Declaration of Service - Washington State Courts Washington Courts by vSTnB6

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									Superior Court of Washington
County of
 State of Washington, Plaintiff,

 vs.                                                            No.
 ___________________________________________.
 Defendant                                      DOB             Declaration of Service
 PCN:                                                           (Optional Use)
 SID:                                                           (DCLR)
      **********************************************

 ___________________________________________,
       Petitioner (Defendant)
 vs.

 Prosecuting Attorney of _________________County.
       Respondent

I Declare, I am over the age of 18 years, and I am not a party to this action.

On ______________________________ (date), I served the following documents:

[]      Petition for [ ] Relief from Duty to Register [ ] Exemption from Community Notification
[]      Note for Hearing

To:
        __________________________ County Prosecuting Attorney, by (describe how service was
        made including name, date, and place):
        ______________________________________________________________________________
        _____________________________________________________________________________.

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                                                  Print or Type Name



Declaration of Service (DCLR) - Page 1 of 1
RR 01.0250 (6/2010) - CR 4(g), RCW 4.28.080(1)

								
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