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Superior Court of Washington County of In re Parentage: Petitioner, and Respondent and Respondent. No. Petition for Establishment of Parentage ( PTDTP ) Use this petition when there is no adjudicated father or Acknowledgment of Paternity filed with the Washington State Registrar of Vital Statistics; otherwise use form WPF PS 16.0100. I. Basis 1.1 Cause of Action This is a petition for the establishment of parentage. This action is brought on behalf of: _________________________________ [Name of child], born on _______________ [Date], a resident of _________________________________ [Name of County] County, Washington. _________________________________ [Name of child], born on _______________ [Date], a resident of _________________________________ [Name of County] County, Washington. 1.2 Parties to the Action Petitioner, ___________________________ [Name] the [ ] mother [ ] alleged father [ ] presumed father brings this action pursuant to Chapter 26.26 RCW against the respondents: _______________________________ [Name] mother; _______________________________ [Name] alleged father of the child; _______________________________ [Name] presumed father of the child. 1.3 Presumed Father Pet for Establishment of Parentage (PTDTP) - Page 1 of 7 WPF PS 01.0100 (6/200 6 ) - RCW 26.26.505, .525, .530 [ ] Does not apply. [ ] Under RCW 26.26.116 the presumed father of the child is ____________ [Name]. [ ] The presumed father is not named as a party because he is not subject to the jurisdiction of the court. [ ] The child has a presumed father and not more than two years have passed since the birth of the child. [ ] The child has a presumed father. The presumed father and mother of the child did not cohabit or engage in sexual intercourse with each other during the probable time of conception; and the presumed father never openly treated the child as his own. [ ] Other: 1.4 Jurisdiction [ ] The mother and _________________________ [Name(s)] engaged in sexual intercourse in the state of Washington as a result of which the child may have been conceived. Jurisdiction over the mother [check all that apply]: [ ] The mother was personally served with summons and petition within this state. [ ] The mother submits to jurisdiction of this state by consent as evidenced by joinder or consent to jurisdiction signed by respondent. [ ] The mother resided with the child in this state. [ ] The mother resided in this state and provided prenatal expenses or support for the child. [ ] The child resides in this state as a result of the acts or directives of the mother. [ ] Other: Jurisdiction over the alleged or presumed father [check all that apply]: [ ] _______________________ [Name] was personally served with summons and petition within this state. [ ] _______________________ [Name] submits to jurisdiction of this state by consent as evidenced by joinder or consent to jurisdiction signed by the alleged or presumed father. [ ] _______________________ [Name] resided with the child in this state. [ ] _______________________ [Name] resided in this state and provided prenatal expenses or support for the child. [ ] The child resides in this state as a result of the acts or directives of _____________________ [Name of alleged father or presumed father]. [ ] Other: [ ] The following parties are presently residing in the state of Washington: [ ] mother [ ] alleged father [ ] presumed father [ ] other Pet for Establishment of Parentage (PTDTP) - Page 2 of 7 WPF PS 01.0100 (6/200 6 ) - RCW 26.26.505, .525, .530 [ ] Other: 1.5 Jurisdiction Over the Child This court has jurisdiction over the child for the reasons set forth below. [ ] 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 child because [ ] the child 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 child is less than six months old and has 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 child within six months before the commencement of this proceeding and the child is absent from the state but a parent or person acting as a parent continued to live in this state. [ ] The child and the parent or the child and at least one parent or 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 child's care, protection, training and personal relationships and [ ] the child has no home state elsewhere. [ ] the child'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 child'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 child under RCW 26.27.261 or .271. [ ] No other state has jurisdiction. [ ] This court has temporary emergency jurisdiction over this proceeding because the child is present in this state and the child has been abandoned or it is necessary in an emergency to protect the child because the child, or a sibling or parent of the child 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 child shall last until _______________________________ [Date]. Pet for Establishment of Parentage (PTDTP) - Page 3 of 7 WPF PS 01.0100 (6/200 6 ) - RCW 26.26.505, .525, .530 [ ] 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. 1.6 Child Support and Residential Placement The child is entitled to financial support pursuant to the Washington State Support Schedule and health insurance coverage from any parent owing a duty of child support, and it is otherwise in the child’s best interests to obtain a judicial determination of the parentage and residential placement of the child. [ ] Other : 1.7 Current Residence of the Child The child currently resides with _____________________________________ [Name]. 1.8 Reimbursement [ ] Does not apply. [ ] The state of Washington and/or ______________________________ is entitled to reimbursement for support or assistance provided to the child, for expenses incurred on behalf of the child. [ ] Other: 1.9 Continuing Restraining Order [ ] Does not apply. [ ] A continuing restraining order should be entered which restrains or enjoins _______________________________ [Name] from disturbing the peace of _____________________________ [Name]. [ ] A continuing restraining order should be entered which restrains or enjoins _____________________________ [Name] from going onto the grounds of or entering the home, work place or school of __________________________________ [Name] or the day care or school of the child. [ ] A continuing restraining order should be entered which restrains or enjoins _____________________________ [Name] from knowingly coming within or knowingly remaining within ___________ (distance) of the home, work place or school of ____________________________ [Name] or the day care or school of the child. Other: ___________________________________________________________. [ ] A continuing restraining order should be entered which restrains or enjoins _________________________________ [Name] from molesting, assaulting, harassing, or stalking _______________________________________ [Name]. (If the court orders this relief, the restrained person will be prohibited from possessing a firearm or ammunition under federal law for the duration of the order. An exception exists for law Pet for Establishment of Parentage (PTDTP) - Page 4 of 7 WPF PS 01.0100 (6/200 6 ) - RCW 26.26.505, .525, .530 enforcement officers and military personnel when carrying department/government- issued firearms. 18 U.S.C. § 925(a)(1). ) 1.10 Protection Order [ ] Does not apply. [ ] A domestic violence protection order should be entered protecting __________________________ [Name] from __________________________ [Name] because ____________________________ [Name] has committed domestic violence as defined by 26.50 RCW against ____________________________ [Name]. (If the court orders this relief, the restrained person will be prohibited from possessing a firearm or ammunition under federal law for the duration of the order. An exception exists for law enforcement officers and military personnel when carrying department/government- issued firearms. 18 U.S.C. § 925(a)(1). ) If you need immediate protection, contact the clerk/court for RCW 26.50 Domestic Violence forms. 1.11 Other II. Relief Requested The court is requested to enter an order and judgment that: [ ] __________________________________ [Name] be declared to be the father of __________________________________ [Name of child]. [ ] The birth certificate of the child be amended to identify the father. [ ] Support be determined for the dependent child pursuant to the Washington State Child Support Schedule and either or both parents be ordered to maintain or provide health insurance coverage for the child and pay extraordinary uninsured costs proportionate to their income. [ ] The father pay past support, medical, and other expenses incurred on behalf of the child. [ ] A residential plan or parenting plan for the child be adopted by the court as proposed by the parents or as the court finds to be in the child’s best interest. [ ] In the event no residential plan or parenting plan is proposed, the custodian and primary residential parent be the parent with whom the child currently resides and the other parent’s residential time be denied. [ ] Provides for a domestic violence protection order. [ ] Provides for a continuing restraining order. Pet for Establishment of Parentage (PTDTP) - Page 5 of 7 WPF PS 01.0100 (6/200 6 ) - RCW 26.26.505, .525, .530 [ ] Court costs, genetic test costs, guardian ad litem, attorney, and other reasonable fees be awarded by the court. [ ] Other: Dated: Signature of Petitioner or Lawyer/WSBA No. Print or Type 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]. Signature of Petitioner Print or Type 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. Dated: Signature of Joining Party Pet for Establishment of Parentage (PTDTP) - Page 6 of 7 WPF PS 01.0100 (6/200 6 ) - RCW 26.26.505, .525, .530 Print or Type 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. Dated: Signature of Joining Party Print or Type Name Pet for Establishment of Parentage (PTDTP) - Page 7 of 7 WPF PS 01.0100 (6/200 6 ) - RCW 26.26.505, .525, .530

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