SUPERIOR COURT OF WASHINGTON
COUNTY OF _______________________
Declaration of Petitioner for
Nonparental Custody Decree
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
filed a Petition for Nonparent Custody under chapter 26.10 RCW and I agree to entry of a
custody decree granting custody of the child to me.
I declare under penalty of perjury under the laws of the state of Washington that the foregoing statement
is true and correct.
Dated at __________________________________ [city], Washington on ____________________ [date].
Type or Print Name
Decl of Petitioner (DCLR) - Page 1 of 1
WPF JU 03.0800 (11/2009) - RCW 13.34.155