Fill and Sign the Petition to Withdraw Rescind Paternity Acknowledgment Form

Judgment/Ord (Resc Denial of Pat) (JDOEP) - Page 1 of 4 WPF PS 12.0500 (6/2006) - RCW 26.26.330 and .340 Superior Court of Washington County of In re Parentage: Petitioner, and Respondent and Respondent. No. Judgment and Order on Rescission of Denial of Paternity Within 60 Days and Granting Other Relief (JDOEP) Clerk’s action required [ ] Law Enforcement Notification Sec. III. 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 Section III . Violation of a Restraining Order in Section III below with actual knowledge 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) $ E. Interest to date of judgment $ F. Attorney fees $ G. Costs $ H. Other recovery amount $ Judgment/Ord (Resc Denial of Pat) (JDOEP) - Page 2 of 4 WPF PS 12.0500 (6/2006) - RCW 26.26.330 and .340 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 M. Other: II. Basis This matter has come before the cour t on _____________________ [Name]’s Petiti on for Rescission of Denial of Paternity Within 60 Days. The court cons idered the case record and has previously entered its Findings of Fact and Conclusions of Law. This order affects the paternity of _____________________________ [Name of Child] _________ [Age on the date of this order]. III. Order It is Ordered : [ ] This proceeding to rescind the Denial of Paternity was not timely begun and is dismissed. [ ] The Petition for Rescission of Denial of Pa ternity is granted and the Acknowledgment of Paternity is void. [ ] The Petition for Rescission of Denial of Paternity is denied. [ ] The birth certificate of th e child, _______________________________ [Nam e], shall be amended by the Washington State Registrar of Vital Statistics by removing the acknowledged father’s name from the birth certif icate, by adding the presumed father to the birth certificate [ ] and by changing the child’s surname to _________________________ [Surname]. [ ] __________________________ [Name] is orde red to pay attorney fees and costs in the amount of $________________ payabl e to _____________________________ [Name]. [ ] The parties shall comply with the Order for Protection signed by the court on this date, _____________________________ in this cau se number. The Order for Protection signed by the court is approved and inco rporated as part of this decree. [ ] A continuing restraining order is entered as follows: [ ] ______________________________ [Name] is restrained and enjoined from disturbing the peace of the other party. [ ] _______________________________ [Name] is r estrained 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 (Resc Denial of Pat) (JDOEP) - Page 3 of 4 WPF PS 12.0500 (6/2006) - RCW 26.26.330 and .340 [ ] _____________________________ [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 th is 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 a nd a $250,000 fine. An exception exists for law enforcement officers and military personnel when carrying department/government-issue firearms. 18 U.S.C. § 9259a)(1).) [ ] O th er: Violation of a Restraining Order with actual knowledge of its terms is a criminal offense under Chapter 26.50 RCW and will subject the violator to 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 judi cial day, to______________________________________ [name of the appropriate law enforcement agency ] which shall 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 attorney and provided with this order before this order will be entered into the law enforcement computer system .) Service [ ] The restrained party or attorn ey 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: ______________________________ la w enforcement agency where Petitioner resides which shall enter this order into an y computer-based criminal intelligence system available in this state used by law enfor cement 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. Dated: ________________________________ _____________________________________ Judge/Commissioner Judgment/Ord (Resc Denial of Pat) (JDOEP) - Page 4 of 4 WPF PS 12.0500 (6/2006) - RCW 26.26.330 and .340 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 Case. The DSHS’ Division of Child Support Received Signature of Party or Lawyer/WSBA No. 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