venue) This is the correct county for this case to be heard because this is where: [ ] The child lives or is located. [ ] The Respondent (name): lives or is located, if the child lives outside Washington.  Petitioner’s Statement (Affidavit) (If you need more space for any section, add lines or use Declaration form FL All Family 135. ) 10 . Residence for a significant period I live d with the child as a regular member of the child's household for a significant period . (List the dates when you lived with the child and who else lived in the household .) 11 . Caretaking/Parenting Responsibilities I provided consistent caretakin g for the child and undertook full and permanent parenting responsibilities without expectation of being paid. (Describe .) RCW 26.26A.440 (07 /2019) FL Parentage 341 Petition for De Facto Parent age p. 6 of 10 12 . Holding Out I held the child out as my child. (Describe when and how you have told others that you were the child’s parent or acted with others as the child’s parent .) 13. Bonded Relationship I have a bonded and dependent parental relationship with the child. (Describe) 14. Parent Fostered/Supported Relationship At least one of the child’s parents fo stered or supported my relationship with the child . (Describe how the parent/s encouraged your bonded/dependent parental relationship. ) 15. Best Interest It is in the child’s best interest for our relationship to continue because:  Other Requests 16. Parenting Plan or Residential Schedule It is in the child ’s best interest for the court to decide with whom the child will live, if the court ha s jurisdiction over the child . The child currently live /s with (name/s): [ ] I will file and se rve my proposed Parenting Plan (form FL All Family 140) or Residential Schedule (FL Parentage 304) with this Petition or in the future. RCW 26.26A.440 (07 /2019) FL Parentage 341 Petition for De Facto Parent age p. 7 of 10 [ ] I am not asking the court for a Parenting Plan or Residential Schedule . 17. Child Support The child has a right to child support (including medical support) from the legal parents, including any parent determined to be a de facto parent, according to state law. The court will order child support unless all parents are living together with the child or there is alre ady an administrative order set by the Division of Child Support. 18. Past support and repayment of specific expenses [ ] No request. [ ] Past Support – The state of Washington or (name): has provided support to the children and has the right to re ceive up to five years of past child support according to the Washington State Child Support Schedule. [ ] Specific Expenses – The state of Washington or (name): has incurred expenses for the mother’s pregnancy and childbirth or provided other servi ces to the children and has the right to be repaid (check one): [ ] (amount): $ . [ ] an amount to be proven later. 19. Protection Order Do you want the court to issue an Order for Protection as part of the final orders in this case? [ ] No. I do not want an Order for Protection . [ ] Yes. (You must file a Petition for Order for Protection, form DV -1.015 for domestic violence, or form UHST -02.0200 for harassment. You may file your Petition for Order for Protection using the same case number as signed to this case.) Important! If you need protection now , ask the court clerk about getting a Temporary Order for Protection. [ ] There already is an Order for Protection between (name): and me. (Describe below. Attach a copy if you have one. ): Court that issued the order: Case number: Expiration date: 20 . Restraining Order Do you want the court to issue a Restraining Order as part of the final orders in this case ? [ ] No. (Skip to 21 .) [ ] Yes. Check the type of orders you want: [ ] Do not disturb – Order ( name/s ) not to disturb my peace or the peace of any child listed in 1. [ ] Stay away – Order ( name/s ) not to go onto the grounds of or enter my home, workplace, or school, and the daycare or school of any child listed in 1. RCW 26.26A.440 (07 /2019) FL Parentage 341 Petition for De Facto Parent age p. 8 of 10 [ ] Also, not knowingly to go or stay within feet of my home, workplace, or school, or the daycare or school of any child listed in 1. [ ] Do not hurt or threaten – Order ( name/s ) :  Not to assault, harass, stalk or molest me or any child listed in 1; and  Not to use, try to use, or threaten to use physical force against me or the children that would reasonably be expected to cause bodily injury. Warning! If the court makes this order, the court must consider if weapons restrictions are required by state law; federal law may also prohibit the Restrained Person from possessing firearms or ammunition. [ ] Prohibit weapons and order surrender – Order ( name/s ) :  Not to access, possess , or obtain any firearms, other dangerous weapons, or concealed pistol license s until the Order ends, and  To immediately surrender any firearms, other dangerous weapons, and any concealed pistol license s that he/she possesses t o (check one): [ ] the police chief or sheriff. [ ] his/her lawyer. [ ] other perso n (name): . [ ] Other orders: Important! If you want a restraining order now , you must file a Motion for Temporary Family Law Order and Restraining Order (form FL Parentage 323) or a Motion for Immediate Restraining Order (Ex Parte) (form FL Paren tage 321). 21. Name Change [ ] No request for name change. [ ] I ask the court to change the children’s names to: The name change should be ordered because of the following good reasons: 22. Birth Record [ ] No request for changes to the l isted parents on the birth record . [ ] I ask the court to change the parents listed on the birth certificate and any other birth record as follows: The birth certificate and any other birth record should be changed because of the following good reas ons: RCW 26.26A.440 (07 /2019) FL Parentage 341 Petition for De Facto Parent age p. 9 of 10 23. Fees and Costs [ ] Does not apply. [ ] I ask the court to order the Respondent (name/s): to pay filing fees, r easonable lawyer fees , other costs, and necessary travel and other reasonable expenses. 24. Other (if any) Petition er fills out below: I declare under penalty of perjury under the laws of the state of Washington that the facts I have provided on this form are true. Signed at (city and state): Date: Petitioner signs here Print name Other Petitioner (if any) f ills out below: I declare under penalty of perjury under the laws of the state of Washington that the facts I have provided on this form are true. Signed at (city and state): Date: Other Petitioner signs here Print name Petitioner’s lawyer (if a ny) fills out below: Petitioner’s lawyer signs here Print name and WSBA No. Date Warning! Documents filed with the court are available for anyone to see unless they are sealed. Financial, medical, and confidential reports, as described in General Rule 22, must be sealed so they can only be seen by the court, the other parties, and the lawyers in your case. Seal those documents by filing them separately, using a Sealed cover sheet (form FL All Family 011, 012, or 013). You may ask for an order to seal other documents. [ ] Respondent fills out below if s/he agrees to join this Petition: I, (name): , agree to join this Petition . I understand that if I fill out and sign below, the court may approve the requests listed in this Petition unless I f ile and serve a Response before the court signs final orders. (Check one): RCW 26.26A.440 (07 /2019) FL Parentage 341 Petition for De Facto Parent age p. 10 of 10 [ ] I do not need to be notified about the court’s hearings or decisions in this case. [ ] I ask the Petitioner to notify me about any hearings in this case. (List an address w here you agree to accept legal documents. This may be a lawyer’s address or any other address.) address city state zip (If this address changes before the case ends, you must notify all parties and the court clerk in writing. You may use the Notice o f Address Change form (FL All Family 120). You must also update your Confidential Information Form (FL All Family 001 ) if this case involves parentage or child support .) Respondent signs here Print name Date [ ] Other Respondent fills out below if s/he agrees to join this Petition: I, (name): , agree to join this Petition . I understand that if I fill out and sign below, the court may approve the requests listed in this Petition unless I file and serve a Response before the court signs final ord ers. (Check one): [ ] I do not need to be notified about the court’s hearings or decisions in this case. [ ] I ask the Petitioner to notify me about any hearings in this case. (List an address where you agree to accept legal documents. This may be a l awyer’s address or any other address.) address city state zip (If this address changes before the case ends, you must notify all parties and the court clerk in writing. You may use the Notice of Address Change form (FL All Family 120). You must also update your Confidential Information Form (FL All Family 001 ) if this case involves parentage or child support .) Other Respondent signs here Print name Date