SUPERIOR COURT OF WASHINGTON COUNTY OF IN RE THE

In re the Marriage of:

Petitioner,

and

Respondent.

No.

Residential Time Summary Report

(RTSR)

Clerks Action Required

The court signed the Parenting Plan on _________________________ [Date]

It was: [ ] by agreement of the parties

[ ] after a contested hearing or trial

[ ] by default

It is: [ ] an original order

[ ] a modification of a prior order

It applies to ____________ [number] of children.

Starting with your oldest child, for each child, list his or her age and check the box that best represents the time the child spends with each parent:

Oldest Child - Age: ______

Next Child - Age: _____

Next Child - Age: _____

[ ] 0 % of the time with mother and 100 % of the time with father

[ ] 1 – 34 % of the time with mother and 66 – 99 % of the time with father

[ ] 35 – 49 % of the time with mother and 51 – 65 % of the time with father

[ ] 50 % of the time with each parent

[ ] 51 – 65 % of the time with mother and 35 – 49 % of the time with father

[ ] 66 – 99 % of the time with mother and 1 – 34 % of the time with father

[ ] 100 % of the time with mother and 0 % of the time with father

[ ] 0 % of the time with mother and 100 % of the time with father

[ ] 1 – 34 % of the time with mother and 66 – 99 % of the time with father

[ ] 35 – 49 % of the time with mother and 51 – 65 % of the time with father

[ ] 50 % of the time with each parent

[ ] 51 – 65 % of the time with mother and 35 – 49 % of the time with father

[ ] 66 – 99 % of the time with mother and 1 – 34 % of the time with father

[ ] 100 % of the time with mother and 0 % of the time with father

[ ] 0 % of the time with mother and 100 % of the time with father

[ ] 1 – 34 % of the time with mother and 66 – 99 % of the time with father

[ ] 35 – 49 % of the time with mother and 51 – 65 % of the time with father

[ ] 50 % of the time with each parent

[ ] 51 – 65 % of the time with mother and 35 – 49 % of the time with father

[ ] 66 – 99 % of the time with mother and 1 – 34 % of the time with father

[ ] 100 % of the time with mother and 0 % of the time with father

(Continued) Starting with your next child, for each child, list his or her age and check the box that best represents the time the child spends with each parent:

Next Child - Age: _____

Next Child - Age: _____

Next Child - Age: _____

[ ] 0 % of the time with mother and 100 % of the time with father

[ ] 1 – 34 % of the time with mother and 66 – 99 % of the time with father

[ ] 35 – 49 % of the time with mother and 51 – 65 % of the time with father

[ ] 50 % of the time with each parent

[ ] 51 – 65 % of the time with mother and 35 – 49 % of the time with father

[ ] 66 – 99 % of the time with mother and 1 – 34 % of the time with father

[ ] 100 % of the time with mother and 0 % of the time with father

[ ] 0 % of the time with mother and 100 % of the time with father

[ ] 1 – 34 % of the time with mother and 66 – 99 % of the time with father

[ ] 35 – 49 % of the time with mother and 51 – 65 % of the time with father

[ ] 50 % of the time with each parent

[ ] 51 – 65 % of the time with mother and 35 – 49 % of the time with father

[ ] 66 – 99 % of the time with mother and 1 – 34 % of the time with father

[ ] 100 % of the time with mother and 0 % of the time with father

[ ] 0 % of the time with mother and 100 % of the time with father

[ ] 1 – 34 % of the time with mother and 66 – 99 % of the time with father

[ ] 35 – 49 % of the time with mother and 51 – 65 % of the time with father

[ ] 50 % of the time with each parent

[ ] 51 – 65 % of the time with mother and 35 – 49 % of the time with father

[ ] 66 – 99 % of the time with mother and 1 – 34 % of the time with father

[ ] 100 % of the time with mother and 0 % of the time with father

Father: [ ] self-represented [ ] represented by an attorney

The court found under paragraphs 2.1 and 2.2: [ ] does not apply, or

the Father [ ] committed domestic violence [ ] abused or neglected a child

[ ] has chemical dependency issues [ ] has mental health issues

[ ] other:______________________________________________________________.

Mother: [ ] self-represented [ ] represented by an attorney

The court found under paragraphs 2.1 and 2.2: [ ] does not apply, or

the Mother [ ] committed domestic violence [ ] abused or neglected a child

[ ] has chemical dependency issues [ ] has mental health issues

[ ] other:______________________________________________________________.

[ ] Arbitration [ ] Mediation [ ] Counseling [ ] No dispute resolution process except court action.