Fill and Sign the To the Individuals Listed on the Attached Exhibit a Form

NT of Right to Request Special Notice (NT)- Page 1 of 3WPF GDN 04.0800 (01/2009) RCW 11.92.150Superior Court of WashingtonCounty ofIn the Guardianship of:_______________________________, Incapacitated PersonNo. Notice of Right to Request Special NoticeRCW 11.92.150(NT)To: The individuals listed on the attached Exhibit A.You are notified that you have the right under RCW 11.92.150 to file a Request for Special Notice of Proceedings regarding this Guardianship.To file a request for Special Notice, you must serve a copy of your Request upon the Guardian, or upon the attorney for the Guardian (if there is one), and you must file the original of your Request with the Clerk of the court where this guardianship is pending. Your Request must designate the name, street address, and mailing address of the person to receive special notice. If your Request for Special Notice identifies specific actions for which you request advance notice, you will be entitled to receive only the documents you specifically request. If your Request for Special Notice is a general one and does not request advance notice of specific matters, the Guardian shall provide copies of all documents filed with the court and advance notice of the Guardian’s application for court approval of any action in the Guardianship.Serve a copy of your request upon: Guardian: ____________________________________________________ Address:____________________________________________________ ____________________________________________________ Guardian’s Attorney:____________________________________________________ Address:____________________________________________________ ____________________________________________________ NT of Right to Request Special Notice (NT)- Page 2 of 3WPF GDN 04.0800 (01/2009) RCW 11.92.150File the original of your request with:Clerk of the Court, __________________________ County, Superior Court Address: ______________________________________________________ ______________________________________________________ I certify (or declare) under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct.Signed at (city) __________________________, (state) ___________ on (date) ____________________. ____________________________________ _______________________ ______________Signature of GuardianPrint Name of Guardian [ ]WSBA [ ]CPG#_____________________________________ ______________________________________AddressCity, State, Zip Code_____________________________________________________________________________*TelephoneEmail Address*If you do not want your personal phone number on this public form, you may list your telephone number on a separate form which may be available to parties and the court, as well as its staff and volunteers, but will not be made available to the public. Use Form WPF GDN 03.0100, Guardianship Confidential Information form (Telephone Numbers), for this purpose. NT of Right to Request Special Notice (NT)- Page 3 of 3WPF GDN 04.0800 (01/2009) RCW 11.92.150 EXHIBIT A List name(s) and address(es) of all persons and agencies requiring notice. Name(s)Address(es) Certificate of Service I certify (or declare) under penalty of perjury, under the laws of the State of Washington that I mailed, first class, postage prepaid a copy of the foregoing Notice of Right to Request Special Notice to the person(s) listed above on (date of mailing) __________________________________.Signed at (city) ___________________________, (state) ___________ on (date) ___________________.__________________________________ _____________________________________________SignaturePrint Name