Fill and Sign the What is This is for Statistical Reporting Purposes Only Form pdfFiller

Res. Time Summary Rpt (RTSR) - Page 1 of 2WPF DR 01.0410 - Mandatory (4/2008) – RCW 26.09.231, 26.18.230Superior Court of WashingtonCounty ofIn re the Marriage of: Petitioner, and Respondent. No. Residential Time Summary Report(RTSR)Clerks Action Required Submit with final Parenting Plan, only. This form is for statistical reporting purposes only. 1. The Parenting PlanThe court signed the Parenting Plan on (Date) ___________________________________.It was:[ ] by agreement of the parties[ ] after a contested hearing or trial[ ] by defaultIt is:[ ] an original order[ ] a modification of a prior orderHow many children under the parenting plan have the residential schedule summarized in paragraph 2, below? _______________2. Residential Schedule from Part III of the Parenting PlanIf the same schedule does not apply to all children, fill out a separate Residential Time Summary Report for each schedule.Check the box that comes closest to representing the time spent with each parent:% of time the children spend with the Mother% of time the children spend with the Father [ ] 0%100% [ ] 10%90% [ ] 20%80% [ ] 30%70% [ ] 40%60% [ ] 50%50% [ ] 60%40% [ ] 70%30% [ ] 80%20% [ ] 90%10% [ ] 100%0% Res. Time Summary Rpt (RTSR) - Page 2 of 2WPF DR 01.0410 - Mandatory (4/2008) – RCW 26.09.231, 26.18.2303. Information about the ParentsFather: [ ] self-represented [ ] represented by an attorneyThe court found under paragraphs 2.1 and 2.2: [ ] does not apply, or the Father [ ] committed domestic violence [ ] abused or neglected a child [ ] has chemical dependency issues [ ] has mental health issues [ ] other:______________________________________________________________Mother: [ ] self-represented [ ] represented by an attorneyThe court found under paragraphs 2.1 and 2.2: [ ] does not apply, or the Mother [ ] committed domestic violence [ ] abused or neglected a child [ ] has chemical dependency issues [ ] has mental health issues [ ] other:______________________________________________________________4. Dispute Resolution from Part V. of the Parenting Plan[ ] Arbitration [ ] Mediation [ ] Counseling [ ] No dispute resolution process except court actionPrepared by: ______________________________________, on (Date) _________________________.