SUPERIOR COURT OF WASHINGTON
COUNTY OF _______________________
JUVENILE COURT
No:
Dependency of:
Motion and Declaration for Order
Dismissing Dependency
D.O.B. (MTAF)
I. Basis
________________________________ [name] or DSHS/Supervising Agency’s asks the court for an
order dismissing the dependency. This motion is based upon the following declaration.
Dated: ________________________________ ______________________________________
Signature
_______________________________________
Print Name WSBA No.
I. Declaration
The undersigned declares:
[ ] Dependency has not been established, and the petition should be dismissed.
[ ] Dependency was established, and should be dismissed because:
[ ] The youth is 18 ½ years of age and has not requested extended foster care.
[ ] The youth is in extended foster care and is no longer eligible for services
[ ] The youth is in extended foster care and he or she requests dismissal.
[ ] The permanent plan of return home to the [ ] mother [ ] father has been achieved and
court supervision is no longer needed.
[ ] a parenting plan/residential schedule signed by the court has been entered in
cause number ____________________________.
[ ] The permanency plan of third party custody was achieved and court supervision is no
longer needed.
[ ] The child was adopted.
[ ] A Title 13 RCW guardianship was established as to the child.
[ ] Other:
I declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and
correct.
Signed at ________________________ (city), Washington, on ________________________(date).
________________________________________ ____________________________________
Signature Print Name
MTAF for Or dismissing Dependency (MTAF) - Page 1 of 1
WPF JU 03.0600 (07/2011) – Laws of 2010, ch. 272 §11(3) Laws of 2011, ch. 330, §7
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