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Declaration Of A Party To the Action To Establish Parentage PS 01.0150 - Washington
| Declaration Of A Party To the Action To Establish Parentage Form. This is a Washington form and can be used in Parentage Domestic Relations Statewide . |
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Superior Court of Washington County of In re Parentage: Petitioner, and Respondent, and Respondent, and Child(ren) over the age of 2. No. Declaration of a Party to the Action to Establish Parentage (Parentage) (DCLR) I. Declaration (Name) ___________________________________ Declares: 1.1 I am the parent of the child (name) ___________________________ , born on (date) ___________________ because I: A. [ ] B. [ ] C. [ ] am the birth mother. legally adopted the child. signed an affidavit and filed the affidavit and physician's certificate with the Washington State Registrar of Vital Statistics within ten days after the birth of the child born through assisted reproduction. consented to assisted reproduction by my spouse or domestic partner. asserted in a valid surrogate parentage contract that I am the intended parent of the child. signed a Paternity Acknowledgment. am an alleged parent because within the period from (date) _________________ to (date) ____________________ I had sexual intercourse with (name) ___________________ and I believe I am the father of the child. D. [ ] E. [ ] F. [ ] G. [ ] Declaration of Party (DCLR) - Page 1 of 6 WPF PS 01.0150 (06/2012) Chapter 26.26 RCW American LegalNet, Inc. www.FormsWorkFlow.com H. [ ] am a presumed parent because (Select all that apply): [ ] (Name) _______________________ and I are or were married to each other or in a domestic partnership with each other and this child was born during the marriage or domestic partnership. [ ] (Name) ________________________ and I were married to each other or in a domestic partnership with each other and this child was born within three hundred days after the marriage or domestic partnership was terminated by death, annulment, dissolution, legal separation, or declaration of invalidity. [ ] Before the birth of this child, (name) ________________________ and I married each other or entered into a domestic partnership with each other in apparent compliance with the law, even if the attempted marriage or domestic partnership is, or could be declared invalid and this child was born during the invalid marriage or invalid domestic partnership or within three hundred days after its termination by death, annulment, dissolution, legal separation, or declaration of invalidity. [ ] After the birth of this child, (name) __________________________ and I married each other or entered into a domestic partnership with each other in apparent compliance with the law, whether or not the marriage or domestic partnership is or could have been declared invalid, and I voluntarily asserted parentage of the child: [ ] in a record filed with the state registrar of vital statistics; [ ] and I agreed to be named as a parent on this child's birth certificate; [ ] and I promised in a record to support this child as my own. [ ] The petition in this case was or will be filed or served no later than four years after the birth of this child, and for the first two years of this child's life, I resided in the same household with this child and openly held out this child as my own, by doing the following: . [ ] I attached more pages that are part of this declaration. 1.2 I believe the other party (name) _____________________ is: (select section A, B, or C. and check the box that applies in that section) A. [ ] a parent because: [ ] she is the birth mother. [ ] he or she legally adopted the child. [ ] she signed an affidavit and filed the affidavit and physician's certificate with the Registrar of Vital Statistics within ten days after the birth of the child born through assisted reproduction. [ ] he or she consented to assisted reproduction by me. Declaration of Party (DCLR) - Page 2 of 6 WPF PS 01.0150 (06/2012) Chapter 26.26 RCW American LegalNet, Inc. www.FormsWorkFlow.com [ ] he or she asserted in a valid surrogate parentage contract that he or she is the parent of the child. [ ] he or she signed a Paternity Acknowledgment. B. [ ] an alleged parent because (Select all that apply): [ ] Within the period from (date) ______________ to (date) ______________ this child was conceived. I had sexual intercourse only with (name) _____________________ within this time period and he must be the father. [ ] Within the period from (date) ______________ to (date) ______________, this child was conceived. I had sexual intercourse with: (name(s)) __________________________________________________________ __________________________________________________________________. Within this period, this child was conceived and one of these men must be the father. C. [ ] a presumed parent because (Select all that apply): [ ] (Name) ________________________ and I are or were married to each other or in a domestic partnership with each other and this child was born during the marriage or domestic partnership. [ ] (Name) ________________________ and I were married to each other or in a domestic partnership with each other and this child was born within three hundred days after the marriage or domestic partnership was terminated by death, annulment, dissolution, legal separation, or declaration of invalidity. [ ] Before the birth of this child, (name) ________________________ and I married each other or entered into a domestic partnership with each other in apparent compliance with the law, even if the attempted marriage or domestic partnership is, or could be declared invalid and this child was born during the invalid marriage or invalid domestic partnership or within three hundred days after its termination by death, annulment, dissolution, legal separation, or declaration of invalidity. [ ] After the birth of this child, (name) __________________________ and I married each other or entered into a domestic partnership with each other in apparent compliance with the law, whether or not the marriage or domestic partnership is or could have been declared invalid, and (name) ____________________________ voluntarily asserted parentage of the child: [ ] in a record filed with the state registrar of vital statistics; [ ] and agreed to be and is named as a parent on this child's birth certificate; [ ] and promised in a record to support this child as his or her own. [ ] The petition in this case was or will be filed or served no later than four years after the birth of this child, and for the first two years of this child's life, (name) _________________________ resided in the same household with this child and openly held out this child as his or her own by
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