Superior Court of Washington
County of
In re:
Petitioner,
and
Respondent. No .
Petition for Modification/
Adjustment of Custody Decree/
Parenting Plan/Residential
Schedule
( PTMD )
Para. 2.14: check box if petition is
attached for:
Order for protection DV (PTORPRT)
Order for protection UH (PTORAH)
1.1 Identification of Requesting Party/Parties
Name (first/last) Birth date
Last known residence (county and state only) .
Name (first/last) Birth date
Last known residence (county and state only) .
1.2 Identification of Other Party/Parties
Name (first/last) Birth date
Last known residence (county and state only) .
Name (first/last) Birth date
Last known residence (county and state only) .
Name (first/last) Birth date
Last known residence (county and state only) .
1.3 Dependent Children
Name (first/last) Age
Pet for Mod/Adj Parenting Pln (PTMD) - Page 1 of 11
WPF DRPSCU 07.0100 Mandatory (03/2013) - CR 4.1; RCW 26.09.181; .260; .270, RCW 26.26.130(7)(b)
Name (first/last) Age
Name (first/last) Age
Name (first/last) Age
Name (first/last) Age
Name (first/last) Age
II. Basis
2.1 Petition for an Order Modifying Custody Decree/Parenting Plan/Residential
Schedule
This is a petition for an order modifying the prior custody decree/parenting plan/residential
schedule/judgment establishing parentage and approving my proposed parenting plan/residential
schedule, which is filed with this petition.
The court entered a judgment and order establishing parentage on
(date) ____________________ at (county and state) ___________________________
under cause number ________________ and did not enter a Parenting Plan or Residential
Schedule at the same time. I attached a copy of the order establishing parentage if it was
filed in another county or state.
2.2 Adequate Cause
There is adequate cause for hearing the petition for modification.
2.3 Child Support
Does not apply.
Child support should be modified or established if the court grants the petition to modify
the parenting plan or residential schedule. A child support worksheet and financial
declaration must be filed with this action. RCW 26.09.170.
2.4 Jurisdiction and Venue
The court has proper jurisdiction and venue.
The requesting party/parties reside(s) in (county and state only) ___________________________ .
The children reside in (county and state only) __________________________________________ .
The other party/parties reside(s) in (county and state only) ________________________________
_______________________________________________________________________________ .
2.5 Jurisdiction Over Proceeding
This court has jurisdiction over this proceeding for the reasons below:
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WPF DRPSCU 07.0100 Mandatory (03/2013) - CR 4.1; RCW 26.09.181; .260; .270, RCW 26.26.130(7)(b)
This court has exclusive continuing jurisdiction. The court has previously made a child
custody, parenting plan, residential schedule or visitation determination in this matter and
retains jurisdiction under RCW 26.27.211.
This state is the home state of the children because:
the children lived in Washington with a parent or a person acting as a parent for at
least six consecutive months immediately preceding the commencement of this
proceeding.
the children are less than six months old and have lived in Washington with a
parent or a person acting as parent since birth.
any absences from Washington have been only temporary.
Washington was the home state of the children within six months before the
commencement of this proceeding and the children are absent from the state but a
parent or person acting as a parent continues to live in this state.
The children and the parents or the children and at least one parent or a person acting as a
parent have significant connection with the state other than mere physical presence, and
substantial evidence is available in this state concerning the children’s care, protection,
training and personal relationships, and:
The children have no home state elsewhere.
The children’s home state has declined to exercise jurisdiction on the ground that
this state is the more appropriate forum under RCW 26.27.261 or .271.
All courts in the children's home state have declined to exercise jurisdiction on the ground
that a court of this state is the more appropriate forum to determine the custody of the
children under RCW 26.27.261 or .271.
No other state has jurisdiction.
This court has temporary emergency jurisdiction over this proceeding because the children
are present in this state and the children have been abandoned or it is necessary in an
emergency to protect the children because the children, or a sibling or parent of the
children is subjected to or threatened with abuse. RCW 26.27.231.
There is a previous custody determination that is entitled to be enforced under
this chapter or a child custody proceeding has been commenced in a court of a
state having jurisdiction under RCW 26.27.201 through 26.27.221. The
requirements of RCW 26.27.231(3) apply to this matter. T his st ate’s jurisdiction
over the children shall last until (date) _______________________________.
There is no previous custody determination that is entitled to be enforced under
this chapter and a child custody proceeding has not been commenced in a court
of a state having jurisdiction under RCW 26.27.201 through 26.27.221. If an
action is not filed in (potential home state) _____________________________
by the time the child has been in Washington for six months,
(date) _______________________________, then Washington's jurisdiction will
be final and continuing.
Other:
2.6 Uniform Child Custody Jurisdiction and Enforcement Act Information
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WPF DRPSCU 07.0100 Mandatory (03/2013) - CR 4.1; RCW 26.09.181; .260; .270, RCW 26.26.130(7)(b)
Name of Child Parent’s Name Parent’s Name
During the last five years, the children have lived:
in no place other than the state of Washington and with no person other than the requesting
party or the other party.
in the following places with the following persons (list each place the children lived,
including the state of Washington, the dates the children lived there and the names of the
persons with whom the children lived. The present addresses of those persons must be
listed in the required Confidential Information Form.):
Claims to custody or visitation:
The requesting party does not know of any person other than the other party who has
physical custody of, or claims to have custody or visitation rights to, the children.
The following persons have physical custody of, or claim to have custody or visitation
rights to, the children (list their names and the children concerned below and list their
present addresses in the Confidential Information Form. Do not list the other party.):
Involvement in any other proceeding concerning the children:
The requesting party has not been involved in any other proceeding regarding the children.
The requesting party has been involved in the following proceedings regarding the children
(list the court, the case number, and the date of the judgment or order):
Other legal proceedings concerning the children:
The requesting party does not know of, any other legal proceedings concerning the
children.
The requesting party knows of, the following legal proceedings that concern the children
(list the children concerned, the court, the case number, and the kind of proceeding):
Pet for Mod/Adj Parenting Pln (PTMD) - Page 4 of 11
WPF DRPSCU 07.0100 Mandatory (03/2013) - CR 4.1; RCW 26.09.181; .260; .270, RCW 26.26.130(7)(b)
2.7 Custody Decree or Parenting Plan/Residential Schedule
The Custody Decree/Parenting Plan/Residential Schedule was entered on (date) _______________
at (county and state) ________________________________________ . A certified copy of the
Custody Decree/Parenting Plan /Residential Schedule to be modified is filed with or attached to
this petition, if the decree or plan to be modified was entered in another county or state.
2.8 Modification Under RCW 26.09.260(1), (2)
Does not apply.
The custody decree/parenting plan/residential schedule should be modified because a
substantial change of circumstances has occurred in the circumstances of the children or the
other party and the modification is in the best interests of the children and is necessary to
serve the best interests of the children. This request is based on the factors below.
The parties agree to the modification.
The children have been integrated into my family with the consent of the other
party in substantial deviation from the decree/parenting plan/residential schedule.
The children’s environment under the custody decree/parenting plan/residential
schedule is detrimental to the children’s physical, mental or emotional health and
the harm likely to be caused by a change in environment is outweighed by the
advantage of a change to the children.
The other party has been found in contempt of court at least twice within three
years because the party failed to comply with the residential time provisions in the
court-ordered parenting plan, or the parent has been convicted of custodial
interference in the first or second degree under RCW 9A.40.060 or 9A.40.070.
2.9 Modification or Adjustment Under RCW 26.09.260(4) or (8)
Does not apply.
The custody decree/parenting plan/residential schedule should be modified because the
reduction or restriction of the residential time for the person with whom the child does not
reside a majority of the time would serve and protect the best interests of the child using
the criteria in RCW 26.09.191, as described here:
Pet for Mod/Adj Parenting Pln (PTMD) - Page 5 of 11
WPF DRPSCU 07.0100 Mandatory (03/2013) - CR 4.1; RCW 26.09.181; .260; .270, RCW 26.26.130(7)(b)
The custody decree/parenting plan/residential schedule should be adjusted because the
nonresidential party has voluntarily failed to exercise residential time for one year or more
and the adjustment is in the best interest of the children.
2.10 Adjustments to Residential Provisions Under RCW 26.09.260(5)(a) and (b)
Does not apply.
The custody decree/parenting plan/residential schedule should be adjusted because a
substantial change in circumstances of either parent or of the child has occurred and the
proposed modification to the custody decree/parenting plan/residential schedule is in the
best interest of the children and is a minor modification in the residential schedule that
does not change the residence the children are scheduled to reside in the majority of the
time and:
is not more than 24 full days in a calendar year; or
is based on a change of residence of the parent with whom the child does not
reside a majority of the time or an involuntary change in work schedule by a party
which makes the residential schedule in the parenting plan impractical to follow.
2.11 Adjustments to Residential Provisions Under RCW 26.09.260(5)(c), (7), (9)
Does not apply.
This section only applies to a person with whom the child does not reside a
majority of the time who is seeking to increase residential time.
2.11.1 Parent subject to limitations under RCW 26.09.191(2) or (3)
The residential time of (name) ________________________________________ is not
subject to limitations.
The residential time of (name) ___________________________________ is subject to
limitations. This parent demonstrates a substantial change in circumstances specifically
related to the basis for the limitation.
2.11.2 Parent Required to Complete Evaluations, Treatment, Parenting or Other Classes
(Name) _____________________________ is not required under the existing Parenting
Plan/Residential Schedule to complete evaluations, treatment, parenting or other classes.
(Name) __________________________, is required by the existing Parenting
Plan/Residential Schedule to complete evaluations, treatment, parenting or other classes.
This parent has fully complied with such requirements as described here:
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WPF DRPSCU 07.0100 Mandatory (03/2013) - CR 4.1; RCW 26.09.181; .260; .270, RCW 26.26.130(7)(b)
2.11.3 Adjustment to Residential Provision Under RCW 26.09.260(5)(c)
The Custody Decree/Parenting Plan/Residential Schedule should be adjusted because a
substantial change in circumstances of (parent’s name) ____________________________
or (child(ren)’s name(s)) _________________________________________________ has
occurred. The proposed modification to the Custody Decree/Parenting Plan/Residential
Schedule is in the best interest of the children. It is a minor modification in the residential
schedule that does not change the residence the children are scheduled to reside in the
majority of the time. The increase is more than 24 full days but less than 90 overnights per
year total. The Custody Decree/Parenting Plan/Residential Schedule does not provide
reasonable time with the nonprimary residential party.
2.12 Adjustments to Nonresidential Provisions Under RCW 26.09.260(10)
Does not apply.
The following nonresidential provisions of the parenting plan should be adjusted because
there is a substantial change of circumstances of either party or of the children and the
adjustment is in the best interest of the children:
Dispute resolution.
Decision making.
Transportation arrangements.
Other:
2.13 Substantial Change in Circumstance
( You must complete this part if you request a modification or adjustment in
paragraphs 2.8, 2.10, 2.11.1, 2.11.3 or 2.12.)
The requested modification or adjustment of the custody decree/parenting plan/residential schedule
is based upon the following substantial change in circumstance:
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WPF DRPSCU 07.0100 Mandatory (03/2013) - CR 4.1; RCW 26.09.181; .260; .270, RCW 26.26.130(7)(b)
2.14 Protection Order
Does not apply.
There is a protection order between the parties filed in case number ________________,
court __________________________, which expires on (date) ____________________.
The court should grant the domestic violence antiharassment petition for order for
protection:
attached to this petition.
filed separately under this case number case number __________________.
If you need immediate protection, contact the clerk/court for RCW 26.50 Domestic
Violence forms or RCW 10.14 Antiharassment forms .
2.15 Servicemembers Civil Relief Act Statement
2.15.1 A. Service member status -- (name of other party) _____________________________:
is not a service member;
is on active duty in the U.S. armed forces (excluding National Guard and
reserves);
is on active duty and is a National Guard member or a Reservist residing in
Washington;
is not on active duty in the U.S. armed forces (excluding National Guard and
reserves);
is not on active duty and is a National Guard member or a Reservist residing in
Washington;
I am unable to determine whether the other party is or is not on active duty in the
U.S. armed forces;
I am unable to determine whether the other party is or is not on active duty as a
National Guard member or a Reservist residing in Washington.
B. Factual basis:
See the attached Department of Defense Manpower Data Center Status Report
Pursuant to Servicemembers Civil Relief Act (SCRA) obtained from
https://www.dmdc.osd.mil/appj/scra/ . (You must have the person’s social
security number to search in this site.)
Other factual basis:
C. As indicated above, the other party is on active duty and (check all that apply):
The other party is represented by an attorney.
The court has appointed an attorney to represent the other party.
A stay of these proceedings has has not been entered by the court.
2.15.2 A. Dependent of a service member status -- (name of other party) _________________
____________________________:
is a dependent of a resident of Washington who is on active duty and is a
National Guard member or a Reservist;
is not a dependent of a resident of Washington who is on active duty and is a
National Guard member or a Reservist;
Pet for Mod/Adj Parenting Pln (PTMD) - Page 8 of 11
WPF DRPSCU 07.0100 Mandatory (03/2013) - CR 4.1; RCW 26.09.181; .260; .270, RCW 26.26.130(7)(b)
I am unable to determine whether the other party is a dependent of a resident of
Washington who is on active duty and is a National Guard member or a
Reservist.
B. Factual basis:
The other party failed to respond to a notice to him or her as a dependent of a
person in Military Service that was served on mailed by first class mail on
(date) ________________________________________, therefore he or she
should be presumed not a dependent of a resident of Washington who is on
active duty and is a National Guard member or a Reservist.
Other factual basis:
C. As indicated above, the nonmoving party is a dependent of a resident of
Washington who is on active duty and is a National Guard member or a
Reservist and (check all that apply):
The nonmoving party is represented by an attorney.
The court has appointed an attorney to represent the nonmoving party.
A stay of these proceedings has has not been entered by the court.
2.16 Other
III. Relief Requested
The moving party requests that the court find that there is adequate cause for hearing this petition and
enter an order modifying the custody decree/parenting plan/residential schedule in this matter and
approving the proposed parenting plan/residential schedule, which is filed with this petition.
The moving party also requests that the court:
Enter an order establishing child support in conjunction with the proposed parenting
plan/residential schedule. The child support worksheet and financial declaration are filed
with this petition.
Enter a domestic violence protection order.
Enter an antiharassment protection order.
Other:
Date Signature of Requesting Party or Lawyer/WSBA No. Print Name
Date Signature of Requesting Party or Lawyer/WSBA No. Print Name
I 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) ____________________ .
Pet for Mod/Adj Parenting Pln (PTMD) - Page 9 of 11
WPF DRPSCU 07.0100 Mandatory (03/2013) - CR 4.1; RCW 26.09.181; .260; .270, RCW 26.26.130(7)(b)
Signature of Requesting Party Print Name
Signed at (city) _________________________, (state) ___________ on (date) ___________________ _.
Signature of Requesting Party Print Name
Joinder
I, __________________________, join in the petition. I understand that by joining in the
petition, a decree or judgment and order may be entered in accordance with the relief requested in
the petition unless, prior to the entry of the decree or judgment and order, a response is filed and
served.
I waive notice of entry of the decree.
I demand notice of all further proceedings in this matter. Further notice should be sent to
the following address (you may list an address that is not your residential address where
you agree to accept legal documents):
Any time this address changes while this action is pending, you must notify the opposing parties
in writing and file an updated Confidential Information Form (WPF DRPSCU 09.0200) with the
court clerk.
Date Signature Print Name
I, __________________________, join in the petition. I understand that by joining in the
petition, a decree or judgment and order may be entered in accordance with the relief requested in
the petition unless, prior to the entry of the decree or judgment and order, a response is filed and
served.
I waive notice of entry of the decree.
I demand notice of all further proceedings in this matter. Further notice should be sent to
the following address (you may list an address that is not your residential address where
you agree to accept legal documents):
Any time this address changes while this action is pending, you must notify the opposing parties
in writing and file an updated Confidential Information Form (WPF DRPSCU 09.0200) with the
court clerk.
Date Signature Print Name
I, __________________________, join in the petition. I understand that by joining in the
petition, a decree or judgment and order may be entered in accordance with the relief requested in
the petition unless, prior to the entry of the decree or judgment and order, a response is filed and
served.
I waive notice of entry of the decree.
Pet for Mod/Adj Parenting Pln (PTMD) - Page 10 of 11
WPF DRPSCU 07.0100 Mandatory (03/2013) - CR 4.1; RCW 26.09.181; .260; .270, RCW 26.26.130(7)(b)
I demand notice of all further proceedings in this matter. Further notice should be sent to
the following address (you may list an address that is not your residential address where
you agree to accept legal documents):
Any time this address changes while this action is pending, you must notify the opposing parties
in writing and file an updated Confidential Information Form (WPF DRPSCU 09.0200) with the
court clerk.
Date Signature Print Name
Pet for Mod/Adj Parenting Pln (PTMD) - Page 11 of 11
WPF DRPSCU 07.0100 Mandatory (03/2013) - CR 4.1; RCW 26.09.181; .260; .270, RCW 26.26.130(7)(b)
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