Wpf ps 110100 petition for rescission of acknowledgment of paternity within 60 days washington form
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Superior Court of Washington, County of
In re parentage:
Petitioner (person who started this case) :
And Respondent/s: ( other person/s who signed
the Acknowledgment or Denial)
No.
Petition to Withdraw (Rescind)
Paternity Acknowledgment
Denial of Paternity
(PTWD)
Petition to Withdraw (Rescind) Paternity
Acknowledgment / Denial of Paternity
This form asks the Court to withdraw the Paternity Acknowledgment or Denial of Paternity. It does not ask the court
to decide who the child’s legal parents are. To do that, you must file a Petition to Decide Parentage.
1. I ask the court to withdraw (rescind) the (check one):
Paternity Acknowledgment Denial of Paternity
that I signed about (child’s name): ,
who was born on (date): .
I am filing a copy of the Paternity Acknowledgment and/or Denial of Paternity with this
Petition under a sealed cover sheet (form FL Parentage 329).
Important! If a Paternity Acknowledgment is withdrawn, any related Denial of Paternity is cancelled.
If a Denial of Paternity is withdrawn, the related Paternity Acknowledgment is cancelled.
2. Parties to this case
Mother Acknowledged Father
(man who signed the
Paternity Acknowledgment ) Presumed Parent
(person who signed the
Denial of Paternity , if any)
I am the (check one):
The Respondent
( name ): is the:
Other Respondent (if any)
( name ): is the:
RCW 26.26.330, 340
Mandatory Form (07/2017)
FL Parentage 341 Petition to Withdraw (Rescind)
Paternity Acknowledgment / Denial
p. 1 of 5
3. Correct County (Venue)
This is the correct county for this case to be heard because this is where:
the child lives,
a Respondent lives, if the child lives outside Washington, or
a deceased Respondent’s estate is probated.
This child lives in (county): , (state):
.
The Respondent (name): lives in
(county): , (state): .
The other Respondent (if any) (name): lives in
(county): , (state): .
4. Personal Jurisdiction
Each party agreed to personal jurisdiction in Washington by signing a Paternity
Acknowledgment or Denial of Paternity that was filed with the State Registrar of Vital
Statistics on (date): .
5. Effective Date
The Paternity Acknowledgment (and Denial , if any) became effective on
(date): . This is either the date the child was born,
or the date the Paternity Acknowledgment (and Denial , if any) was filed with the Washington
State Registrar of Vital Statistics, whichever happened later .
6. Withdrawal Deadline
I am starting this case before the deadline for withdrawing (rescinding) the Paternity
Acknowledgment or Denial (check all that apply):
I am filing or serving this Petition within 60 days of the Effective Date listed above, and
t here has not yet been a court hearing involving this child in any case I am a party to .
I was under 18 when I signed the Paternity Acknowledgment or Denial , and I am filing
or serving this Petition on or before my 19 th
birthday.
7. Parentage Petition
I will file a Petition to Decide Parentage (form FL Parentage 301).
I will not file a Petition to Decide Parentage .
A court in (name of county): , (state):
is deciding the child’s parentage now. The case number is: .
8. Child Support
No request.
The Washington Division of Child Support ordered (name):
to pay (amount): $ per month in child support for this child.
I (check one): will will not file a motion to suspend that child support order.
RCW 26.26.330, 340
Mandatory Form (07/2017)
FL Parentage 341 Petition to Withdraw (Rescind)
Paternity Acknowledgment / Denial
p. 2 of 5
9. Protection Order
Do you want the court to issue an Order for Protection as part of the final orders in this
case?
No. I do not want an Order for Protection
Yes. (You must file a Petition for Order for Protection, form DV-1.015 for domestic
violence, or form UHST-02.0200 for harassment. You may file your Petition for Order
for Protection using the same case number assigned to this case.)
Important! If you need protection now , ask the court clerk about getting a Temporary Order for Protection.
There already is an Order for Protection between (name):
and me. (Describe):
Court that issued the order:
Case number:
Expiration date:
10. Restraining Order
Do you want the court to issue a Restraining Order as part of the final orders in this case?
No. (Skip to 11 .)
Yes. Check the type of orders you want:
Do not disturb – Order (name/s): not to
disturb my peace or the peace of the child.
Stay away – Order (name/s): not to
go onto the grounds of or enter my home, workplace, or school, and the daycare or
school of the child.
Also, not knowingly to go or stay within feet of my home, workplace,
or school, or the daycare or school of the child.
Do not hurt or threaten – Order ( name/s ) :
Not to assault, harass, stalk or molest me or any child listed in 1 ; and
Not to use, try to use, or threaten to use physical
force against me or the child that would reasonably
be expected to cause bodily injury.
Warning! If the court makes this order, the court must consider if weapons restrictions are required by
state law; federal law may also prohibit the Restrained Person from possessing firearms or ammunition.
Prohibit weapons and order surrender – Order ( name/s ) :
Not to possess or obtain any firearms, other dangerous weapons, or concealed
pistol license until the Order ends, and
To surrender any firearms, other dangerous weapons, and any concealed
pistol license that he/she possesses t o (check one): t he police chief or
sheriff. h is/her lawyer. other person (name): .
Other restraining orders:
RCW 26.26.330, 340
Mandatory Form (07/2017)
FL Parentage 341 Petition to Withdraw (Rescind)
Paternity Acknowledgment / Denial
p. 3 of 5
Important! If you want a restraining order now , you must file a Motion for Temporary Family Law Order and
Restraining Order (form FL Parentage 323) or a Motion for Immediate Restraining Order (Ex Parte) (form FL
Parentage 321).
11. Summary of Requests
I ask the court to (check all that apply):
Acknowledgment / Denial of Paternity
Withdraw the Paternity Acknowledgment (and cancel any related Denial of
Paternity ).
Withdraw the Denial of Paternity (and cancel the related Paternity
Acknowledgment ).
Child’s Name and Birth Certificate
Change the child’s birth certificate so:
(Acknowledged father’s name):
is no longer listed as the child’s parent.
(Presumed parent’s name):
is listed as the child’s parent.
The child’s last name is changed to: .
Protection or Restraining Order
Approve the requested Order for Protection .
Approve the requested Restraining Order.
Fees
Order who should pay the court costs and lawyer fees.
Orders who should pay any guardian ad litem (GAL) fees.
Petitioner 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:
Petitioner signs here Print name
Petitioner’s lawyer (if any) fills out below:
Petitioner’s lawyer signs here Print name and WSBA No. Date
RCW 26.26.330, 340
Mandatory Form (07/2017)
FL Parentage 341 Petition to Withdraw (Rescind)
Paternity Acknowledgment / Denial
p. 4 of 5
Respondent fills out below if s/he agrees to join this Petition:
I, (name): , agree to join this Petition . I understand
that if I fill out and sign below, the court may approve the requests listed in this Petition
unless I file and serve a Response before the court signs final orders. (Check one):
I do not need to be notified about the court’s hearings or decisions in this case.
I ask the Petitioner to notify me about any hearings in this case. (List an address where you
agree to accept legal documents. This may be a lawyer’s address or any other address.)
address city state zip
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 Address Change form (FL All Family 120). You must also update your
Confidential Information Form (FL All Family 001 ) .
Respondent signs here Print name Date
Other Respondent fills out below if s/he agrees to join this Petition:
I, (name): , agree to join this Petition . I understand
that if I fill out and sign below, the court may approve the requests listed in this Petition
unless I file and serve a Response before the court signs final orders. (Check one):
I do not need to be notified about the court’s hearings or decisions in this case.
I ask the Petitioner to notify me about any hearings in this case. (List an address where you
agree to accept legal documents. This may be a lawyer’s address or any other address.)
address city state zip
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 Address Change form (FL All Family 120). You must also update your
Confidential Information Form (FL All Family 001 ) .
Other Respondent signs here Print name Date
RCW 26.26.330, 340
Mandatory Form (07/2017)
FL Parentage 341 Petition to Withdraw (Rescind)
Paternity Acknowledgment / Denial
p. 5 of 5
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