IDesILaytagsWX109474081991072002ASDDSHS09_474h4jW  "KZt{S &,28>DJPV\bhntz6`Submit ) 6 pu:to ). Petition.6 ):an ):Indian )}6$d )in ).25 ):U.)*S.64*40980670010765030IndianjB",X  p Ax @@@@@@, @@@@@*?I?pAzIpIINI(I@@ @@p#4@@pIIpII(ڻ @p@@@pAxIIIڻ@pLڻH@p A(IIڻHA@p޴AO\pAxIp@@I@@@`  @@`X  b IAz @@@.)!3  +yOName )yof ).father: )Q______N68-`(!`P1&@XXjdVXXd'  *?d Lp>V" <D dm0n7p>qErLsStZuavhewoxvy}z{|}~f %,3hi ryjk$:AHOV]dl*kCell1Cell2Cell3Cell5Cell6Cell7Cell8Cell9Cell10Cell11Cell13Cell14Cell15Cell16Cell17Cell18Cell19Cell20Cell21Cell22Cell23Cell24Cell25Cell26Cell27Cell28Cell29Cell30Cell31Cell32Cell33Cell34Cell52Cell53Cell54Cell55Cell56Cell57Cell58Cell60Cell80Cell81Cell82Cell39Cell40Cell42Cell83Cell84Cell85Cell86Cell87Cell88Cell89Cell90Cell64Cell65Cell66Cell91Cell92Cell93Cell94Cell95Cell96Cell97Cell98Cell99Cell100Cell101Cell100Cell101Cell63Cell64Cell65Cell66Cell67Cell68Cell69Cell70Cell72Cell73Cell74Cell75Cell76Cell77Cell78Cell79Cell80Cell81Cell82X   @@@  @@X   2H"an )h Tribe/Other )party )  ( g3 DEPENDENCY ) PETITION ( 3DSIS )?09-428 )W ())/0000) )dNEW )C REVISION )}TONI )BBENHAM )u 902-8342 )q )45805 5A m !( xoPAGE )d2 )0F ).2 / a *(The )Schild )`has )Ono );parent, ) guardian, )or )2 custodian )capable )of )- adequately )caring )}for ):the )Gchild, )msuch )dthat )Othe )Gchild )_is )*in (Acircumstances (Awhich )y constitue )a )%danger )of ). substantial )damage )to ).the )Fchild's )}psychological (Aor )2 physical (o development: (oor ( *.The )Schild )`is )*developmentally ( delayed, )as ):defined )in ).RCW )q71.)620.):016, )`and )Othe )Gchild's )}parent, ) guardian, )or )2 custodian (has )Kreached )a )%joint )Xdetermination (twith )X DeNZ3Submit f09474081991072002pIt1pAA(,ڷd@AASDA5/DSHSp(6AhO<pAI09_474A@ Al,, y g(,,(d'h6r6t~this Signature VersionAA Data VersA$ Blue Keys *Graphics 0HeaderD@A6 FieldListAp< Form Infof LayoutPropsx DesPathInfoʠ~V3Submit Distribution````d'@Lʜot$ od&C[R RELINQUISHMEx @4@ @ " 4,o6t^,o6t^,o,o,op,o,m,oh,oh,o  propalisZ propalis` propalisl propalisr porpsila porpsila<EDataDdefhijklmnpqrstuvwxyz{|}~Times New RomanArial,c` ??c` ?llell54Cell55Cell56Cell57Cell58Cell59Cell60Cell61Cell62Cell63Cell64Cell65Cell66Cell67Cell68Cell69Cell70Cell72Cell73Cell74Cell75Cell76Cell77Cell78Cell79x @,@ @ ",o6t^o6t^popYNoޥo  propalisZ propalis` propalisl propalisr porpsila porpsila<Ew RomanArial,c` ??c` ?Times New Roman(Np I. BASIS   % p0 'I represent to the court the following:     1.1     ! u(CHILD MUST BE AT LEAST TEN (10) DAYS OLD IF THE INDIAN CHILD WELFARE ACT APPLIES TO THE PROCEEDING. SEE 1.3 BELOW.)  "">& ">&  >&,Arial (OR(CHILD MUST BE AT LEAST TEN (10) DAYS OLD IF THE INDIAN CHILD WELFARE ACT APPLIES (#TO THE PROCEEDING. SEE 1.3 BELOW.)%&! {(PETITION CANNOT BE FILED ON AN UNBORN CHILD IF THE INDIAN CHILD WELFARE ACT APPLIES TO THE PROCEEDING. SEE 1.3 ON PAGE 2.)  ((O>y& (>O&y >& O>y&,Arial (aXM(PETITION CANNOT BE FILED ON AN UNBORN CHILD IF THE INDIAN CHILD WELFARE ACT (l.APPLIES TO THE PROCEEDING. SEE 1.3 ON PAGE 2.)* @+p ODistribution: Court file, Service file, Parents, Indian Tribe/Other party ,`/% |PETITION FOR RELINQUISHMENT AND TERMINATION OF PARENT-CHILD RELATIONSHIP (RCW 26.33) DSHS 09-474 (REV 08/1991) (AC 07/2002)   ((>[ (>[ O>y& >[,Arial (HIPETITION FOR RELINQUISHMENT AND TERMINATION OF PARENT-CHILD RELATIONSHIP (H (RCW 26.33) (H'DSHS 09-474 (REV 08/1991) (AC 07/2002) , -"  Page 1 of 3 )` IN THE INTEREST OF:   h .`2`00 p0  0 &SUPERIOR COURT OF WASHINGTON COUNTY OF  A  A  >[ A ,Arial (KSUPERIOR COURT OF WASHINGTON (K COUNTY OF0p@! TPETITION FOR RELINQUISHMENT AND TERMINATION OF PARENT-CHILD RELATIONSHIP (RCW 26.33)  -N% -%N A  -N%,Arial (+7 PETITION FOR RELINQUISHMENT AND (67TERMINATION OF PARENT-CHILD (A7RELATIONSHIP (RCW 26.33)p NO:     0 H 0 dTitle  P @ 0 eTitle   0 H 0 fTitle  P`!@ 0 hTitle  @  i Name:  *  Information about the child:   x   Sex:    0 Address:   '  H 0  jTitle  `!H 0  kTitle  P !H  0  lTitle   @!@ @   m P!@ =The child, who is currently unborn, was conceived on or about  * 0!`!H  0  nTitle   p!!0" ,    " 0" at    !#!H  0  pTitle  "0!"" .    #0$p &The child's expected date of birth is:    #` $H  0  qTitle  p0 D.O.B.    ^b!`!` Date of Birth:  q q  q,Arial ({Date of ({Birth:0  H 0  Title   ({Date of ({Birth:0  H 0  Title  ________________________________________________________________________(@qA Declaration of Adoption Facilitator has has not been filed as required by RCW 26.33.040(1).(@yIn this proceeding the Soldiers and Sailors Relief Act of 1940, 50 U.S.C. 501 et seq., does does not apply.-0P- 1.4  4G * ** *p**0- -- -p. .. .0 ` ` @ !` !P & '` & '` /P /@ ODistribution: Court file, Service file, Parents, Indian Tribe/Other party 4G00 PETITION FOR RELINQUISHMENT AND TERMINATION OF PARENT-CHILD RELATIONSHIP (RCW 26.33) DSHS 09-474 (REV 00/0000) NEW REVISION TONI BENHAM 902-8342 45805""S S  S,Arial (TPETITION FOR RELINQUISHMENT AND TERMINATION OF PARENT-CHILD RELATIONSHIP (RCW 26.33)( DDSHS 09-474 (REV 00/0000) NEW REVISION TONI BENHAM 902-8342 45805/!0`$  Page 1 of 2 4G).0@.p 1.5  4G   q*IN THE MATTER OF:     V V S V,Arial (IN THE MATTER OF:$p$p~$$P ) ) ) ) ) ) ) ) )  t8 t8 V t8,Arial (%)(%)(%)(%)(%)(%)(%)(%)(%) > B` @ @`  `  ` > B` @ @` ` ` CHILD'S FULL NAME4GD  @  BIRTHDATE4G* `  TRIBE(S)/BAND(S)4G>/"T,c+p @, KDistribution: Court file, Service file, Parents, Indian Tribe/Other party ,- !  Page 3 of 3 )p@ 1.6     1.7     0 0p Name: Address:  T T ? T,Arial (^Name: (^Address:P P@,  `P (Department of Social and Health Services   G @ The     PP@-  `Pp     `GL p!H. Title  p! agency agrees to assume custody of the child and to have power and authority to authorize and provide all necessary care for the child which includes but is not limited to foster care, medical and dental care, and evaluation of the child.  MT& TM& T MT&,Arial (_^^agency agrees to assume custody of the child and to have power and authority to authorize and (k^gprovide all necessary care for the child which includes but is not limited to foster care, medical and (w^)dental care, and evaluation of the child.0 ;Agency/person arranging pre-adoptive or adoptive placement:      `!H/ Title    `!H0 Title     II. RELIEF REQUESTED   o   Petitioner requested:   \ @ 2.1    p P@1  P mother    pP@2P  `P father   p p`P# @30  @P# alleged    ## P AThe parent-child relationship between the child and the child's      !father be permanently terminated.    P 2.2    `  7The child be committed to the permanent custody of the     @` "`@40  P@ "P (Department of Social and Health Services   "@&e `P@5  `@     0:k 0H6 Title  p`! %agency and the permanent custodian be     ! authorized to place the child with prospective adoptive parents, consent to the child's adoption, and exercise additional authority as provided by Chapter 26.33 RCW.  NNDT|# NTD#|  DT|#,Arial (V^fauthorized to place the child with prospective adoptive parents, consent to the child's adoption, and (n^?exercise additional authority as provided by Chapter 26.33 RCW.p0 DATE   PETITIONER* TITLE/AGENCY/RELATIONSHIPg p H7 Title  0"H8 Title  p"H9 Title   @ III. CERTIFICATION   [ "P#@0  SIGNATURE)$P%P TYPE OR PRINT NAMEK&P@& ADDRESS"(0( p   ZIP CODE#*@*0 TELEPHONE NUMBERJ @ DAY @ ` MONTH @ 0 YEAR @ 0 CITY`! tI certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct.  >% >%  >%,Arial (HlI certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and (Hcorrect.` @ @H: Title  P   Dated this   - P P  P day of     @H; Title  P p ,     @H< Title  P  at    ` @H= Title  P "  , Washington.   = !p "!H> Title  #0 $!H? Title  $ &P!H@ Title  & (0HA Title  ( *HD Title  &(0HB Title  &(0!HC Title  (0@( CITY(0( STATE,P-@ |PETITION FOR RELINQUISHMENT AND TERMINATION OF PARENT-CHILD RELATIONSHIP (RCW 26.33) DSHS 09-474 (REV 08/1991) (AC 07/2002) >~ >~  >~,Arial (HUPETITION FOR RELINQUISHMENT AND TERMINATION OF PARENT-CHILD RELATIONSHIP (RCW 26.33) (H'DSHS 09-474 (REV 08/1991) (AC 07/2002) TION OF PARENT-CHILD RELATIONSHIP (RCW 26.33) (H'DSHS 09-474 (REV 08/1991) (AC 07/2002) 0KZ-0 ,Name of legal guardian/custodian: Address:   ei ie q ei,Arial ({s"Name of legal guardian/custodian: (s Address: 0 a. b. c. d. e.  PPUYz PYUz ei UYz,Arial (kca. (cb. ( cc. (+cd. ({ce. 1.3    " The Indian Child Welfare Act, 25 U.S.C. 1901., A Declaration of Adoption Facilitator The Soldiers and Sailors Relief Act of 1940, 50 U.S.C. 501 et seq.,  TTT, TT, UYz T,,Arial (^/The Indian Child Welfare Act, 25 U.S.C. 1901., (^&A Declaration of Adoption Facilitator (^CThe Soldiers and Sailors Relief Act of 1940, 50 U.S.C. 501 et seq., 1.4     P! 1.5    p0 1.2    @` >Known information about the parent(s), guardian, or custodian:    00 0 'Name of mother: Address: The mother  Yi iY T, Yi,Arial (ksName of mother: (ws (s Address: (s (s The mother @   r  is    P@  s  @ is not a minor.   0?   !H 0  tTitle  0 !H 0  uTitle   00 'Name of father: Address: The father  i i Yi i,Arial (sName of father: (s (s Address: (s (s The father  @   v  is    P@  w@ is not a minor.   0?  !H 0  xTitle   0 !H 0  yTitle  00 Name of presumed father:    w  !H 0  zTitle  00 <Name of alleged father(s): Address(es): The alleged father  ii ii  ii,Arial (+sName of alleged father(s): (Cs Address(es): ([sThe alleged father `@ `  { p is  R @  | is not a minor.   R?  !H 0  }Title  0 !H 0  ~Title   !H 0  Title    !H 0  Title  @   may   < @   does   pa "0@  " #does not apply to this proceeding.   , ,  ,,Arial (#does not apply to this proceeding. @    has    0"@!0  @! 3has not been filed as required by RCW 26.33.040(1).   !5 + @+ ODistribution: Court file, Service file, Parents, Indian Tribe/Other party , -0"  Page 2 of 3 )@@"@  P does    !@#  ! does not apply to this    !`  p  proceeding.   4  `! !P TThe parent-child relationship should be terminated between the child and the child's   o !P"0 P@$  !`"0 @ mother   0k !P "0 0@%   !` "0 father   !P "0 @&   !` "0 $alleged father should be terminated.   "p#p @'  "#p The   )n "p #H( 0 Title  "0#P! 8has signed a consent to termination and adoption, which   ?' '? , ?',Arial (1#8has signed a consent to termination and adoption, which #&  Qaccompanies this petition. The parent has consented for the follwoing reason(s):  4blg b4gl  4blg,Arial (Flaccompanies this petition. (^l5The parent has consented for the follwoing reason(s):&0)!H) 0 Title  )*@ The other parent   J )P *Pp@*   )` *P`  agrees with  P3 )P`*P@+`  )`p*P opposes this petition.   ] ,`- P |PETITION FOR RELINQUISHMENT AND TERMINATION OF PARENT-CHILD RELATIONSHIP (RCW 26.33) DSHS 09-474 (REV 08/1991) (AC 07/2002) ? ? 4blg ?,Arial (IUPETITION FOR RELINQUISHMENT AND TERMINATION OF PARENT-CHILD RELATIONSHIP (RCW 26.33) (I'DSHS 09-474 (REV 08/1991) (AC 07/2002) HIP (RCW 26.33) (I'DSHS 09-474 (REV 08/1991) (AC 07/2002)  P@  w@ is not a minor.  ?  !H 0  xTitle   0 !H 0  yTitle h{S00 Name of presumed father:   v"w  !H 0  zTitle  00 <Name of alleged father(s): Address(es): The alleged father  ii ii  ii,Arial (+sName of alleged father(s): (Cs Address(es): ([sThe alleged father `@ `  { p is   @  | is not a minor.  ? p !H 0  }Title  0 !H 0  ~Title   !H 0  Title    !H 0  Title  @   may   @   does   "0@  " #does not apply to this proceeding.   , ,  ,,Arial (#does not apply to this proceeding. @    has   0"@!0  @! 3has not been filed as required by RCW 26.33.040(1).   + @+ ODistribution: Court file, Service file, Parents, Indian Tribe/Other party ?,`- @ PETITION FOR RELINQUISHMENT AND TERMINATION OF PARENT-CHILD RELATIONSHIP (RCW 26.33) DSHS 09-474 (REV 00/0000) NEW REVISION TONI BENHAM 902-8342 4580566>~ 6>~ , >~,Arial (HUPETITION FOR RELINQUISHMENT AND TERMINATION OF PARENT-CHILD RELATIONSHIP (RCW 26.33) (HDDSHS 09-474 (REV 00/0000) NEW REVISION TONI BENHAM 902-8342 45805, -0"  Page 2 of 3 ?)@@+@  P does  " !@,  ! does not apply to this   "`  p  proceeding.  ?4  `! !P TThe parent-child relationship should be terminated between the child and the child's  ?o !P"0 P@-  !`"0 @ mother  ~o !P "0 0@.   !` "0 father  ~o !P "0 @/   !` "0 $alleged father should be terminated.   "p#p @0  "#p The 0| //   , () -(###) ###-####(000) 000-0000@@X   " @@@@@@ @@@@@Xn$Z*N{XxT*{XxT*{Xn$Z*N{Xn$Z NhINn$Z$({X n$ZiI \In$Zn$Z>)ZRxIiIZxIn$ZwI "(Z{IdD ">)ZɫD֫D\ " "bD8XORBN@@@  @@X  D8X @@@  @@X  D8X @@@   @@X  D8X @@RbD8XOR@@X D8X LBHNT Title  $p %!HK Title  "#HL Title  "#!HM Title  #@$` CITY#$` STATE`p@N`  p` @*Addendum to Petition (DSHS 09-771) is attached for Indian Child.  #  * @+ KDistribution: Court file, Service file, Parents, Indian Tribe/Other party ,0,@ PETITION FOR RELINQUISHMENT AND TERMINATION OF PARENT-CHILD RELATIONSHIP (RCW 2