Declaration of Petitioner for Nonparental Custody Order by rak58497

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									 SUPERIOR COURT OF WASHINGTON
 COUNTY OF _______________________
              JUVENILE COURT

 Dependency of
                                                             No:

                                                             DECLARATION OF PETITIONER FOR
                                                             NONPARENTAL CUSTODY ORDER
 D.O.B.:                                                     (DCLR)


The undersigned STATES that:

        1.      I am not a party to this dependency proceeding.

        2.      Pursuant to an agreement with the parents, guardians, or legal custodian of the child, I
                am the petitioner for a custody order under chapter 26.10 RCW and I agree to entry of a
                custody order.

I declare under penalty of perjury under the laws of the state of Washington that the foregoing statement
is true and correct.

Dated at _____________________________________, Washington on _________________________.
                         (Place)                                     (Date)

                                                         ______________________________________
                                                         Signature

                                                         ______________________________________
                                                         Type or Print Name

                                                         ______________________________________
                                                         Address
                                                         ______________________________________

                                                         ______________________________________
                                                         Telephone




DECL OF PETITIONER (DCLR) - Page 1 of 1
WPF JU 03.0800 (*/****) - RCW 13.34.155

								
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