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Dependency Petition JU 03.0100 - Washington
| Dependency Petition Form. This is a Washington form and can be used in Dependency Juvenile Court Statewide . |
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SUPERIOR COURT OF WASHINGTON COUNTY OF _______________________ JUVENILE COURT Dependency of: No: D.O.B.: Dependency Petition (DPP) I. Basis I represent to the court the following: 1.1 Child alleged to be dependent: [ ] male [ ] female Name Date of Birth Home Address 1.2 Parent(s) or Legal Guardian(s): [ ] Mother Name Date of Birth Marital status Driver's License or Identicard (# and State) Home Address [ ] Father [ ] presumed [ ] alleged Name Date of Birth Marital status Driver's License or Identicard (# and State) Home Address FOR OFFICIAL USE ONLY Juv. Ref. No:______________________ Dependency Petition (DPP) Page 1 of 3 WPF JU 03.0100 (07/2011) JuCR 3.3; RCW 13.34.030, .040 American LegalNet, Inc. www.FormsWorkFlow.com [ ] Father [ ] presumed [ ] alleged 2 1 [ ] single [ ] married [ ] other [ ] single [ ] married [ ] other [ ] Custodian/Legal Guardian 4 3 [ ] single [ ] married [ ] other 1.3 Child's Indian Status: [] The petitioner has made the following efforts and cannot determine whether the child is an Indian child as defined in Laws of 2011, ch. 309, §4: . [] Based upon the following, the child is not an Indian child as defined in Laws of 2011, ch. 309, §4, and the federal and Washington State Indian Child Welfare Acts do not apply to these proceedings: . [] Based upon the following, the child is an Indian child as defined in Laws of 2011, ch. 309, §4 and the federal and Washington State Indian Child Welfare Acts do apply to these proceedings: . [] The petitioner has made the following preliminary efforts to provide notice of these proceedings to all tribes to which the petitioner knows or has reason to know the child may be a member or eligible for membership: . 1.4 Dependency: The child should be declared dependent according to RCW13.34.030 as follows: [] [] [] (a) the child has been abandoned as defined in RCW 13.34.030; (b) the child is abused or neglected as defined in chapter 26.44 RCW; or (c) the child has no parent, guardian or custodian capable of adequately caring for the child, such that the child is in circumstances which constitute a danger of substantial damage to the child's psychological or physical development. 1.5 Allegations: The allegation of Dependency is based on the following facts: _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ Dependency Petition (DPP) Page 2 of 3 WPF JU 03.0100 (07/2011) JuCR 3.3; RCW 13.34.030, .040 American LegalNet, Inc. www.FormsWorkFlow.com _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ . II. Relief Requested I request that the court inquire into this matter and enter such order as the court finds just and in the best interest of the child. Dated: _____________________________ ______________________________________ Petitioner ______________________________________ Type or Print Name/Title WSBA No. III. Certification I declare under penalty of perjury under the laws of the State of Washington that the foregoing representations are true and correct. Signed at _____________________________(City), Washington on _______________________(Date). _________________________________________ Signature ______________________________________ Print Name Dependency Petition (DPP) Page 3 of 3 WPF JU 03.0100 (07/2011) JuCR 3.3; RCW 13.34.030, .040 American LegalNet, Inc. www.FormsWorkFlow.com
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