Fill and Sign the Summons Notice About Non Parent Custody Petition 400 Form

RCW 26.10.030(1) Mandatory Form (07/201 9) FL Non -Parent 401 Non -Parent Custody Petition p. 1 of 11 Superior Court of Washington, County of In re custody of: Children : Petitioner/s (person/s who started this case) : Respondents (parents and any guardian or custodian) : No. Non -Parent Custody Petition (PTCUS) Non -Parent Custody Petition 1. Petitioner’s Information My name is: My relationship to the children in this case: I live in (county and state only): If there is another Petitioner in this case, put the other Petitioner’s information below. My name is: My r elationship to the children in this case: I live in (county and state only): 2. Children I ask the court for custody of the following children who can be found or permanently reside in the county and state where this Petition is filed: Child’s Name Age Child’s Name Age 1. 2. 3. 4. 5. 6. RCW 26.10.030(1) Mandatory Form (07/201 9) FL Non -Parent 401 Non -Parent Custody Petition p. 2 of 11 3. The following adults live in Petitioner’s household: Adult’s Name Age Adult’s Name Age 1. 2. 3. 4. 4. Respondents’ Information List the children’s parents, and any guardian or custodian other than the par ents. Respondent (name): Relationship to the children in this case: Lives in (county and state only): Other Respondent, if any (name): Relationship to the children in this case: Lives in (county and state only): Other Respondent, if any (nam e): Relationship to the children in this case: Lives in (county and state only): 5. Why the children should not live with a parent I have valid reasons (adequate cause) to ask for custody of these children. The children should not live with either parent and (check at least one box): [ ] The children are not living with either parent. The children have been living with (name/s): since (date): . [ ] Neither parent is a suitable custodian. AND The parents are unfit, or even if they may be fit, the children will suffer actual detriment (harm) to their growth and development if they live with either parent. (Give facts that support the statements above for each parent.) RCW 26.10.030(1) Mandatory Form (07/201 9) FL Non -Parent 401 Non -Parent Custody Petition p. 3 of 11 6. Why the children should live with Petitioner/s It i s in the children’s best interests for the court to give me custody and approve the other requests in this Petition because (explain): 7. Respondents ’ Visitation [ ] I ask the court to approve my proposed Residential Schedule (form FL Non -Parent 405). This schedule may include reasons for limiting one or both parents’ visitation. (Check one): [ ] I am filing and serving my proposed Residential Schedule with this Petition . [ ] I will file and serve my proposed Residential Schedule late r. [ ] I ask the court to give no visitation to either parent because the following reasons for limiting visitation apply and are severe enough to justify no visitation (check at least one reason for each parent and name the parent/s that factor applies to): [ ] Abandonment – (name/s): intentionally abandoned a child listed in 2 for an extended time. [ ] Neglect – (name/s): substantially refused to perform his/her parenting duties for a child listed in 2. [ ] Child Abuse – (name/s): (or s omeone living in that parent’s home) abused or threatened to abuse a child. The abuse was (check all that apply): [ ] physical [ ] sexual [ ] repeated emotional abuse. [ ] Domestic Violence – (name/s): (or someone living in that parent’s hom e) has a history of domestic violence as defined in RCW 26.50.010(1). [ ] Assault – (name/s): (or someone living in that parent’s home) has assaulted or sexually assaulted someone causing grievous physical harm or fear of such harm. [ ] Sex Offens e – [ ] (name/s): has been convicted of a sex offense as an adult. [ ] someone living in (name/s): ‘s home has been convicted as an adult or adjudicated as a juvenile of a sex offense. [ ] Other Reason (specify): RCW 26.10.030(1) Mandatory Form (07/201 9) FL Non -Parent 401 Non -Parent Custody Petition p. 4 of 11 8. Support, insurance, and ta xes The children have a right to child support (including medical support) from the legal parents according to state law. Support – I ask the court to order the parents to (check all that apply): [ ] pay child support according to the Child Support Schedule Worksheets . [ ] provide and keep health insurance for the children. [ ] pay children’s day care, uninsured medical or other expenses. [ ] no request . Tax Issues – I ask the court to order: [ ] Petitioners have the right to claim the childre n as dependents for purposes of personal tax exemptions and associated tax credits on our tax forms. Important! Although the personal tax exemptions are currently suspended through tax year 2025, other tax benefits may flow from claiming a child as depend ent. [ ] (other): 9. Personal jurisdiction over Respondents Does a Washington state court have personal jurisdiction (authority to make decisions) over (Respondent’s name): ? [ ] Yes , because s/he (check all that apply): [ ] will be personally ser ved in this state with a Summons and Petition for this case. [ ] lives in this state now. [ ] lived in this state with the children. [ ] lived in this state and paid for pregnancy costs or support for the children. [ ] did or said something that caused the children to live in this state. [ ] had sex in this state, which may have produced the children. [ ] signed an agreement to join this Petition or other document agreeing that the court can decide his or her rights in this case . [ ] other (specify ): [ ] No . (None of the reasons listed above apply.) Does a Washington state court have personal jurisdiction (authority to make decisions) over (Other Respondent’s name): ? [ ] Yes , because s/he (check all that apply): [ ] will be personally served i n this state with a Summons and Petition for this case. [ ] lives in this state now. [ ] lived in this state with the children. [ ] lived in this state and paid for pregnancy costs or support for the children. [ ] did or said something that caused the children to live in this state. [ ] had sex in this state, which may have produced the children. RCW 26.10.030(1) Mandatory Form (07/201 9) FL Non -Parent 401 Non -Parent Custody Petition p. 5 of 11 [ ] signed an agreement to join this Petition or other document agreeing that the court can decide his or her rights in this case . [ ] other (specify): [ ] No . (None of the reasons listed above apply.) [ ] Check here if there are more Respondents . Give those people’s names, say whether or not the court has personal jurisdiction over each person, and why: 10. 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 other than Petitioners and/or Respondents? [ ] No. (Skip to 11 .) [ ] Yes. (Fill out below to show where each child has liv ed during the last 5 years.) Dates Children Lived with In which state, Indian reservation, or foreign country From: To: [ ] All children [ ] (Name/s): [ ] Petitioner/s [ ] Resp. (name/s): [ ] Other (name): From: To: [ ] All children [ ] (Name/s): [ ] Petitioner/s [ ] Resp. (name/s): [ ] Other (name): From: To: [ ] All children [ ] (Name/s): [ ] Petitioner/s [ ] Resp. (name/s): [ ] Other (name): From: To: [ ] All children [ ] (Name/s): [ ] Petitio ner/s [ ] Resp. (name/s): [ ] Other (name): From: To: [ ] All children [ ] (Name/s): [ ] Petitioner/s [ ] Resp. (name/s): [ ] Other (name): RCW 26.10.030(1) Mandatory Form (07/201 9) FL Non -Parent 401 Non -Parent Custody Petition p. 6 of 11 11. Other people with a legal right to spend time with a child Do you know of anyone b esides you and the Respondents who has or claims to have a legal right to spend time with any of these children? (Check one): [ ] No. (Skip to 12 .) [ ] 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): 12. Other court cases involving a child Do you know of any court cases involving any of these children? (Check one): [ ] No. (Skip to 13 .) [ ] Yes. (Fill out below.) Kind of case (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): [ ] All children [ ] (Name/s): 13. Are any of the children Indian children ? (An Indian child is a child who is a member of an Indian tribe, or who is the biological child of an Indian tribe member and eligible for membership. You must try to find out i f any child in this case is an Indian child. If so, the federal and state Indian Child Welfare Acts will apply to your case.) Check all that apply: [ ] No. [ ] None of the children are Indian children . [ ] These children are not Indian children (name/s): I know this because: RCW 26.10.030(1) Mandatory Form (07/201 9) FL Non -Parent 401 Non -Parent Custody Petition p. 7 of 11 [ ] Yes. These children are Indian children: Children Tribe [ ] All children [ ] (name/s): [ ] All children [ ] (name/s): I will provide the Indian Child Welfare Act Notice (form FL Non -Parent 402) and a copy of this Petition to the tribe/s named above and other necessary people or agencies. [ ] Maybe. These children may be eligible for membership in these tribes: Children Tribe [ ] All children [ ] (name/s): [ ] All children [ ] (name/s ): I will provide the Indian Child Welfare Act Notice (form FL Non -Parent 402) and a copy of this Petition to the tribe/s named above (and other necessary people or agencies) to find out whether any of the children are eligible for membership. [ ] I do not know if any of the children are Indian children. I have done the following things to try to find out: 14. Jurisdiction over Indian children [ ] Does not apply. None of the children are Indian children. [ ] A state court can decide this case for the Indian children because: [ ] (Children’s names): are not domiciled or living on an Indian reservation, and are not wards of a tribal court. (25 USC §1911) [ ] (Children’s names): are domiciled or living on an Indian reservation, and (ch eck all that apply): [ ] The children’s tribe agrees to Washington State’s concurrent jurisdiction. [ ] The children’s tribe decided not to use its exclusive jurisdiction (expressly declined). (RCW 13.38.060) [ ] Washington State should claim emergenc y jurisdiction for children temporarily located off the reservation to protect the children from immediate physical damage or harm. (RCW 13.38.140) RCW 26.10.030(1) Mandatory Form (07/201 9) FL Non -Parent 401 Non -Parent Custody Petition p. 8 of 11 15. Jurisdiction over the children (RCW 26.27.201 – .221, .231, .261 , .271) This Court can decide this ca se 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): [ ] Exclusive, continuing jurisdiction – A Washington court has already made a custody order or parenting p lan for the children, and the court still has authority to make other orders for (children’s names): . [ ] Home state jurisdiction – Washington is the children’s home state because (check 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 parent or someone acting as a parent since birth. [ ] There were tim es 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. [ ] (Children’s names): do not live in Washington right now, but Wa shington wa s 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 hom e 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 it is better to have this case in Washington and:  The children and a pare nt, or someone acting as a parent , have ties to Washington beyond just living here; and  There is a lot of information (substantial evidence) about the children’s care, protection, education , and relationships in this state. [ ] Other state declined – The courts in other states (or tribes) that might be (children’s names): ’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 (children’s nam es): 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. ( Check one): [ ] A custody case involving the children was filed in the children’s home state (name of state or tribe): . Washington should take temporary emergency jurisdiction over the children until the Petitioner can get a court order from the children’s home state (or tribe). [ ] There is no valid custody order or open custody case in the children’s home state (name of state or tribe): . If no case is filed in the children’s home state (or tribe) by the time the children have been in RCW 26.10.030(1) Mandatory Form (07/201 9) FL Non -Parent 401 Non -Parent Custody Petition p. 9 of 11 Washington for 6 months, (date): , Washington s hould have final jurisdiction over the children. [ ] Other reason (specify): 16. 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 assigned to this case.) Important! If yo u 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): Court that issued the order: Case number: Expiration date: 17. Restrai ning Order Do you want the court to issue a Restraining Order as part of the final orders in this case ? [ ] No. (Skip to 18 .) [ ] Yes. Check the type of order s you want: [ ] Do not disturb – Order ( name/s ) not to disturb my peace or the peace of any child listed in 2. [ ] 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 2. [ ] 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 2. [ ] Do not hurt or threaten – Order ( name/s ) :  Not to assault, harass, stalk or molest me or any child listed in 2; 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 possessin g 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 RCW 26.10.030(1) Mandatory Form (07/201 9) FL Non -Parent 401 Non -Parent Custody Petition p. 10 of 11  To immediately surrender any firear ms, 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 restrain ing order now , you must file a Motion for Temporary Non -Parent Custody Order and Restraining Order (form FL Non -Parent 423) or a Motion for Immediate Restraining Order (Ex Parte) (form FL Non -Parent 421). 18. Fees and costs [ ] No request. [ ] Order who should pay for court costs, guardian ad litem fees, lawyer fees, and other reasonable fees. 19. Othe r requests, if any Petitioner 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) fills out below: I declare under penalty of perjury under the laws of the state of Washington that the facts I have provi ded on this form are true. Signed at (city and state): Date: Other Petitioner signs here Print name Petitioner’s lawyer (if any) fills out below: Petitioner’s lawyer signs here Print name and WSBA No. Date Warning! Documents filed with t he 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 th ose 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. RCW 26.10.030(1) Mandatory Form (07/201 9) FL Non -Parent 401 Non -Parent Custody Petition p. 11 of 11 [ ] Respondent fills out below if s/he agrees to join this Petition: I, (name): , agree to j oin 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 orders. (Check one): [ ] I do not need to be notified about t he 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 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 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 .) 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 s ign below, the court may approve the requests listed in this Petition 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. [ ] 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 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 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