Fill and Sign the Residential Time Summary Statement Washington Form

Superior Court of Washington County of In re the Marriage of: Petitioner, and Respondent. No. Residential Time Summary Report (RTSR) Clerks Action Required Submit with final Parenting Plan, only . This form is for statistical reporting purposes only. 1. The Parenting Plan The court signed the Parenting Plan on (Date) ___________________________________. It was: [ ] by agreement of the parties [ ] after a contested hearing or trial [ ] by default It is: [ ] an original order [ ] a modification of a prior order How many children under the parenting plan have the residential schedule summarized in paragraph 2, below? _______________ 2. Residential Schedule from Part III of the Parenting Plan If the same schedule does not apply to all children, fill out a separate Residential Time Summary Report for each schedule . Check the box that comes closest to representing the time spent with each parent: % of time the children spend with the Mother % of time the children spend with the Father [ ] 0% 100% [ ] 10% 90% [ ] 20% 80% [ ] 30% 70% [ ] 40% 60% [ ] 50% 50% [ ] 60% 40% [ ] 70% 30% [ ] 80% 20% [ ] 90% 10% [ ] 100% 0% R es. Time Summary Rpt (RTSR) - Page 1 of 2 WPF DR 01.0410 - Mandatory (4/2008 ) – RCW 26.09.231, 26.18.230 3. Information about the Parents Father: [ ] self-represented [ ] represented by an attorney The court found under paragraphs 2.1 and 2.2: [ ] does not apply, or the Father [ ] committed domestic violence [ ] abused or neglected a child [ ] has chemical dependency issues [ ] has mental health issues [ ] other:______________________________________________________________ Mother: [ ] self-represented [ ] represented by an attorney The court found under paragraphs 2.1 and 2.2: [ ] does not apply, or the Mother [ ] committed domestic violence [ ] abused or neglected a child [ ] has chemical dependency issues [ ] has mental health issues [ ] other:______________________________________________________________ 4. Dispute Resolution from Part V. of the Parenting Plan [ ] Arbitration [ ] Mediation [ ] Counseling [ ] No dispute resolution process except court action Prepared by: ______________________________________, on (Date) _________________________. R es. Time Summary Rpt (RTSR) - Page 2 of 2 WPF DR 01.0410 - Mandatory (4/2008 ) – RCW 26.09.231, 26.18.230