Superior Court of Washington

County of

In re the Custody of:
Child(ren),
Petitioner(s),
and
Respondent(s). / No.
Order Directing DCFS/CPS to
Release Information and
Order Restricting Access
(Nonparental custody)
(ORDINFO)
Clerk’s Action Required

I. Basis

This order is entered because of a petition for nonparental custody filed by ______[Names of Petitioners]. Under RCW 26.10.135, before entering a final nonparental custody order, the Court must direct the Department of Social and Health Services (DCFS/CPS) to release information as provided under RCW 13.50.100. The children at issue are: (names and ages):

.

II. Order

It is Ordered that DCFS/CPS shall provide information (authenticated as true and correct under penalty of perjury) regarding the following adults and persons aged 16 or older residing in the household of the petitioners:

(for 16 or 17 year olds list age instead of birth date):

1. Petitioner (Last, First, Middle): / Other Names Used: / Birth date/age:
Counties of Residence from October 1, 1998 to present:


(for 16 or 17 year olds list age instead of birth date):

2. Petitioner (Last, First, Middle): / Other Names Used: / Birth date/age:
Counties of Residence from October 1, 1998 to present:
3. Name (Last, First, Middle): / Other Names Used: / Birth date/age:
Counties of Residence from October 1, 1998 to present:
4. Name (Last, First, Middle): / Other Names Used: / Birth date/age:
Counties of Residence from October 1, 1998 to present:
5. Name (Last, First, Middle): / Other Names Used: / Birth date/age:
Counties of Residence from October 1, 1998 to present:
6. Name (Last, First, Middle): / Other Names Used: / Birth date/age:
Counties of Residence from October 1, 1998 to present:

RCW 13.50.100(4) Subject to (a) of this subsection, the department of social and health services may release information retained in the course of conducting child protective services investigations to a family or juvenile court hearing a petition for custody under chapter 26.10 RCW.
(a) Information that may be released shall be limited to information regarding investigations in which: (i)The juvenile was an alleged victim of abandonment or abuse or neglect; or (ii) the petitioner for custody of the juvenile, or any individual aged sixteen or older residing in the petitioner's household, is the subject of a founded or currently pending child protective services investigation made by the department subsequent to October 1, 1998.
(b) Additional information may only be released with the written consent of the subject of the investigation and the juvenile alleged to be the victim of abandonment or abuse and neglect, or the parent, custodian, guardian, or personal representative of the juvenile, or by court order obtained with notice to all interested parties.

The requested information should be provided to the designated recipient within two weeks of the date of this order and shall be submitted with form WPF CU 03.0520, Cover Sheet for DCFS/CPS Investigative Information to:

______

[Name of Designated Recipient at Superior Court and Mailing Address]

It is further Ordered that the information provided by DCFS/CPS, shall be maintained as confidential and shall be protected against unauthorized disclosure, pursuant to RCW 13.50.100(5).

It is further Ordered that access to the information provided by DCFS/CPS shall be restricted to petitioners, attorneys for petitioners, respondents, attorneys for respondents, the guardian ad litem and the subject of the information. Absent written consent of the subject of the information, the information shall not be further disseminated without an in camera review and court order of dissemination.

Dated:

Judge/Commissioner

Presented by: Approved by:

Signature of Party or Lawyer/WSBA No. Signature of Party or Lawyer/WSBA No.

Print Name Print Name

Order re DCFS/CPS (ORDINFO) - Page 1 of 1

WPF CU 03.0500 Mandatory (06/2014) – RCW 26.10.135, RCW 13.50.100