IDesILaytags&'1 09766081991ASDDSHS09_766Xr4j& L lJd <[ &,28>DJPV\bhntz6ZSubmit 6 *,4>6l)6$64*02509107359060832jB"@X  G[ @@@@@@ @@@@@T*BOfBOfBOfBOf*lXBT*YfBXTOfhIYfXTBTiI \I XTTI RxIiIXZxITwIG[T{IdDG[I ɫD֫D4G[G[  KbDiORY@@@  0X  Di @@@N681&@(J"p r , "  ,,G,G,G,G,G,G+,,;,;,G  porpsilaT porpsilaZ<E porpsilaf porpsilal$Data'defgox}ArialTimes New Roman t    qrIbDvϨOR^t@@@  @@X  Dv @@@  @@X  Dv @@@   @@X  Dv @@IRbDvϨOR@@X  DvH"NLT3Submit J` 09766081991BOfBO1*t`BT*hWASDB`TOfhIDSHS`T09_766TiIfXXjdVXXd'@L;?d6dl6xthis< SignatureVersion Data VersV`H$ Blue Keys*Graphics0HeaderW0P6 FieldList< Form Info` LayoutProps r DesPathInfo(xrz , "  ,,G,G,G,G,G,G+,,;,;,G  porpsilaT porpsilaZ<E porpsilaf porpsilal$Times New RomanvX<S'8doxe}&f g-4;BIPW^elsz Cell1Cell2Cell3Cell4Cell12Cell19Cell24Cell49Cell63Cell66Cell67Cell68Cell69Cell71Cell72Cell73Cell74Cell75Cell76Cell77Cell78Cell79Cell80Cell81Cell82Cell83Cell84Cell85Cell86Cell87Cell88Cell89Cell90Cell70Cell91Cell92Cell93Cell94Cell95l29Cell30Cell31Cell32Cell33Cell34Cell35Cell36Cell37Cell38Cell39Cell40Cell41Cell42Cell43Cell44Cell45Cell46Cell47Cell48Cell49Cell50Cell51Cell52Cell53Cell54Cell55Cell56Cell57Cell58Cell59Cell60Cell61Cell62Cell63Cell64Cell65Cell66Cell67;N7 p0 .SUPERIOR COURT OF WASHINGTON FOR THE COUNTY OF   = p"@ dTitle  p @ JUVENILE DIVISION   i  @  DEPENDENCY OF:  X  0  NO.     !@ eTitle   `0 $ APETITION FOR TERMINATION OF PARENT-CHILD RELATIONSHIP (RCW 13.34)  9J 9J 8 9J,Arial (CPETITION FOR TERMINATION OF (C%PARENT-CHILD RELATIONSHIP (RCW 13.34) P H fTitle  0H gTitle  p0 Name:   -P. |DISTRIBUTION: White - Court File Yellow - Service File Pink - Parents Goldenrod - Indian Tribe/Other Party  /@0PP DSHS 09-766 (08/1991)  L/P@/0 APETITION FOR TERMINATION OF PARENT-CHILD RELATIONSHIP (RCW 13.34)  ,`  I. BASIS   ) p00 'I represent to the Court the following:   P0` 1.1   P Information about the child:  x ppP$H  xTitle  pp Address:  ' 0p` 1.2   p  The child:  + p@0@   }@    * $p is an Indian child as defined in 25 USC 1903(4). The Indian Child Welfare A ct, 25 U.S.C. 1901 et seq., applies to this proceeding. See attached Addendum to Petition.  JJ?EkQ JE?Qk 8 ?EkQ,Arial (QOtis an Indian child as defined in 25 USC 1903(4). The Indian Child Welfare A ct, 25 U.S.C. 1901 et seq., applies to (]O4this proceeding. See attached Addendum to Petition.`0 ` 1.3   `  =Known information about the parent(s), guardian or custodian:   "p0#0` 1.4   "p#0 ?The parent-child relationship between the child and the child's   #`$ p a.   #p$00 HThe child has been found to be a dependent child under RCW 13.34.030(2).  O /p 0$  PAGE 1 0F 2  0 0P @ Title   @ p D.O.B.   00H Title  p0 Age:   0$H Title  p0 Date of birth:  9 0`H Title  p0 Sex:   0@        * 0$p may be an Indian child as defined in 25 USC 1903(4). The Indian Child Welfare A ct may apply to this proceeding. See attached Addendum to Petition.  66YEQ 6EYQ 8 YEQ,Arial (kOsmay be an Indian child as defined in 25 USC 1903(4). The Indian Child Welfare A ct may apply to this proceeding. (wO"See attached Addendum to Petition.0@       * P$p is or may be a Canadian Indian child or an unenrolled Indian as defined in WAC 388-70-091(2) and (3). The Indian Child Welfare Act does not apply to this proceeding.  FFsEQ FEsQ YEQ sEQ,Arial (Okis or may be a Canadian Indian child or an unenrolled Indian as defined in WAC 388-70-091(2) and (3). The (O;Indian Child Welfare Act does not apply to this proceeding.P 0@   `     * p0$p OIs not Indian. The Indian Child Welfare Act does not apply to this proceeding.  U  p a.   0 Name of father:  E  p$H Title  0 Address:  ' $H Title  @p b.   P Name of mother:  K  $H Title  P Address:  '  $H Title  ` p c.   p 0  Marital status of parents:  m @ #H Title   p!0p d.    !@ !Name of legal guardian/custodian:    P!0#H Title  !"@ Address:  ' !P"0$H Title  "P0# @0  "`@#     * "pp#0 mother   "P# @  "`#     * "p@#00 father   "p#0#p should be terminated:  ` $0$p b.   $@%0 FThe court has entered a dispositional order pursuant to RCW 13.34.130.  ? %%p c.   %&$0 The child has been removed or will, at the time of the hearing, have been removed from the custody of the parent for a period of at least six months pursuant to a finding of dependency under RCW 13.34.030(2).  ppGEsM pEGMs 8 GEsM,Arial (YOqThe child has been removed or will, at the time of the hearing, have been removed from the custody of the parent (eO_for a period of at least six months pursuant to a finding of dependency under RCW 13.34.030(2).&'Pp d.   &($ The services ordered under RCW 13.34.130 have been offered or provided and all necessary services, reasonably available, capable of correcting the parental deficiencies within the foreseeable future have been offered or provided.  `ER E`R GEsM `ER,Arial (rOnThe services ordered under RCW 13.34.130 have been offered or provided and all necessary services, reasonably (~Onavailable, capable of correcting the parental deficiencies within the foreseeable future have been offered or (O provided.()p e.   (*p$ There is little likelihood that conditions will be remedied so that the child can be returned to the parent in the near future.    ER  ER `ER ER,Arial (OxThere is little likelihood that conditions will be remedied so that the child can be returned to the parent in the near (Ofuture.*p+0P f.   *,$ Continuation of the parent and child relationship clearly diminishes the child's prospects for early integration into a stable and permanent home.  44ER 4ER ER ER,Arial (OxContinuation of the parent and child relationship clearly diminishes the child's prospects for early integration into a (Ostable and permanent home.,,p g.   ,,$ -Termination is in the child's best interests.   Address:   ( ,`-@$H! Title  -.P Tribal affiliation:   F -` .@$H" Title  +,@p b.    /p 0$  PAGE 1 0F 2 /3/ l~@ H oTitle    DATE @      * 0p mother   0P` 1.5   P <The request for termination is based on the following facts:   !$ agency,  #  !0H Title  0` 2.1   @ <The Court reaffirms the child's status as a dependent child.   ` II. RELIEF REQUESTED   r P0 Petitioner requests:  V @!H Title     PETITIONER * @@! !H Title  !0 ! TITLE/AGENCY/RELATIONSHIP g"#`0 III. CERTIFICATION   ] $0%# I certify under penalty of perjury under the laws of the state of Washington that the foregoing representations are true and correct.  &&7cI &7Ic 8 7cI,Arial (I#}I certify under penalty of perjury under the laws of the state of Washington that the foregoing representations are true and (U#correct.&P0'  Signed at   - &P' , Washington, this  P &P'p day of   &P!P'"0 20    /00`@ DSHS 09-766 (08/1991)  L/`0/ 5PETITION FOR TERMINATION OF PARENT-CHILD RELATIONSHIP  / 0$  PAGE 2 0F 2  0P`#@ Title  0` 2.2    ?The parent-child relationship between the child and the child's   P@  @    *  father   $ be permanently terminated.  y @  p    *  (Department of Social and Health Services   0` 2.3   ` 6The child be committed to the permanent custody of the   0@      * P$P and the permanent custodian be authorized to place the child with prospective adoptive parents, consent to the child's adoption, and exercise additional authority as provided by RCW 13.34.210.  ``1O `1O 8 1O,Arial (;wand the permanent custodian be authorized to place the child with prospective adoptive parents, consent to the child's (;Iadoption, and exercise additional authority as provided by RCW 13.34.210.() ` SERVICE WORKER @** ADDRESS "* *0 STREET +p+` CITY +p+ STATE +p+! ZIP CODE !,-@ TELEPHONE NUMBER J&0'H  Title  &0'0H! Title  &0p'!H" Title  &0"'#H# Title  '(#H$ Title  ))#H% Title  *p+P#H& Title  +,#H' Title  Name of care providers:   k  $H3 Title  p Address:   ( `$H4 Title   p Tribal affiliation (if any):   g  P#H5 Title  0 1.11    p 2Agency/person that arranged foster care placement.     Name:    p#H6 Title  p Address:   ( `p$H7 Title  `  II. RELIEF REQUESTED   r  0"$ I request that the court set the matter for a validation hearing and that the court validate the voluntary consent to foster care placement, as provided in Chapter 13.34 RCW and 25 U.S.C. 1913(a).  ff+S fS+  +S,Arial (#I request that the court set the matter for a validation hearing and that the court validate the voluntary consent to foster care (#Bplacement, as provided in Chapter 13.34 RCW and 25 U.S.C. 1913(a)."p@#P!H8 Title  #` #  PETITIONER*$@$!H9 Title  $ %` TITLE/AGENCY/RELATIONSHIPh%&p0 III. CERTIFICATION   ^ &0(# I certify under penalty of perjury under the laws of the state of Washington that the foregoing representations are true and correct.  &&^I &^I +S ^I,Arial (p#}I certify under penalty of perjury under the laws of the state of Washington that the foregoing representations are true and (|#correct.(0(  Signed at    - (((((( , Washington, this   P ( (P( (P((p day of    (p(!(p(!(!P("0 20     ("@($("@($.^ .b$.` .`$, -$- -$+ +$+ +$*> *B$*@ *@$/00`P DSHS 09-758 (08/1991) M/`0/ ^PETITION FOR COURT VALIDATION OF VOLUNTARY CONSENT TO FOSTER CARE PLACEMENT OF AN INDIAN CHILD / 0$  PAGE 2 0F 2 /[0^  , () -(###) ###-####(000) 000-0000@@X     @@@@@@ @@@@@ ,*BX 3* 3* ,*C ,3hIC, ,iIs\Is,,tRxIiIZxI,wI  ,{IDdD  DtɫD֫Dt    qrIbDvϨOR^t@@@  @@X  Dv @@@  @@X  Dv @@@   @@X  Dv @@IRbDvϨOR@@X  Dv LBHN~