Fill and Sign the Petitioner Seeking a Guardianship for the Child is Form

GUARDIANSHIP PETITION (PTAPGD) - Page 1 of 3WPF JU 03.0700 (6/2004) - RCW 13.34.230; .231SUPERIOR COURT OF WASHINGTONCOUNTY OF _______________________JUVENILE COURTGUARDIANSHIP OF:D.O.B.: NO: GUARDIANSHIP PETITION(PTAPGD) I. BASIS 1.1 The petitioner seeking a guardianship for the child is: _________________________________. (Name: Title/Agency/Relationship) 1.2 Information about the child: Name: ______________________________________________________________________Date of Birth: __________________________ Age: ______________ Sex: ______________Address: __________________________________________________________ __________________________________________________________ 1.3The child is not an Indian child as defined in 25 U.S.C. 1903(4).is an Indian child as defined in 25 U.S.C. 1903(4). 1.4 The child is in the custody of _____________________________________________________ (Name of Institution, Agency, or Person) Address: __________________________________________________________ __________________________________________________________ FOR OFFICIAL USE ONLY Juv. Ref. No.: _____________________________ GUARDIANSHIP PETITION (PTAPGD) - Page 2 of 3WPF JU 03.0700 (6/2004) - RCW 13.34.230; .2311.5Information about persons most closely related by blood or marriage to the child: Name: ________________________________________________________ Address:________________________________________________________ ________________________________________________________ Relationship:________________________________________________________Name:________________________________________________________Address:________________________________________________________ ________________________________________________________ Relationship:________________________________________________________Name:________________________________________________________Address:________________________________________________________ ________________________________________________________ Relationship:________________________________________________________ 1.6There is is not in any state, a guardian or limited guardian for the person of the child. 1.7 Information about the proposed guardian: Name: ________________________________________________________Address:________________________________________________________ ________________________________________________________ 1.8A guardianship should be established. (a) The child has been found to be a dependent child under RCW 13.34.030.(b) A dispositional plan has been entered pursuant to RCW 13.34.130.(c) The child has been removed, or will, at the time of the hearing, have been removed from the custody of the parent for a period of at least six months pursuant to a finding of dependency under RCW 13.34.030.(d) The services ordered under RCW 13.34.130 and 13.34.136 have been offered or provided and all necessary services reasonably available, capable of correcting the parental deficiencies within the foreseeable future have been offered or provided.(e) There is little likelihood that conditions will be remedied so the child can be returned to the parents in the near future.(f) A guardianship rather than termination of the parent-child relationship or continuation of the child's current dependent status would be in the best interest of the child. 1.9 The request for the establishment of a guardianship is based upon the following facts: GUARDIANSHIP PETITION (PTAPGD) - Page 3 of 3WPF JU 03.0700 (6/2004) - RCW 13.34.230; .231 II. RELIEF REQUESTED Petitioner requests:2.1The court appoint a guardian for the child.2.2 The duration of the guardianship be until the child attains the age of 18 years, or until further order of the court.2.3 The proposed guardian be vested with the authority to provide day to day care and shelter for the child, to authorize the provision of necessary medical and dental care and treatment, and to otherwise assist the court in supervising the dependent child.Dated: JUDGE/COMMISSIONER III. CERTIFICATION I certify under penalty of perjury under the laws of the state of Washington that the foregoing Guardianship Petition is true and correct.Dated at __________________________________, Washington on ____________________________ (Place) (Date) ____________________________________Signature______________________________________Type or Print Name______________________________________Address______________________________________Telephone