Fill and Sign the Use This Form Only for Cases About Changing a Parentingcustody Order When it is an Emergency

RCW 26. 09.260 , CR 65(b) Mandatory Form (07/2019 ) FL Modify 621 Motion for Immediate Restraining Order (Ex Parte) p. 1 of 7 Superior Court of Washington, County of _______________ In re: Petitioner/s (as listed on the Petition ): And Respondent/s (as listed on the Petition ): No. Motion for Immediate Restraining Order (Ex Parte) (MT SC ) Motion for Immediate Restraining Order (Ex Parte) Use this form only for cases about changing a parenting/custody order when it is an emergency. . For other cases, use FL Divorce 221, FL Parentage 321, or FL Non -Parent 421, depending on the type of case . To both parties: Deadline! Your papers must be filed and served by the deadline in your county’s Local Court Rules, or by the State Court Rules if there is no local rule. Court Rules and forms are online at www.courts.wa.gov . If you want the cou rt to consider your side, you must :  File your original documents with the Superior Court Clerk; AND  Give the Judge/Commissioner a copy of your papers (if required by your county’s Local Court Rules); AND  Have a copy of your papers served on all other parti es or their lawyers; AND  Go to the hearing. Read your county’s Local Court Rules, if any. Bring proposed orders to the hearing. To the person filing this motion: You must ask the court to sign the Immediate Restraining Order (Ex Parte) and Hearing Notic e (FL Modify 6 22). This Order may be signed “ex parte” (without the other party there). Contact the Superior Court Clerk’s office for the procedure in your county. You must have this Motion and the Immediate Restraining Order personally served (by someo ne else) on the restrained person. To the person receiving this motion: If you do not agree with the requests in this motion, file a statement (using form FL All Family 135, Declaration ) explaining why the court should not approve those requests. You may file other written proof supporting your side, and propose your own Parenting Plan, Residential Schedule, or Child Support Worksheets . If the court grants an Immediate Restraining Order without notice to you, you can file a motion to change or term inate it before the hearing date. (Civil Rule 65(b).) There is no pattern form for that motion. RCW 26. 09.260 , CR 65(b) Mandatory Form (07/2019 ) FL Modify 621 Motion for Immediate Restraining Order (Ex Parte) p. 2 of 7 1. My name is: . I am asking the court for an Immediate Restraining Order against (name/s): . [ ] I want these child ren under 18 to be protected by t he order : Child ’s name Age Child ’s name Age 1. 4. 2. 5. 3. 6. 2. I ask the court to approve an Immediate Restraining Order to protect me and/or any child listed in 1. Without this Order, the children or I could be hurt or suffer da mage or loss immediately. This harm could be irreparable. (Explain how you or the children could be harmed beyond repair): (If you need additional space use the Declaration form FL All Family 135.) 3. Notice (check one): [ ] I should not have to notify the other parties in advance that I am filing this Motion because any child listed in 1 or I could be harmed beyond repair if I gave any advance notice. (Explain why you or the children could be harmed by providing advance notice ): [ ] I have notified the other parties that I am asking for an Immediate Restraining Order . (Describe any steps taken to give the other parties or their lawyers notice of this Motion): RCW 26. 09.260 , CR 65(b) Mandatory Form (07/2019 ) FL Modify 621 Motion for Immediate Restraining Order (Ex Parte) p. 3 of 7 4. Court hearing request I ask the court to approve an Im mediate Restraining Order now and hold a hearing within 14 days to consider my requests for temporary orders listed below. I will have the other parties served with notice of the hearing so the court can hear their sides. [ ] Other: 5. Active duty military (The federal Servicemembers Civil Relief Act covers:  Army, Navy, Air Force, Marine Corps, and Coast Guard members on active duty;  National Guard or Reserve members under a call to active service for more than 30 days in a row; and  commissioned c orps of the Public Health Service and NOAA. The state Service Members’ Civil Relief Act covers those service members listed above who are either stationed in or residents of Washington state, and their dependents, except for the commissioned corps of the Public Health Service and NOAA. ) [ ] None of the other parties are covered by the state or federal Service Members ’ Civil Relief Acts. [ ] (Name): is covered by the [ ] state [ ] federal Service Members ’ Civil Relief Act. [ ] For persons cove red only by the state act – Military duty may keep the service member or dependent from responding or coming to the hearing on this motion. I ask the court to approve temporary orders even if the covered person asks for a stay or doesn’t respond. It woul d be very unfair (a manifest injustice) not to make temporary orders now because:  I ask the Court to approve these orders immediately (check all that apply): 6. Do not disturb [ ] No request. [ ] Order (name/s): not to disturb my peace or the p eace of any child listed in 1. 7. Stay away [ ] No request. [ ] 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 1. [ ] 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 1. RCW 26. 09.260 , CR 65(b) Mandatory Form (07/2019 ) FL Modify 621 Motion for Immediate Restraining Order (Ex Parte) p. 4 of 7 8. Do not hurt or threaten [ ] No request. [ ] Order (name/s): not to:  Assault, harass, stalk or molest me or any child listed in 1; or  Use, try to use, or threa ten to use physical force against me or the children that would reasonably be expected to cause bodily injury. Warning! If the court extends this order after a full hearing and the parties are intimate partners, the court must consider if weapons restri ctions are required by state law; f ederal law may also prohibit the Restrained Person from possessing firearms or ammunition . [ ] Intimate Partner : The Restrained Person and the Protected Person are/were intimate partners because they are ( check all th at apply): [ ] current or former spouses or d omestic partners , or parents of a child -in- common . [ ] age 16 or older and are/were in a dating relationship , and are currently residing together or resided together in the past. [ ] age 16 or older and are/w ere in a dating relationship , but have never resided together. 9. Surrender weapons [ ] No request. [ ] Order (name/s): to immediately surrender any firearms and other dangerous weapons that he/she possesses t o (check one): [ ] the police chief o r sheriff. [ ] his/her lawyer. [ ] other person : (name): . 10. Care and safety of children until the hearing [ ] No request. [ ] Order (name/s): not to take the children listed in 1 out of Washington State. [ ] Order that the children listed in 1 will live with me until the hearing. [ ] Other (specify): 11. Other immediate orders [ ] No request. [ ] (Specify): RCW 26. 09.260 , CR 65(b) Mandatory Form (07/2019 ) FL Modify 621 Motion for Immediate Restraining Order (Ex Parte) p. 5 of 7  I ask the court to approve these temporary orders at the hearing to stay in effect until the case is done (check all t hat apply) : 12. Extend immediate orders Extend the immediate orders I asked for above to stay in effect until the case is done. 13. Prohibit weapons and order surrender [ ] No request. [ ] Order (name/s): :  Not to access, possess , or obtain any firear ms, other dangerous weapons, or concealed pistol license s until the Order ends, and to  Immediately s urrender any firearms, other dangerous weapons, or concealed pistol license s that he/she possesses or controls t o (check one): [ ] the police chief or county sheriff. [ ] his/her lawyer. [ ] other person (name): . 14. Care and safety of children (check all that apply) [ ] No request. [ ] Approve the Parenting Plan (form FL All Family 140) or Residential Schedule (form FL Parentage 304 or FL Non -Parent 405 ) proposed by (check one): [ ] me [ ] (name): . [ ] Order (name): not to take the children out of Washington State. [ ] Appoint a person to investigate and report to the court about what is in the children ’s best interest, and ord er who will pay this person’s fees. This person should be a/n (check one): [ ] Guardian ad Litem (GAL) or Evaluator/Investigator as chosen by the court. [ ] Guardian ad Litem (GAL). [ ] Evaluator/Investigator. [ ] (Name): [ ] Other: 15. Provide support [ ] No request. [ ] Order child support according to the Washington state child support schedule. 16. Pay fees and costs [ ] No request. [ ] Order (name): to: [ ] Pay my lawyer’s fees for this case. Amount: $ RCW 26. 09.260 , CR 65(b) Mandatory Form (07/2019 ) FL Modify 621 Motion for Immediate Restraining Order (Ex Parte) p. 6 of 7 Make payments to (name) : [ ] Pay other professional fees and costs for this case. Amount: $ to (name): for (purpose): 17. Other temporary orders [ ] No request. [ ] (Specify):  Reasons for my requests 18. Why are you asking the court for the orders you checked above? (Explain):  If you need additional space use the Declaration form FL All Family 135.  If you are asking for a parenting plan or residential schedule, also fill out the Information for Temporary Parenting Plan , form FL All Family 139, and a p roposed Parenting Plan , form FL All Family 140, or Residential Schedule , form FL Parentage 304 or FL Non -Parent 405 .  If you are asking for child support, also fill out the Child Support Worksheets and Financial Declaration , form FL All Family 131, and fil e the required financial records. If you or anyone else has ever received public assistance for any child in this case , also fill out the Public Assistance Declaration , form FL All Family 132.  If you are asking to prohibit weapons or order surrender, gi ve your reasons at the end of this section.  If you are asking to change an earlier temporary order, give the date of the earlier order and explain how circumstances have changed since then. RCW 26. 09.260 , CR 65(b) Mandatory Form (07/2019 ) FL Modify 621 Motion for Immediate Restraining Order (Ex Parte) p. 7 of 7 [ ] Reasons for “Prohibit weapons a nd order surrender” request (check all that apply): [ ] (Name): has used, displayed, or threatened to use a firearm or other dangerous weapon in a felony. (Describe): [ ] (Name): previously committed an offense making him or her ineligible t o possess a firearm under RCW 9.41.040. (Describe): [ ] (Name): ’s possession of firearm presents a serious and imminent threat (harm that may happen immediately) to public health or safety, or to the health or safety of any individual. (Descri be): Person asking for this order 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: Person asking for this order signs here Print name here I agree to accept legal papers for this case at (check one): [ ] my lawyer’s address, listed below. [ ] the following address (this does not have to be your home address): street address or PO box city state zip Note : You and the other party/ies may agree to accept legal papers by email under Civil Rule 5 and local court rules. (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 Add ress 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.) Lawyer (if any) fills out below: Lawyer signs here Print name and WSBA No. Date Lawyer’s street address or PO box city state zip Email (if applicable): Warning! Documents filed with the court are available for anyone to see unless they are sealed. Financial, medical, and confidential reports, as described in General Rule 22, mus t be sealed so they can only be seen by the court, the other party, and the lawyers in your case. Seal those 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 doc uments.