CR 4.1; RCW 26.09.181, .260, .270
Mandatory For m (07/2019 )
FL Modify 601
Petition to Change a
Parenting/ Custody Order
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Superior Court of Washington, County of
In re:
Petitioner/s (see * below) :
And Respondent/s (other party/parties) :
No.
Petition to Change a Parenting Plan,
Residential Schedule or Custody Order
(PTMD)
* If you’re filing this Petition in:
the same case number as the current parenting/custody order, the person who is listed as the Petitioner in the
current order will stay Petitioner, even if s/he is not the person asking for the change now.
a different case number or county from where the curren t parenting/custody order was issued, the person
asking for the change may be the Petitioner.
To modify a parenting/custody order from a sealed Parentage case, contact the Superior Court Clerk’s office about
who to list as Petitioner and if there is a ne w case number.
Petition to Change a Parenting Plan,
Residential Schedule or Custody Order
1. Who is asking to change the parenting/custody order?
Name Lives in (county and state) Relation to the children
[ ] Parent
[ ] Non -Parent Custodian
2. W ho are the other parents or custodians involved in this case?
Name Lives in (county and state) Relation to the children
[ ] Parent
[ ] Non -Parent Custodian
[ ] Parent
[ ] Non -Parent Custodian
CR 4.1; RCW 26.09.181, .260, .270
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Petition to Change a
Parenting/ Custody Order
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3. Who are the children involved in this case?
Child’s name Age Child’s name Age
1. 4.
2. 5.
3. 6.
4. Describe the parenting/custody order you have now:
My current parenting/custody order is a (check one):
[ ] Parenting Plan [ ] Residential Schedule
[ ] Non -Parent Custod y Order [ ] Other (title of order):
signed by a court on in
date county and state
Important! Attach or file a certified copy of the current parenting/custody order that you want to change if it
was issued in a different county or state.
5. Expla in why you are filing your request for change with this court:
I ask the court to make the changes requested in sections 6 through 12 below, and to
approve my proposed Parenting Plan or Residential Schedule that is filed with this Petition .
This Petition shows I have valid reasons to ask for these changes. The changes are in the
children’s best interest.
I am filing this Petition in this county court because (check all that apply):
[ ] I live in this county .
[ ] the child/ren live in this county .
[ ] the other parent (or non -parent custodian) lives in this county.
[ ] the parenting/custody order that I want to change is from this county.
Note – If you need more space to explain in any of the sections below, you may add more pages to this Petition.
Number, date and sign each page that you add .
6. Request for minor change (RCW 26.09.260(5), (7) and (9))
[ ] No request.
[ ] I ask the court to adjust the parenting schedule, but not change the person the child
lives with most of the time. T he situa tion of the child/ren, a parent, or a non -parent
custodian has changed substantially.
Reason for minor change (check all that apply):
Note – Your reasons must be based on information that you learned about after the current
parenting/custody order was issu ed, or if the order was uncontested (issued by default or
agreement), your reasons may be based on information that was unknown to the court when
the order was issued.
CR 4.1; RCW 26.09.181, .260, .270
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Parenting/ Custody Order
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[ ] the current parenting/custody order is difficult to follow because the parent w ho has
less residential time with the children has moved.
[ ] the current parenting/custody order is difficult to follow because one parent’s work
schedule changed and the change was not by his/her choice.
[ ] the requested change will affect the child ren’s schedule on fewer than 25 full days
a year.
[ ] the requested change will impact the children’s schedule on more than 24 full days,
but fewer than 90 overnights a year. This change is needed because the current
parenting/custody order does not give the children a reasonable amount of time
with one parent and it’s in the children’s best interest to have more than 24 full
days of increased time with that parent.
Are there any limitations on the parent whose time would be increased?
[ ] No. The curr ent parenting/custody order does not limit that parent’s time
with the children because of abandonment, abuse, domestic violence, sex
offense, or other serious problems.
[ ] Yes. That parent’s time with the children is limited because of problems
listed in the current parenting/custody order. I ask the court to allow that
parent more parenting time with the children because the problems that
caused the limitations have changed substantially.
Explain:
Has the parent whose time would be increased com pleted any required
evaluations, treatment, or classes?
[ ] Does not apply. The current parenting/custody order does not require
that parent to complete any evaluations, treatment , or classes.
[ ] Yes. That parent has completed all court -ordered eval uations, treatment, or
classes.
List completed evaluations, treatment, or classes here:
7. Request for major change (RCW 26.09.260(1) and (2))
[ ] No request.
[ ] I ask the court to make a major change in the parenting schedule or to change the
pe rson the child lives with most of the time. The situation of the child/ren or the other
parent (or non -parent custodian) has changed substantially.
Reason for major change (check all that apply):
Note – Your reasons must be based on information that you l earned about after the current
parenting/custody order was issued, or if the order was uncontested (issued by default or
agreement), your reasons may be based on information that was unknown to the court when
the order was issued.
CR 4.1; RCW 26.09.181, .260, .270
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Petition to Change a
Parenting/ Custody Order
p. 4 of 10
[ ] the other parent (or non -parent custodian) and I agree with the changes asked for
in my proposed Parenting Plan or Residential Schedule .
[ ] the children are living in my home now with the other parent’s (or non -parent
custodian’s) permission. This is very different than what was ordered in the current
parenting/custody order .
Explain:
[ ] the children’s current living situation is harmful to their physical, mental , or emotional
health. It would be better for the children to change the parenting/custody order.
Explain:
[ ] the other parent (or non -parent custodian) has not followed the court’s
parenting/custody order . A court found him/her in contempt for disobeying the
parenting schedule more than once in three years, or guilty of custodial
interf erence in the first or second degree. (RCW 9A.40.060 or 9A.40.070)
Explain:
8. Request for limitations on one parent’s parenting time and decision -making
[ ] No request.
[ ] Limit – The children already live with me the majority of the time . To protect the
children, I ask the court to limit the other parent’s parenting time and participation.
The reasons for limitation are listed in my proposed Parenting Plan or Residential
Schedule . (RCW 26.09.191 , 26.09.260(4) )
[ ] Adjust – The other parent is allowed some parenting time in the current
parenting/custody order. But that parent has chosen not to spend any of his/her
parenting time with the children for at least one year. I ask the court to adjust the
parenting time for the other parent as shown in my proposed Parenting Plan or
Residential Schedule . (RCW 26.09.260(8))
CR 4.1; RCW 26.09.181, .260, .270
Mandatory For m (07/2019 )
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Petition to Change a
Parenting/ Custody Order
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9. Request for other changes (RCW 26.09.260(10))
[ ] No request.
[ ] Because of a substantial change in one parent’s/child’s situation, I ask the court to adjust
the following (check all that apply):
[ ] dispute resolution
[ ] decision making
[ ] transportation arrangements
[ ] other (specify):
Explain:
10. Child Support (RCW 26.09.170)
[ ] No request. I am not asking the court to adjust or change chil d support.
[ ] My request to change the parenting schedule affects child support because:
I’m asking to change the parent the children live with most of the time, or
I’m asking for a substantial change in the amount of time the children spend with
the pa rent who pays child support.
If the court makes my requested changes, I also ask the court to set or change child
support. I will file a Financial Declaration and proposed Child Support Worksheets .
Warning! If the court does not change the parenting/c ustody order, your request to change child support
may be denied. If you have other reasons to change child support, you may file separate forms to make
that request (use form FL Modify 501 or 521).
11. 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. Y ou may file your Petition for Order
for Protection using the same case number assigned 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 Protecti on between (name):
and me. (Describe):
Court that issued the order:
Case number:
Expiration date:
CR 4.1; RCW 26.09.181, .260, .270
Mandatory For m (07/2019 )
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Petition to Change a
Parenting/ Custody Order
p. 6 of 10
12. Restraining Order
Do you want the court to issue a Restraining Order as part of the final orders in this case ?
[ ] No. (Skip to 13 .)
[ ] 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 3.
[ ] 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 3.
[ ] 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 3.
[ ] Do not hurt or threaten – Order ( name/s ) :
Not to assault, harass , stalk or molest me or any child listed in 3; 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 cons ider 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 firea rms, 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 person (name): .
[ ] Other restraining orders:
Important! If you want a restraining order now , you must file a Motion for Temporary Family Law Order and
Restraining Order or a Motion for Immediate Restraining Or der (Ex Parte).
13. Children’s Home/s
During the past 5 years have any of the children lived:
on an Indian reservation,
outside Washington state,
in a foreign country, or
with anyone who is not a party to this case?
[ ] No. (Skip to 14 .)
CR 4.1; RCW 26.09.181, .260, .270
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[ ] Yes. (Fill out below to show where each child has lived during the last 5 years.)
Dates Children Lived with
In which state,
Indian reservation,
or foreign country
From:
To:
[ ] All children
[ ] (Name/s):
[ ] Petitioner [ ] Respondent
[ ] Other (name):
From:
To:
[ ] All children
[ ] (Name/s):
[ ] Petitioner [ ] Respondent
[ ] Other (name):
From:
To:
[ ] All children
[ ] (Name/s):
[ ] Petitioner [ ] Respondent
[ ] Other (name):
From:
To:
[ ] All children
[ ] (Name/s):
[ ] Petitioner [ ] Respondent
[ ] Other (name):
From:
To:
[ ] All children
[ ] (Name/s):
[ ] Petitioner [ ] Respondent
[ ] Other (name):
14. Other people with a legal right to spend time with a child
Do you know of any one besides the Petitioner and Respondent who has or claims to have a
legal right to spend time with a child?
(Check one): [ ] No. (Skip to 15 .) [ ] Yes. (Fill out below.)
Name of person Children this person may have
the right to spend time with
[ ] All children
[ ] (Name/s):
[ ] All children
[ ] (Name/s):
15. Other court cases involving a child
Do you know of any court cases involving any of the children?
(Check one): [ ] Yes. (Fill out below.) [ ] No. (Skip to 16 .)
Kind of c ase
(Family Law, Criminal,
Protection Order, Juvenile,
Dependency, Other)
County and State Case number
and year
Children
[ ] All children
[ ] (Name/s):
[ ] All children
[ ] (Name/s):
[ ] All children
[ ] (Name/s):
CR 4.1; RCW 26.09.181, .260, .270
Mandatory For m (07/2019 )
FL Modify 601
Petition to Change a
Parenting/ Custody Order
p. 8 of 10
16. Jurisdiction ov er children (RCW 26.27.201 – . 231, .261, .271)
The court can change a parenting/custody order for the children because (check all that
apply; if a box applies to all of the children, you may write “the children” instead of listing names) :
[ ] Washington order/ exclusive, continuing jurisdiction – The parenting plan /custody
order I want to change was made by a Washington state court, and the court still has
authority to make orders for (children’s names): .
[ ] Other state’s order – The parenting/custody order I want to change was not made by
a Washington state court AND (check one):
[ ] A court in the state (or tribe) that made the parenting/custody order has
made another order saying that it no longer has jurisdiction or that it is
better to have thi s case decided in Washington ;
[ ] No child, parent , or person acting as a parent still lives in the state (or tribal
reservation ) that made the order;
AND (check one):
[ ] Home state jurisdiction – Washington is the children’s home state
because (che ck all that apply):
[ ] (Children’s names): 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 children are less than 6 months old,
they have lived in Washington with a p arent or someone acting as a
parent since birth.
[ ] There were times the children were 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.
[ ] (Childre n’s names): do not live in Washington
right now, but Washington was the children’s home state sometime in
the 6 months just before this case was filed, and a p arent or someone
acting as a parent of the children still lives in Washington.
[ ] (Children’s names): do not have another
home state.
[ ] No home state or home state declined – No court of any other state (or
tribe) has the jurisdiction to make decisions for (children’s names):
, or a court in the children’s home
state (or tribe) decided i t is better to have this case in Washington , and:
The children and a parent or someone acting as a parent have ties to
Washington beyond just living here (significant connection) ; and
There is a lot of information (substantial evidence) about the children’ s
care, protection, education , and relationships in this state.
[ ] Temporary emergency jurisdiction – The parenting/custody order I want to change
was not made by a Washington state court . A Washington court can make decisions
for (children’s names): because the children are in
this state now and were abandoned here or need emergency protection because the
children (or the children’s parent, brother or sister) were abused or threatened with
abuse. Washington should take temporary emergency jurisdictio n over the children
CR 4.1; RCW 26.09.181, .260, .270
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Parenting/ Custody Order
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until the Petitioner can get a court order from the state (or tribe) that made the original
parenting/custody order .
[ ] Other reason (specify):
17. Summary of requests
I ask the court to find that I have valid reasons for my Pet ition (adequate cause), and to
approve the following orders (check all that apply):
[ ] my proposed Parenting Plan or Residential Schedule
[ ] my proposed Child Support Order setting or changing child support according to my
proposed plan or schedule
[ ] an order terminating non -parent custody
[ ] Order for Protection or Restraining Order
[ ] other (specify):
Person filing this Petition fills out below:
I declare under penalty of perjury under the laws of the state of Washington that the facts I ha ve
provided on this form (including any attachments) are true. [ ] I have attached (#): ____ pages.
Signed at (city and state): Date:
Person filing Petition signs here Print name
Lawyer (if any) for person filing this Petition fills out bel ow:
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 the y 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.
[ ] The other parent (or non -parent custodian) fills out below if he/she agrees to
join this Petition:
(If more than one other parent or non -parent custodian agrees to join the Petition, each person should copy
and fill out the section below.)
I, (name): , ag ree to join this Petition . I understand
that if I fill out and sign below, the court may approve the requests listed in this Petition
including the proposed Parenting Plan unless I file and serve a Response before the court
signs final orders. (Check one ):
[ ] I do not need to be notified about the court’s hearings or decisions in this case.
CR 4.1; RCW 26.09.181, .260, .270
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Parenting/ Custody Order
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[ ] The person who filed this Petition must notify me about any hearings in this case.
(List an address where you agree to accept legal documents. This may be a lawyer’s address or any
other address.)
street number or P.O. box 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 .)
Person joining Petition signs here Print name Date