Thomas L Van Dam vs. Sara L Van Dam Case Number 07-3-02242-1

E-FILED
IN COUNTY CLERK'S OFFICE

PIERCE COUNTY, WASHINGTON
July 06 2007 8:30 AM
KEVIN STO CK
CO UNTY CLERK
IN THE SUPERIOR COURT OF THE STATE OF WASHINGTON

IN AND FOR PIERCE COUNTY
No. 07-3-02242-1
ORDER ASSIGNING CASE TO DEPARTMENT
In accordance with PCLR 40(b), this case is hereby assigned to Department 22, Judge JOHN R. HICKMAN.
Notice to Petitioner:
Once the case has been filed, the petitioner shall serve a copy of this Order Assigning Case to Department on the
respondent with the summons and petition. Provided, however, that in those cases where service is by
publication the petitioner shall serve a copy of this Order Assigning Case to Department within five (5) court days
of service of the respondent's first response/appearance. If the case has not been filed, but an initial pleading is
served, a copy of this Order Assigning Case to Department shall be served within five (5) court days of filing.
PCLR 1(b).
Trial Date:
A trial date may be obtained pursuant to PCLR 40(d) by filing a 'Note of Issue' for assignment of a trial date by
noon at least six (6) court days prior to the date fixed for assignment of the trial date. PCLR 40(d)
If a trial date is not obtained pursuant to PCLR 40(d), failure to appear on this date will result in dismissal of
the case by the Court. PCLR 40(d)
Assignment to Set Trial Date
Friday, November 09, 2007 9:00 AM
At that time the Court will provide you with a Case Schedule which shall include the trial date. Failure to
appear on this date will result in dismissal of the case by the Court. PCLR 40(d).
Certificate of Completion of Mandatory Parenting Seminar due from both parties by 09/07/2007. See PCLSPR
94.05(c) & (4)0)
Uncontested Dissolutions/Settlements:
If this case is agreed upon by both petitioner and respondent, you are not required to wait for the trial date in
order to settle your case. If you settle your case and the appropriate time requirements have been met, you may
file a Note for Commissioner's Calendar' to appear before a Court Commissioner for entry of final papers.
DATED: July 6, 2007

Judge JOHN R. HICKMAN
Department 22
astsup-0003.pdf
3277
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00001
PIERCE COUNTY SUPERIOR COURT/CASE INFORMATION COVER SHEET
07-3-02242-1
27802807
C lC S
07-08-07
Case Number:
3 0 22 4 T 1
Case Title:
Van Dam
Attorney Name: Clint P. Johnson
Street Address: 5920 100th Street S.W., Suite 25
City: Lakewood
State: WA Zip: 98499
Bar U 14794 Phone # (253) 581-0660________
Please check one category that best describes this case for indexing purposes.
Presumed tracks are listed next to the cause codes. (Non PCLR indicates no Track Assignment Request is required.)
I f you cannot determine the appropriate category, please describe the cause o f action below, This will create a "Miscellaneous" cruise which is not
subject to PCLR I. and does not require a Track Assignment Request Form,
APPEAL/REVIEW
____Administrative Law Review (ALR 2) Non PCLR
____Civil, Non-Traffic (LCA 2)Non PCLR
____Civil, Traffic (LCI 2) Non PCLR
CONTRA CT/COM M ERCIAL
____Breach of Contract (COM 2) EXPEDITED
____Commercial Contract (COM 2) EXPEDITED
____Commercial Non-Contract (COL 2) EXPEDITED
____Third Party Collection (COL 2) EXPEDITED
DOMESTIC RELATIONS
____Annulment/fnvalidity (INV 3) DISSOLUTION
____Child Custody (CUS 3) DISSOLUTION
_x_D issolution with children (DIC 3) DISSOLUTION
____Dissolution without children (DIN 3) DISSOLUTION
____Foreign Judgment (FJU 3) Non PCLR
____Legal Separation (SEP 3) DISSOLUTION
____Mandatory Wage Assignment (MWA 3)Non PCLR
____Meretricious Relationship (MER 2) Non PCLR
____Modification (MOD 3) Non PCLR
____Out-of-State Custody (OSC 3) DISSOLUTION
____Reciprocal, Respondent in county (RIC 3) Non PCLR
____Reciprocal, Respondent out of county (ROC 3) Non PCLR
____Residential Schedulc/Parenting Plan (PPS 3) Non PCLR
JUDGM ENT
____Abstract Only (ABJ 2) Non PCLR
____Foreign Judgment (FJU 2) Non PCLR
____Judgment, Another County (ABJ 2) Non PCLR
____Judgment. Another State (FJU 2) Non PCLR
____Tax Warrant (TAX 2) Non PCLR
____Transcript of Judgment (TRJ 2) Non PCLR
OTHER COMPLAINT OR PETITION
____Compel/Confirm Private Binding Arbitration (MSC 2) Non PCLR
____Change of Name (CHN 2) Non PCLR
____Deposit of Surplus Funds (MSC 2) Non PCLR
____Emancipation of a Minor (EOM 2) Non PCLR
____Injunction (INJ 2) Non PCLR
____Interpleader (MSC 2) Non PCLR
Malicious Harassment (MHA 2) Non PCLR
Minor ScUlcmcnl/No Guardianship (MST 2) Non PCLR
Petition for Civil Commit/Sexual Predator (PCC 2) Non PCLR
____Seizure of Property from the Comm of Crime (SPC 2) Non PCLR
____Seizure of Property Resulting from Crime (SPR 2) Non PCLR
____Subpoenas (MSC 2) Non PCLR
MISCELLANEOUS
A D O PTIO N ! PATERNITY
____Adoption (ADP 5) Non PCLR
____Confidential Intermediary (MSC 5) Non PCLR
Initial Pre-Placement Report (PPR 5) Non PCLR
____Modification (MOD 5) Non PCLR
____Paternity (PAT 5) Non PCLR
____Patcmity/URESA/UIFSA (PUR 5) Non PCLR
____Relinquishment (REL 5) Non PCLR
____ Termination of Parent-Child Relation (TER 5) Non PCLR
____Rescission of Paternity Affidavit (MSC 5)Non PCLR
PROBATE / GUARDIANSHIP
____Absentee (ABS 4) Non PCLR
____ Disclaimer (DIS 4) Non PCLR
Estate (EST 4) Non PCLR
____Foreign Will (FNW 4) Non PCLR
____Guardianship (GDN 4) Non PCLR
____Guard ianship/Estatc (G/E 4) Non PCLR
____Limited Guardianship (LGD 4 )Non PCLR
____ Minor Settlement/With Guardianship (MST 4) Non PCLR
____Non-Probate Notice to Creditors (NNC 4) Non PCLR
____ Will Only (WLL 4)
PROPERTY RIGHTS
____ Condemnation (CON 2) STANDARD
____Foreclosure (FOR 2) STANDARD
Property Fairness (PFA 2) STANDARD
____Quite Title (QTI 2) STANDARD
____ Unlawful Detaincr/Eviction (UND 2)Non PCLR
TORT / MEDICAL M ALPRACTICE
____Hospital (MED 2) COMPLEX
____Medical Doctor (MED 2) COMPLEX
Other Health Care Professional (MED 2) COMPLEX
TORT / MOTOR VEHICLE
____Death (TMV 2) STANDARD
____ Non-Death Injuries (TMV 2)STANDARD
Property Damage Only (TMV 2 )STANDARD
TO RT / NON MOTOR V EHICLE
____ Asbestos (PIN 2) STANDARD
____Other Malpractice (MAL 2) COMPLEX
____ Personal Injury (PIN 2) STANDARD
Products Liability (TTO 2) COMPLEX
____ Property Damage (PRP 2) STANDARD
____Wrongful Death (WDE 2 )STANDARD
W RIT
____Habeas Corpus (WHC 2) Non PCLR
____ Mandamus (WRM 2) Non PCLR
____Review (5WRV 2) Non PCLR
3 2 7 ?
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1
IN COUNTY CLERKS OFFlfci
xI
-02242-1
27002810
'JU L
SIM
0 6
2007
FIERCE COUNTY, WASHIN IP 1

t e v i n s t o c k , County.
______ 0! pff
BY/___
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IN AND FOR THE COUNTY OF PIERCE
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In re the Marriage of:

THOMAS L. VAN DAM,
Petitioner,
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07 3 02242 1
NO.
SUMMONS (SM)
vs.
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SARA L. VAN DAM,
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Respondent.
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TO THE RESPONDENT: SARA L. VAN DAM
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1.
The Petitioner has started an action in the above court requesting:

that your marriage be dissolved.
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Additional requests, if any are stated in the petition, a copy of which is attached
to this summons.
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2.
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pm
07-08-07
You must respond to this summons and petition by serving a copy of your
written response on the person signing this summons and by filing the original
with the clerk of the court. If you do not serve your written response within 20
days (60 days if you are served outside of the State of Washington) after the
date this summons was served on you, exclusive of the date of service, the
court may enter a default judgment against you, and the court may, without
further notice to you, enter a decree and approve or provide for the relief
requested in the petition. In the case of a dissolution of marriage, the court will
not enter a decree until at least 90 days from filing and service. If you serve a
notice of appearance on the undersigned person, you are entitled to notice
FAUBION, JOHNSON & REEDER, P.S.
SUMMONS (SM) -1
WPF DR 01.0200 (6/2006); CR 4.1
S:\CASES9W anDam'.summons.wpd
A ttorneys at Law
5920 100th Street S.W., Suite 25
Lakew ood , WA 98499
{253) 581-0660
ft
3277
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before an order of default or a decree may be entered.

3.
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Your written answer to the summons and petition must be on form WPF DR
01.0300, Response to Petition (Domestic Relations). This form may be
obtained by contacting the clerk of the court at the address below, by contacting
the Administrative Office of the Courts at (360) 705-5328, or from the Internet
at the Washington State Supreme Court Homepage:
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http://www.courts.wa.gov/forms
4.
If this action has not been filed with the court, you may demand that the
Petitioner file this action with the court. If you do so, the demand must be in
writing and must be served upon the person signing this summons. Within 14
days after you serve the demand, the Petitioner must file this action with the
court, or the service of this summons and petition will be void.
5.
If.you wish to seek the advice of an attorney in this matter, you should do so
promptly so that your written response, if any, may be served on time.
6.
One method of serving a copy of your response on the Petitioner is to send it by

certified mail with return receipt requested.
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This summons is issued pursuant to Superior Court Civil Rule 4.1 of the State of
Washington.
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DATED this
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FILE RESPONSE WITH:
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Moving Party's Lawyer:

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Clerk of the Court

Pierce County Superior Court
County-City Building
930 Tacoma Avenue South
Tacoma, WA 98402
CLINT P. JOHNSON
Lakewood, Washington 98499
(253) 581-0660
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SUMMONS (SM) - 2
WPF DR 01.0200 (6/2006); CR 4.1
S:'CASES9WanDam-summons.wpd
A ttorneys at Law
(253)581-0660
3277
UK L
IN C O U N T? C LER K'S OFI

07-3-1
242-1
27002811
PTDSS
07-06-07
(M. 1JUL 0 6 2007
>|BKCE COUNTY, WASHINOIr
I vin
stock , countyîj
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Petitioner,
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PETITION FOR DISSOLUTION

OF MARRIAGE (PTDSS)
vs.
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07 3 02242 1
THOMAS L. VAN DAM,
SARA L. VAN DAM,

Respondent.
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I. BASIS
1.1
Name (first/last):
Date of Birth:
Last known residence:
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1.2
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1.3
Thomas L. Van Dam

10/21/1969
Pierce County, Washington
IDENTIFICATION OF RESPONDENT.
Name (first/last):
Date of Birth:
Last known residence:
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IDENTIFICATION OF PETITIONER.
Sara L. Van Dam

09/22/1975
Pierce County, Washington
CHILDREN OF THE MARRIAGE DEPENDENT UPON EITHER OR BOTH

SPpUSES.
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The Husband and Wife are both the parents of the following dependent
children:
PETITION FOR DISSOLUTION OF
MARRIAGE (PTDSS) - 1
WPF DR 0 1.0100 (6/2006); RCW 26.09.020
STCASES9\VanDani)Psit[ion wpd
592010m
" ^ "
suite25
La kew o o d . WA 98499
(253) 581 -0660
Name
Age
Silas R. VanDam
The Husband is and the Wife is not the parent of the following dependent
children:
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Name
Age
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None
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The Wife is and the Husband is not the parent of the following dependent
children:
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Name
None
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1.4
1.5
1.6
SEPARATION.
Husband and wife separated in April, 2006.
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DATE AND PLACE OF MARRIAGE.

The parties were married on March 20, 1999, at Newport, Oregon.
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ALLEGATION REGARDING MARRIAGE.

This marriage is irretrievably broken.
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Age
1.7
JURISDICTION.
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This court has jurisdiction over the marriage.
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This court has jurisdiction over the respondent because:

the respondent is presently residing in Washington.
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,
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1.8
the petitioner and respondent lived in Washington during their marriage

and the petitioner continues to reside, or be a member of the armed
forces stationed, in this state.
PROPERTY.
There is community or separate property owned by the parties. The court
should make a fair and equitable division of all the property.
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MARRIAGE (PTDSS)-2
WPF DR 01.0100 (6/2006); RCW 26,09.020
S:\CASES5HVfttiDam Petition wpd

A ttorneys a t Law
5920 100th S treet S.W.. Suite 25
(253) 581-0650
The petitioners recommendation for the division of property is set forth below.
The petitioner should be awarded the parties interest in the following

property:
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2.
3.
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5.
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6.
2005 Ford Focus, subject to the obligation owing thereon;

Any and all household goods, furniture and furnishings presently
in his possession;
Any and all clothing, jewelry and personal effects in his
possession;
Any and all accounts at banks or other financial institutions held
in his name;
Any and all retirement, pension or other employment benefits
earned during his employment; including his 401k with his
employer and his Social Security benefits;
Any and all life insurance insuring his life.
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The respondent should be awarded the parties interest in the following
property:
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1.
2.
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3.
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4.
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5.
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1997 Toyota 4 Runner.

Any and all household goods and furnishings presently in her
possession;
Any and all clothing, jewelry and personal effects in her
possession;
in her name;
Any and ah retirement, pension or other employment benefits
earned during her employment; and her Social Security benefits
Any and all life insurance insuring her life.
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1.9
DEBTS AND LIABILITIES.
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The parties have debts and liabilities. The court should make a fair and
equitable division of all debts and liabilities.
The petitioners recommendation for the division of debts and liabilities
is set forth below.
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The petitioner should be ordered to pay the following debts and

liabilities to the following creditors:
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1. Any and all expenses associated with the vehicle in his

possession to include insurance, tabs and repairs; and
2. Any and all expenses associated with his residence;
3. Obligation owing to Alaska Federal Credit Union for 2005
Ford Focus;
4. Sallie Mae for student loans
5. Wells Fargo, credit card

X ^ D T H A P C
,
WPF DR 0 1.0 i 00 (6/2006); RCW 26.09.020
S^CASES9WanDamPetition,wpd
FAUBION, JOHNSON
& REEDER, P.S.
ATTORNEYS AT LAW
5920 iooth street s .w ., suite25
La ke w o o d , WA 98499
(253)591 '0560
32?7
The respondent should be ordered to pay the following debts and

liabilities to the following creditors:
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1. Any and all expenses associated with the vehicle in her
possession to include insurance, tabs and repairs; and
2. Any and all expenses associated with her residence;
3. Chase for credit card
4. Unicom Financial for loan
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Each party should pay their debts incurred since separation.

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1.10
SPOUSAL MAINTENANCE.
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Spousal maintenance should not be ordered.
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1.11
CONTINUING RESTRAINING ORDER.
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Does not apply.
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1.12
PROTECTION ORDER.
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Does not apply.

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1.13
PREGNANCY.
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The wife is not pregnant.
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1.14
JURISDICTION OVER THE CHILDREN.
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This court has jurisdiction over the child for the reasons set forth below.
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This state is the home state of the child because
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The child lived in Washington with a parent or a person acting as a
parent for at least six consecutive months immediately preceding the
commencement of this proceeding.
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1.15
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CHILD SUPPORT AND PARENTING PLAN FOR DEPENDENT

CHILDREN.
Support for the dependent child listed below should be set pursuant to the
Washington State Child Support Schedule.
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Name of
of Child
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Silas R, Van Dam
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The petitioners proposed parenting plan for the children listed above:
, . . ^
A
WPF DR 01.0100 (6/2006); RCW 26.09.020
S:\CAS ES9\VanDana\Pciiiion,wpd
Mothers
Name
Fathers
Name
Sara L. Van Dam
Thomas Van Dam
FAUBION, JOHNSON
& REEDER, P.S.
t t orneys at Law
5920 100th S treet S.W., S uite 25

L akewood . WA98499
(253) 581-0660
32?7
? /& /
is attached and is incorporated by reference as part of this

Petition.
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(The following information is required only for those children who are included
in the petitioners proposed parenting plan.)
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During the last five years, the child has lived:
in no place other than the state of Washington and with no

person other than the petitioner or the respondent.
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Claims to custody or visitation;
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The petitioner does not know of any person other than the
respondent who has physical custody of, or claims to have
custody or visitation rights to, the child.
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Involvement in any other proceeding concerning the child;

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The petitioner has not been involved in any other proceeding

regarding the child.
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Other legal proceedings concerning the child.
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The petitioner does not know of any other legal proceedings

concerning the child.
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1.16
OTHER:
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II. RELIEF REQUESTED
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The petitioner REQUESTS the Court to enter a decree of dissolution and to grant the
relief below.
Approve the petitioners proposed parenting plan for the dependent children
listed in paragraph 1.15.
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Determine support for the dependent children listed in paragraph 1.15 pursuant
to the Washington State Support Schedule.
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Divide the property and liabilities.
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Order payment of day care expenses for the children listed in paragraph 1.15.
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Award the tax exemptions for the dependent children listed in paragraph 1.15 as
follows:
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MARRIAGE (PTDSS)- 5
WPF DR 01.0100 (6/2006); RCW 26.09.020
S:\CASES9\VanDam\ Petition.wpd

Attorneys at L aw
L akewood , WA 98499
(253)581-0660
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DATED this
/2007.
day of
REEDER, P.S.
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SffWSBA# 14794
ioner
Of Attorneys for
I declare under penalty of perjury under the laws of the State of Washington that
the foregoing is true and correct.
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Signed at '
, UJ]f\
(City and State)
, on
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n
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MARRIAGE (PTDSS)-6
WPF DR 01.0100 (6/2006); RCW 26.09.020
S:\CASEiS9WanDam'Petition.wpd

A ttorneys at Law
{253) 581-0660
yf 'cxerk'S off
07-3-0; 42-1
27802813
ACSR
07-06-07
2007 i
f k c e c o u n ty
WASHING'
5
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THOMAS L. VAN DAM,
Petitioner,
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ACCEPTANCE OF SERVICE
(ACSR)
vs.
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07 3 02242 1
NO.
SARA L. VAN DAM,
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Respondent.
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1.
ACCEPTANCE OF SERVICE.
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SARA L. VAN DAM accepts service of:
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the summons and petition in this action
Temporary parenting plan,
a proposed order of child support
proposed Child Support Worksheets
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2.
SARA L. VAN DAM consents to personal jurisdiction.
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CONSENT TO PERSONAL JURISDICTION.
3.
OTHER:
None.
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ACCEPTANCE OF SERVICE (ACSR) -1

WPF DRPSCU 01.0310 (7/2003)
S;\CASES9WsnDam\accepl.wpd
A ttorneys at Law
59201 00 th Street S.W., Suite 25
(253)581-0660
327?
7/& /2B 9
DATED this ^ 3 _ day of
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Notice to party: You may list an address
that is not your residential address where
you agree to accept legal documents.
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[Address]
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ACCEPTANCE OF SERVICE (ACSR) - 2

WPF DRPSCU 01.0310 (7/2003)
S ;\CASES 9\Vin Dam\accept,wpd
A ttorneys at la w
5920 100 th Street S.W., S uite 25
(253)581-0660
5950
07-3-02242-1
28242084
LTR22
09-13-07
S U P E R IO R
9 /1 4 /2 0 0 7
00092
C O U R T
O F T H E
S T A T E
FO R
O F W A S H IN G T O N
P IE R C E
C O U N T Y
(253) 798-3654
334 County-City Building
FAX (253) 798-7214
930 Tacom a Avenue South

Tacom a, W ashington 98402-2102
DATED: September 13, 2007

Re:
Cause No. 07-3-02242-1
Docket code: CRRSP
THOMAS L VAN DAM

vs.
SARA L VAN DAM
Dear Counsel or Pro Se Litigant:

Court records indicate that the attorneys and/or parties listed below have failed to comply with the
Case Schedule in regard to the following items:
Petitioner's Certificate of Parenting Class - Not Filed
Deadline:
09/07/07
Respondent's Certificate of Parenting Class - Not Filed
Deadline:
09/07/07
Pursuant to Pierce County Local Rule 1 and also pursuant to the Case Scheduling Order given to you
at the time of filing this case, you are out of compliance. Please take the actions necessary to
immediately comply with the Case Schedule. Please file and deliver a courtesy copy of the document
to the Judge.
If the court finds that an attorney or party has failed to comply with the Case Schedule and has no
reasonable excuse, the court may order the attorney or party to pay monetary sanctions to the court,
or terms to any other party who has incurred expense as a result of the failure to comply, or both; in
addition, the court may impose such other sanctions as justice requires. See PCLR 1(k).
Copies mailed to:
Sincerely,
Clint P. Johnson
Van Dam, Sara L
Department 22
Judicial assistant to:
Judge John R. Hickman
Superior Court Clerk for Filing

(Court File Copy)
\Jxcivil. pbM_noncomp!iance_}etter_rBport
IN THE SUPERIOR COURT, PIERCE COUNTY, WASHINGTON

THOMAS L VAN DAM
Cause Number: 0 7 -3 -0 2 2 4 2 -1
Petitioner(s)
MEMORANDUM OF JOURNAL ENTRY
vs.
Page 1 of 2
SARA L VAN DAM

Respondent(s)
Judge/Commissioner: DAVID H. JOHNSON
Court Reporter: Smart Court
Judicial Assistant/Clerk: Jennifer Segobia
VAN DAM, THOMAS L
CLINT P. JOHNSON
Attorney for Plaintiff/Petitioner
VAN DAM, SARA L

VAN DAM, SILAS R
Proceeding Set: Exparte Action

Proceeding Outcome: Uncontested Resolution
Outcome Date: 10/30/2007 9:38
Resolution:
Clerks Scom is Code:MTHRG

Proceeding Outcome code:RESHRG
Resolution Outcome code:
Amended Resolution code:
Report run date/time: 10/30/07 9:44 AM

Ixcalcivil.pbl. d_civilJoum al_report_cover
7733
1 8 /3 1 /2 0 0 7

THOMAS L VAN DAM
Cause Number: 07-3-02242-1
MEMORANDUM OF
JOURNAL ENTRY
vs.
Page: 2 of 2
Judge/Commissioner:
DAVID H. JOHNSON
SARA L VAN DAM
_____________________________________ MINUTES OF PROCEEDING_____________________

Judicial Assistant/Clerk: Jennifer Segobia
Court ReportenSmart Court
Start Date/Time: 10/30/07 9:41 AM
October 30, 2007 09:41 AM

Clint Johnson, attorney for petitioner, present with documents for a final dissolution.
Verification offered and accepted. JIS run. Findings of Fact, Conclusions of Law, Decree
of Dissolution, Parenting Plan and child support worksheets are signed by Comm.
Johnson.
End DaterTime: 10/30/07 9:43 AM
FILED
IN OPEN COURT
EX PARTE DEPARTMENT
OCT
2007
PIERCE COUNTY, Clerk
.By___S .
DEPUTY
JUDGE/CO M M ISSIO NER: DAVID H. JO HNSO N
Year 2007
86854
7??4 1 0 X 3 1 ^
If I III
([/(Iff
07-3.02242-1
20540404
PCOPC
10-31-07
FILED
IN CO UNTY C L E R K S O F F IC E
3
a.m.
OCT 3 0 2007
pm .
PIERCE COUNTY. W ASHINGTON

K E V IN S T O C K lC o /n ty C le rk
BY___________ f t /
OEPUTY
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THOMAS L. VAN DAM,
11
Petitioner,
12
13
vs.
NO. 07-3-02242-1
CERTIFICATION OF
COMPLETION OF PARENTING
CLASS RE:
THOMAS L. VAN DAM
SARA L. VAN DAM,
14
Respondent.
IS
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25
-1
S:\CASES9WanDarri\Parentmg Class Certification cover sheet re Thomas.wpd
Attorneys at Law
5920 100th Street S.W., S uite 25
LAKEWOOD, WA 98499
(253)581-0660
7774
1 0 X 3 1 /2 8 8 7
88095
7774
07-3-02242-1
28540406
RCOPC
10-31-07
!
FILED
IN C O U N TY C L E R K 'S O FF IC E
2
3
mi.
OCT 3 0 2007
p..

K E V IN S TO C K ,|C o unify C le rk
Rv
L - / - 1 DEPUTY
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6
7
9
10

THOMAS L. VAN DAM,
Petitioner,
11
12
13
14
vs.
NO. 07-3-02242-1
CERTIFICATION OF
CLASS RE: SARA L. VAN DAM
SARA L. VAN DAM,

Respondent.
15
16
17
18
19
20
21
22
23
24
25
- I
S:\CASES9WanPam\Paicnting Class Certification cover sheet re Sara.wpd
A ttorneys at Law
L a k e w o o d , WA 98499
( 2 5 3 ) 581 -0 6 6 0
7774
1 0 /3 i/'2 g 3 7
80397
7774
III
07-3-02242-1
20540407
1 8 /3 1 /
10-31-07
RTSR
2
" C0UNTyFC L l& s 0FF1CE
3
4
AM'
BY__
OCT 3 0 2007
p.m.
KEVIN <STQC k 'j^ /ASHINGTO n

7 Y K y C o u n ty C le rk
0pury
6
7
9
10
Petitioner,
11
12
13
NO. 07-3-02242-1
THOMAS L. VAN DAM,
RESIDENTIAL TIME
SUMMARY REPORT (RTSR)
vs.
CLERKS ACTION REQUIRED
SARA L. VAN DAM,
14
Respondent.*1
15
16
17
18
19
20
21
Submit with final Parenting Plan, only. This form is for statistical reporting purposes only.
1. The Parenting Plan

[Date] It was:
The court signed the Parenting Plan on

/ > / $ & /< > ?
b^by agreement of the parties
'
] after a contested hearing or trial
[ ] by default
It isj>j an original order
[ J a modification of a prior order
It applies t o _____ ]______ [number] of children.
22
2. Residential Schedule From Part III of the Parenting Plan
23
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:
________
24
Oldest Child - Ag
Next Child - Age:
25
Next Child - Age:

ATTORNEYS AT LAW
(253) 581-0660
Residential Time Summary Report - 1

WPF DR Ol.tMIO
S.\C AS ES9\ VanDamlfina I1RESIDE NT1AL SUMMARY.wpd
7774
2
3
4
5
6
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8
9
10
[ ] 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 5 1 -6 5 % of the time
with father
[ ] 50 % of the time with each
parent
t ] 51 - 65 % of the time with
with father
with father
[] 100 % of the time with mother
[ ] 0 % o f the time with mother

and 100 % o f the time with
father
[ ] 1 - 34 % o f the time with
mother and 66 - 99 % of the
time with father
[] 3 5 - 4 9 % o f the time with
time with father
'N ^ O % o f the time with each
parent
[] 51 - 6 5 % of the time with
time with father
[] 66 - 99 % of the time with
with father
[ ] 100 % of the time with
mother and 0 % o f the time with
father

mother and 100 % of the
time with father
E] 1 - 34 % of the time
with mother and 66 - 99 %
of the time with father
[ ] 35 - 4 9 % of the time
each parent
[ ] 51 - 65 % of the time
[ ] 66 - 99 % of the time
mother and 0 % of the time
with father
11
12
13
(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:
14
Next Child - A ge:_____

and 100 % of the time with
father
time with father
[] 35 - 4 9 % of the time with
time with father
parent
time with father
with father
mother and 0 % of the time with
father

with father
[] 3 5 - 4 9 % of the time with
with father
parent
with father
with father
E] 0 % of the time with

mother and 100 % of the
time with father
[ ] 1 - 34 % of the time
[] 3 5 - 4 9 % of the time
with mother and 5 1 -6 5 %
each parent
[ ] 51 - 65 % of the time
[ ] 6 6 - 9 9 % of the time
with mother and I - 34 %
[ ] 100 % o f the time with
mother and 0 % o f the time
with father
15
16
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19
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22
23
24
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Residential Time Summary Report - 2

WPF DR 01,0410
S:\CAStiS9WanDam\final\RESIDENTIAL SUMMARY.wpd
A ttorneys at Law
5920 10Oth Street S.W., S uite 25
Lakewood , WA 98499
(253)581-0660
7774
1 0 / '3 1 / 2 8 e 7
39188
7774
3-02242-1
28540417
PP
1Q /31S2-
10-31-07
2
3
FILED
IN COUNTY CLERKS OFFICE
4
A.M. OCT 3 0 2007
P.M.
PIERCE COUNTY , WASHING TON

KEVIN STOCK,, C o u n ty C Ile rk
EPUTY
BY________
- W 1'
9
10
11
PARENTING PLAN
FINAL ORDER (PP)
Petitioner,
12
13
NO. 07-3-02242-1
THOMAS L. VAN DAM,
vs.
SARA L. VAN DAM,
14
Respondent.
15
I. GENERAL INFORMATION
16
17
1.1
This parenting plan is:

The final parenting plan signed by the court pursuant to a decree of
dissolution entered on this date.
18
19
IT IS HEREBY ORDERED, ADJUDGED AND DECREED:

20
1.2
This parenting plan applies to the following child:
21
Name
Age
SILAS R. VAN DAM
22
23
II. BASIS FOR RESTRICTIONS
24
25
Under certain circumstances, as outlined below, the court may limit or prohibit a
parents contact with the child and the right to make decisions fo r the child.
PARENTING PLAN - i
WPF DR 01.0400 (7/2006); RCW 2 6 .0 9 .1 8 1 187; , 194
S:\CASES9Wan Dam\fmaHppfinal.wpd
A ttorneys at Law
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7774
2.1
PARENTAL CONDUCT (RCW 26.09.191(1), (2)).

Does not apply.
2
3
1 8 /3
2.2
OTHER FACTORS (RCW 26.09.191(3)).

Does not apply.
4
5
III. RESIDENTIAL SCHEDULE
The residential schedule must set forth where the child shall reside each day o f the
year, including provisions fo r holidays, birthdays offamily members, vacations, and
other special occasions, and what contact the child shall have with each parent.
Parents are encouraged to create a residential schedule that meets the developmental
needs o f the child and individual needs o f their family. Paragraphs 3.1 through 3.9 are
one way to write your residential schedule. I f you do not use these paragraphs, write
in your own schedule in paragraph 3.13.
7
8
9
10
These provisions set forth where the child shall reside each day of the year and what
contact tlie child shall have with each parent.
11
3.1
SCHEDULE FOR CHILDREN UNDER SCHOOL AGE.
12
Prior to enrollment in school, the child shall reside with the mother and father,
except for the following days and times when the child will reside with or be
with the other parent:
13
14
Every week schedule:

t
From 7:00 a.m. to 1:30 p.m. with father, Monday through Thursday,
*
From 5:00 p.m. to 7:00 a.m. with mother, Monday through Thursday.
From 5:00 p.m. Friday to 1:30 p.m. Sunday with father.
From 1:30 p.m. Sunday to 7:00 a.m. Monday with mother.
15
16
17
Times not otherwise listed, the child shall be in school or at childcare

because of the parents current work schedules.
18
19
3.2
SCHOOL SCHEDULE.
Upon enrollment in school, the child shall reside with the mother and father,
20
21
Same as Paragraph 3.1.
22
23
24
25
3.3
SCHEDULE FOR WINTER VACATION.

The child shall reside with the mother and father during winter vacation, except
for the following days and times when the child will reside with or be with the
other parent:
(
PARENTING PLAN-2
WPF DR Oi,0400 (6/2006); RCW 2 6 .0 9 .1 8 1 187;. 194
S:\CASES9WanDam'ippiemp.wpd
ATTORNEYS AT LAW
5920 100th S treet S.W., Suite 25
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7774
3.4
SCHEDULE FOR OTHER SCHOOL BREAKS.

The child shall reside with the mother and father during other school breaks,
3
4
3.5
SUMMER
SCHEDULE.
{
Upon completion of the school year, the child shall reside with the mother and
father, except for the following days and times when the child will reside with
or be with the other parent:
9
10
3.6
VACATION WITH PARENTS.

The schedule for vacation with parents is as follows:
11
Each parent shall be entitled to exercise up to two weeks of consecutive

vacation with the child over the summer during which time the other
parent's residential time shall be suspended.
12
13
Vacation shall further be defined as when the child goes out of the area
and leaves for a vacation.
14
15
3.7
SCHEDULE FOR HOLIDAYS.
16
The residential schedule for the child for the holidays listed below is as follows:
17
18
19
20
21
22
23
24
25
With Mother
(Specify whether
Odd/Even/Everv)
New Years Day

Martin Luther King Day
Presidents Day
Memorial Day
July 4th
Labor Day
Veterans Day
Thanksgiving Day
EVEN
See 3.1
See 3.1
See 3.1
EVEN
See 3.1
See 3.1
EVEN
With Father
(Specify whether
Odd/Even/Everv)
ODD
See 3.1
See 3.1
See 3.1
ODD
See 3.1
See 3.1
ODD
PARENTING PLAN - 3
WPF DR 01,0400 (6/2006); RCW 26.09.181;. 187; . 194
S:\CASES9\VanDam\pptemp.wpd
attorneys at Law
L akewood . WA 98499
(253) 581-0660
7774
3.8
9
10
Mothers Day
Fathers Day
Mothers Birthday
11
12
With Mother
(Specify whether
Odd/Even/Everv)
EVERY
Fathers Birthday
Childs Birthdays
13
14
With Father
(Specify whether
Odd/Even/Everv)
EVERY
EVERY
ODD
EVERY
EVEN
For purposes of this parenting plan, special occasions shall begin and end as
follows:
15
See Paragraph 3.1.
16
3.9
PRIORITIES UNDER THE RESIDENTIAL SCHEDULE.

Does not apply.
18
3.10
RESTRICTIONS.
Does not apply because there are no limiting factors in paragraphs 2.1 or 2.2.
20
21
EVEN
EVEN
SCHEDULE FOR SPECIAL OCCASIONS.
19
ODD
ODD
The residential schedule for the child for the following special occasions (for
example, birthdays) is as follows:
17
With Father
(Specify whether
Odd/Even/Everv)
For purposes of this parenting plan, a holiday shall begin and end as follows:
5
6
With Mother
(Specify whether
Odd/Even/Everv)
Christmas Eve
Christmas Day
1 8 /3 3 V 2
3.11
TRANSPORTATION ARRANGEMENTS.
%
22
23
24
Transportation costs are included in the Child Support Worksheets and/or the
Order of Child Support and should not be included here.
Transportation arrangements for the child between parents shall be as follows:
The receiving parent shall provide transportation except as follows:
25
PARENTING PLAN - 4
WPF DR 0 1.0400 (6/2006); RCW 26,09.181187; . 194
SACASES9\VanDam\pptempwpd
A ttorneys at Law
(253) 581-0660
During the weekly schedule, the father shall deliver the minor child to
school before it commences or child care no later than l :30 p.m.
Mother shall retrieve the child from child care or school at 5:00 p.m.
and return the child to fathers residence by 7:00 a.m.
2
3
3.12
DESIGNATION OF CUSTODIAN.
4
The child named in this parenting plan are scheduled to reside the majority of
the time with the mother and father. This parent is designated the custodian of
the child solely for purposes of all other state and federal statutes which require
a designation or determination of custody. This designation shall not affect
either parents rights and responsibilities under this parenting plan.
5
6
7
3.13
OTHER
8
a.
It is the responsibility of the parent scheduled to have the child to

arrange suitable alternative care, if necessary, and pay for the needed
care.
b.
Each parent shall notify the other at least forty-eight (48) hours in
advance if he or she is unable to comply with the regular schedule.
c.
Each parent shall keep the other apprized of his or her current residence
address and residence telephone number.
d.
Both parents shall have unlimited access to the childrens school, day
care, and medical records. Neither parent may revoke this provision by
telling the providers to disobey this court order.
e.
Telephone Access
9
10
11
12
13
14
15
16
The child shall have reasonable telephone privileges with the parent
with whom the child is not then residing, without interference of the
residential parent.
17
18
f.
Participation in Childs Events
19
1.
The child shall be accompanied by the parent with whom the

child is residing at the time of a given social event. The other
parent shall not be limited from attendance at that event,
providing said attendance by the non-residential parent is not
disruptive to the other participants.
2.
Each parent shall be responsible for keeping themselves advised

of school, athletic, and social events in which the child
participates. Both parents may participate in school activities
for the child, such as an open house, attendance at an athletic
event, etc.
20
21
22
23
24
25
PARENTING PLAN - 5
WPF DR 0! .0400 (6/2006); RCW 26.09.18 1 187;. 194
S:\CASES9\VanDam\pptcmp.pd
A ttorneys at Law
Lake w o o d , WA 98499
(253) 581-0660
7774
3.14
1 0 /3 1 /
SUMMARY OF RCW 26.09.430 - .480, REGARDING RELOCATION OF A

CHILD:
2
3
4
5
6
7
8
9
This is a summary only. For the full text, please see RCW 26.09.430 through
26.09.480.
If the person with whom the child resides a majority of the time plans to move,
that person shall give notice to every person entitled to court ordered time with
the child.
If the move is outside the childs school district, the relocating person must
give notice by personal service or by mail requiring a return receipt. This notice
must be at least 60 days before the intended move. If the relocating person
could not have known about the move in time to give 60 days notice, that
person must give notice within 5 days after learning of the move. The notice
must contain the information required in RCW 26.09.440. See also form
DRPSCU 07.0500 (Notice of Intended Relocation of A Child.)
r.
10
11
If the move is within the same school district, the relocating person must
provide actual notice by any reasonable means. A person entitled to time with
the child may not object to the move but may ask for modification under RCW
26.09.260.
12
13
Notice maybe delayed for 21 days if the relocating person is entering a

domestic violence shelter or is moving to avoid a clear, immediate and
unreasonable risk to health and safety.
14
15
16
If information is protected under a court order or the address confidentiality

program, it may be withheld from the notice.
A relocating person may ask the court to waive any notice requirements that
may put the health and safety of a person or a child at risk.
17
18
19
20
21
Failure to give the required notice may be grounds for sanctions, including
contempt.
If no objection is filed within 30 days after service of the notice of intended
relocation, the relocation will be permitted and the proposed revised
residential schedule may be confirmed.
A person entitled to time with a child under a court order can file an objection
to the childs relocation whether or not he or she received proper notice.
22
24
An objection may be filed by using the mandatory pattern form WPF DRPSCU
07.0700, (Objection to Relocation/Petition for Modification of Custody
Detree/Parenting Plan/Residential Schedule). The objection must be served on
all persons entitled to time with the child.
25
The relocating person shall not move the child during the time for objection
23
PARENTING PLAN - 6
WPF DR 01.0400 (6/2006); RCW 26.09.181;. 187; . 194
S:\CASES9\VanDam\ppteirp.wpd
Attorneys at Law
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7774
1 8 /3 1
unless: (a) the delayed notice provisions apply; or (b) a court order allows the
move.
1
2
If the objecting person schedules a hearing for a date within 15 days of timely
service of the objection, the relocating person shall not move the child before
the hearing unless there is a clear, immediate and unreasonable risk to the
health or safety of a person or a child.
3
4
5
WARNING: VIOLATION OF THE RESIDENTIAL PROVISIONS OF

THIS ORDER WITH ACTUAL KNOWLEDGE OF ITS TERMS IS
PUNISHABLE BY CONTEMPT OF COURT, AND MAY BE A
CRIMINAL OFFENSE UNDER RCW 9A.40.070(2). VIOLATION OF
THIS ORDER MAY SUBJECT VIOLATOR TO ARREST.
IV. DECISION MAKING
4.1
DAY TO DAY DECISIONS.

Each parent shall make decisions regarding the day-to-day care and control of
each child while the child is residing with that parent. Regardless of the
aliocation of decision making in this parenting plan, either parent may make
emergency decisions affecting the health or safety of the child.
10
11
12
4.2
MAJOR DECISIONS.
13
Major decisions regarding each child shall be made as follows:
14
Education decisions
Non-emergency health care
Religious upbringing
15
Joint
Joint
Mother/Father
16
4.3
RESTRICTIONS IN DECISION MAKING.
17
18
19
20
21
Does not apply because there are no limiting factors in paragraphs 2.1 and 2.2
above.
,
V. DISPUTE RESOLUTION
The purpose o f this dispute resolution process is to resolve disagreements about

carrying out this parenting plan. This dispute resolution process may, and under some
local court rules or the provisions o f this plan must, be used before filing a petition to
modify the plan or a motion for contempt fo r failing to follow the plan.
22
Disputes between the parties shall be submitted to (list person or agency):

23
counseling by Craig Black
24
25
PARENTING PLAN - 7
WPF DR 01.0400 (6/2006); RCW 26.09.181; .187; .194
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i.
A ttorneys at Law
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7774
The cost of this process shall be allocated between the parties as follows:
50% mother, 50 % father.
2
3
1 0 /3 1 /'
The counseling, mediation, or arbitration dispute resolution process shall be

commenced by notifying the other party by written request certified mail.
In the dispute resolution process:

5
(a)
Preference shall be given to carrying out this Parenting Plan.
(b)
Unless an emergency exists, the parents shall use the designated process
to resolve disputes relating to implementation of the plan, except those
related to financial support.
(c)
A written record shall be prepared of any agreement reached in

counseling or mediation and of each arbitration award and shall be
provided to each party.
(d)
If the court finds that a parent has used or frustrated the dispute
resolution process without good reason, the court shall award attorneys
fees and financial sanctions to the other parent.
(e)
The parties have the right of review from the dispute resolution process
to the superior court.
6
7
8
9
10
11
12
13
14
VI. OTHER PROVISIONS

15
There are no other provisions.

16
17
18
, VII. DECLARATION FOR PROPOSED PARENTING PLAN

Does not apply.
VIII. ORDER BY THE COURT
19
20
It is ordered, adjudged and decreed that the parenting plan set forth above is adopted
and approved as an order of this court.
21
22
WARNING: Violation of residential provisions of this order with actual knowledge of

its terms is punishable by contempt of court and may be a criminal offense under
RCW 9A1.40.060(2). Violation of this order may subject a violator to arrest.
23
24
When mutual decision making is designated but cannot be achieved, the parties shall
make a good faith effort to resolve the issue through the dispute resolution process.
25
If a parent fails to comply with a provision of this plan, the other parents obligations
PARENTING PLAN - 8
WPF DR 01.0400 (6/2006); RCW 26.09.181;. 187;. 194
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A ttorneys at Law
Lakewood . WA 98499
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7774
iS /3 1 ^ 2
under the plan are not affected.

DONE IN OPEN COURT this
f) day
0 < X i
, 2007.
4
-JttegS/Commissio
5
6
PRESENTED BY:
8
9
CLINT P. JOHNSON! WSBA# 14794
10
Of Attorneys for Petitions
j
Cl I r K'S
OFFlfcl
OCT 3 02007
pj .
IN COUNTY1
11
12
THOMAS L. VAN DAM

Petitioner
APPROVED AS TO FORM; NOTICE OF

PRESENTMENT WAIVED:
13
Pk e vvnw
I n STOCK,
s r a c TKY'f!!VASHIN<3TCN
County Clert;
----
DEPUTT
14
15
16
By
SARA L. VAN DAM,

Respondent
SARA l /VAN ÂKI

Respondent
17
18
19
20
21
22
23
24
25
PARENTING PLAN - 9
WPF DR 01.0400 (6/2006); RCW 26.09.181; .187; .194
S:\CASES9\VanDanvpptcmpwpd
ATTORNEYS AT LAW
(253) 581-0660
7774
10^31
2
3
4
5
6
7
9
10

THOMAS L. VAN DAM,
Petitioner,
11
vs.
12
13
NO. 07-3-02242-1
CERTIFICATION OF
CLASS RE:
THOMAS L. VAN DAM
SARA L. VAN DAM,

Respondent.
14
15
16
17
18
19
20
21
22
23
24
25
-1
S 'CASES9\VanDam\Parcnting Class Certification cover sheet rc Thomas wpd
A ttorneys at Law
7 774
Pierce County Superior Court Number:
T h is
Certificate of attendance
is h e re b y a w a rd e d to
~ V v \o trsCfr
L . \l< \n
fo r a tte n d in g an d c o m p le tin g th e
J nip act of tDivwce

O n C fiiC c b te a
S eminent
C o n d u c te d b y G a te w a y s fo r Y o u th an d F a m ilie s
In P ie rce C o u n ty , W a s h in g to n o n th is d a y
SEPTEMBER 8, 2007
1 0 /3 1 /'2 8 0 ?
60111
7774
1
2
3
4
5
6
7
9
10

THOMAS L. VAN DAM,
Petitioner,
11
vs.
12
13
NO. 07-3-02242-1
CERTIFICATION OF
CLASS RE: SARA L. VAN DAM
SARA L. VAN DAM,
14
Respondent.
15
16
17
18
19
20
21
22
23
24
25
-I
S:\CASES9WanDam\Parenting Class Certification cover sheet re Sara wpd
Attorneys at Law
LAKEWOOD. WA 98499
660
7774
1 0 /3 1 ^2 8 8 7
C o u rt C a u se N u m b er:
THIS CERTIFIES THAT
Van Ham, Sara

Has successfully completed the four-hour class,
What Children o f Divorce Really Need

Presented by Lesa Swanson, LICSW and Richard MacLeod,LICSW
Dated this 8th day o f October, 2007 at the City o f Tacoma, State o f Washington.
L esa S w a n so n , L IC S W
L ocation: M a ry B rid g e C h ild r e n 's H ea lth C en ter
38113
7774
1 8 /3 1 /2
2
1N countT
OCT 3
omcE
m *.
PIERCE C O U N TY Â SnH^ , Te?l!)

KEVIN STOCK/C/untyoEpun
0 2007
BY.
6
7
9
10

THOMAS L. VAN DAM,
NO. 07-3-02242-1
ORDER OF CHILD SUPPORT
FINAL (ORS)
Petitioner,
11
vs.
12
Clerks Action Required.

13
SARA L. VAN DAM,

Respondent.I.
14
15
I. JUDGMENT SUMMARY
16
Does not apply because no attorneys fees or back support has been ordered.
17
18
19
II. BASIS
2.1
This order is entered pursuant to a:
20
Decree of Dissolution entered on this date.
21
22
2.2
23
CHILD SUPPORT WORKSHEET.

The child support worksheet which has been approved by the court is attached
to this order and is incorporated by reference or has been initialed and filed
separately and is incorporated by reference.
24
25
TYPE OF PROCEEDING
2.3
OTHER:
ORDER OF CHILD SUPPORT - ]

WPF DR 01.0500 (7/2006); RCW 26.26.132; 26.26.132(5)
S:\CASELS9Wan DanMnaftors final.wpd
A ttorneys at Law
LAKEWOOD, WA 98499
(253)581-0660
7774
IT IS ORDERED that:
3.1
4
5
CHILDREN FOR WHOM SUPPORT IS REQUIRED.

Name (Tirst/last)
Age
Silas R. Van Dam

3.2
1 6 /3 1 ^2
PERSON PAYING SUPPORT (OBLIGOR).
Name (first/last):
Sara L. Van Dam
Birth date:
09/22/1975
Service Address*:
P O Box 7143
Bonney Lake, WA 98391
9
* You may list an address that is not your residential address where you agree
to accept legal documents.
10
THE OBLIGOR PARENT MUST IMMEDIATELY FILE WITH THE

COURT AND THE WASHINGTON STATE CHILD SUPPORT REGISTRY,
AND UPDATE AS NECESSARY, THE CONFIDENTIAL INFORMATION
FORM REQUIRED BY RCW 26.23.050.
11
12
13
16
THE OBLIGOR PARENT SHALL UPDATE THE INFORMATION

REQUIRED BY PARAGRAPH 3.2 PROMPTLY AFTER ANY CHANGE IN
THE INFORMATION. THE DUTY TO UPDATE THE INFORMATION
CONTINUES AS LONG AS ANY MONTHLY SUPPORT REMAINS DUE
OR ANY UNPAID SUPPORT DEBT REMAINS DUE UNDER THIS
ORDER.
17
Monthly Net Income:
14
15
18
3.3
$2,310.00
PERSON RECEIVING SUPPORT (OBLIGEE):
19
Name (first/last):
Thomas L. Van Dam
20
Birth date:
10/21/1969
21
Service Address*:
16014 - 64th St. E #C

Sumner, WA 98390
22
23
24
25
* You may list an address that is not your residential address where you agree
to accept legal documents.
THE OBLIGEE MUST IMMEDIATELY FILE WITH THE COURT AND
THE WASHINGTON STATE CHILD SUPPORT REGISTRY, AND
UPDATE AS NECESSARY, THE CONFIDENTIAL INFORMATION FORM
ORDER OF CHILD SUPPORT - 2

WPF DR 0 1.0500 (7/2006); RCW 26.26.122; 26.26.132(5)
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REQUIRED BY RCW 26.23.050.
THE OBLIGEE SHALL UPDATE THE INFORMATION REQUIRED BY

PARAGRAPH 3.3 PROMPTLY AFTER ANY CHANGE IN THE
INFORMATION. THE DUTY TO UPDATE THE INFORMATION
CONTINUES AS LONG AS ANY MONTHLY SUPPORT REMAINS DUE
OR ANY UNPAID SUPPORT DEBT REMAINS DUE UNDER THIS
ORDER.
3
4
5
Monthly Net Income:
$3,641.35
6
The Obligor may be able to seek reimbursement for day care or special child
rearing expenses not actually incurred. RCW 26.19.080.
3.4
SERVICE OF PROCESS.
SERVICE OF PROCESS ON THE OBLIGOR AT THE ADDRESS
REQUIRED BY PARAGRAPH 3.2 OR ANY UPDATED ADDRESS, OR
ON THE OBLIGEE AT THE ADDRESS REQUIRED BY
PARAGRAPH 3.3 OR ANY UPDATED ADDRESS, MAY BE ALLOWED
OR ACCEPTED AS ADEQUATE IN ANY PROCEEDING TO
ESTABLISH, ENFORCE, OR MODIFY A CHILD SUPPORT ORDER
BETWEEN THE PARTIES BY DELIVERY OF WRITTEN NOTICE TO
THE OBLIGOR OR OBLIGEE AT THE LAST ADDRESS PROVIDED.
10
11
12
13
3.5
TRANSFER PAYMENT.
14
The obligor parent shall pay the following amounts per month for the following
children:
15
16
Name
Amount
17
Silas R. Van Dam
$0.00
18
T otal M onthly T ransfer A mount
$0.00
THE OBLIGOR PARENTS PRIVILEGES TO OBTAIN OR MAINTAIN

A LICENSE, CERTIFICATE, REGISTRATION, PERMIT, APPROVAL,
OR OTHER SIMILAR DOCUMENT ISSUED BY A LICENSING
ENTITY EVIDENCING ADMISSION TO OR GRANTING
AUTHORITY TO ENGAGE IN A PROFESSION, OCCUPATION,
BUSINESS, INDUSTRY, RECREATIONAL PURSUIT, OR THE
OPERATION OF A MOTOR VEHICLE, MAY BE DENIED OR MAY
BE SUSPENDED IF THE OBLIGOR PARENT IS NOT IN
COMPLIANCE WITH THIS SUPPORT ORDER AS PROVIDED IN
CHAPTER 74.20A REVISED CODE OF WASHINGTON.
19
20
21
22
23
24
3.6
STANDARD CALCULATION.
25

WPF DR 01.0500 (7/2006); RCW 26.26.132; 26.26.132(5)
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7774
3.6
1 0 /3 1 /2 8 8 7
STANDARD CALCULATION.
$368.75 per month. (See Worksheet A, line 15.)
3.7
REASONS FOR DEVIATION FROM STANDARD CALCULATION.

The child support amount ordered in paragraph 3.5 deviates from the standard
calculation for the following reasons:
The child spends a significant amount of time with the parent who is obligated
to make a support transfer payment. The deviation does not result in
insufficient funds in the receiving parents household to meet the basic needs of
the child. The child does not receive public assistance.
3.8
REASONS WHY REQUEST FOR DEVIATION WAS DENIED.

Does not apply. A deviation was ordered.
3.9
STARTING DATE AND DAY TO BE PAID.

Starting Date:
November 1, 2007
Day(s) of the month support is due: n/a

3.10
INCREMENTAL PAYMENTS.
Does not apply.
3.11
HOW SUPPORT PAYMENTS SHALL BE MADE.

Does not apply.
3.12
WAGE WITHHOLDING ACTION

Withholding action may be taken against wages, earnings, assets, or benefits,
and liens enforced against real and personal property under the child support
statutes of this or any other state, without further notice to the obligor parent at
any time after entry of this order unless an alternative provision is made below:
[If the court orders immediate wage withholding in a case where Division of
Child Support does not provide support enforcement services, a mandatory
wage assignment under Chapter 26.18 RCW must be entered and support
payments must be made to the Support Registry.]
3.13
TERMINATION OF SUPPORT.
Support shall be paid:
Until the child reaches the age of 18 or graduates from high school,

WPF DR 01.0500 (7/2006); RCW 26.26.132; 26.26.132(5)
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whichever occurs last, except as otherwise provided below in Paragraph

3.14.
1
2
3.14
POST SECONDARY EDUCATIONAL SUPPORT.
3
The right to petition for post secondary support is reserved, provided that the
right is exercised before support terminates as set forth in paragraph 3.13.
4
5
3.15
PAYMENT FOR EXPENSES NOT INCLUDED IN THE TRANSFER

PAYMENT.
6
The mother shall pay 50% and the father 50% (each parents proportional share
of income from the Child Support Schedule Worksheet, line 6) of the following
expenses incurred on behalf of the children listed in Paragraph 3.1:
7
8
[x]
[x]
Payments shall be made to the provider of the service.
10
11
3.16
12
13
PERIODIC ADJUSTMENT.
Does not apply.
3.17
INCOME TAX EXEMPTIONS.

Tax exemptions for the children shall be allocated as follows:
14
Father shall be entitled to claim minor child during odd numbered years;
and Mother shall be entitled to claim minor child during even numbered
years.
15
16
17
18
day care.
educational expenses.
The parents shall sign the federal income tax dependency exemption waiver.
3.18
MEDICAL INSURANCE FOR THE CHILDREN LISTED IN

PARAGRAPH 3.1.
19
20
21
Unless one or more of the alternatives below are checked, each parent shall
maintain or provide health insurance coverage if:
Alternative 3: The parent below is not obligated to provide health insurance
coverage.
22
Mother
23
24
This parent is not obligated to provide health insurance coverage

because:
25
The other parent provides insurance coverage.


WPF DR 01.0500 (7/2006); RCW 26.26.132; 26.26.132(5)
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1
2
The parents shall maintain health insurance coverage, if available for the
children listed in paragraph 3.1, until further order of the court or until health
insurance is no longer available through the parents employer or union and no
conversion privileges exist to continue coverage following termination of
employment.
3
4
5
A parent who is required under this order to provide health insurance coverage
is liable for any covered health care costs for which that parent receives direct
payment from an insurer.
6
7
A parent who is required under this order to provide health insurance coverage
shall provide proof that such coverage is available or not available within
twenty days of the entry of this order to the physical custodian or the
Washington State Support Registry if the parent has been notified or ordered to
make payments to the Washington State Support Registry.
8
9
10
If proof of health insurance coverage is available or not available is not

provided within twenty days, the parent seeking enforcement or the Department
of Social and Health Services may seek direct enforcement of the coverage
through the obligors employer or union without further notice to the obligor as
provided under Chapter 26.18 RCW.
11
12
13
3.19
14
EXTRAORDINARY HEALTH CARE EXPENSES.

Unless specifically ordered otherwise, the person receiving support is
responsible for ordinary health care expenses of the child. However, both
parents have an obligation to pay their share of extraordinary health care
expenses. Extraordinary health care expenses mean those monthly medical
expenses that exceed 5% of the basic support obligation from the Child Support
Schedule Worksheet, Line 5.
15
16
17
The OBLIGOR and OBLIGEE shall each pay 50% of extraordinary health care
expenses (the obligors proportional share of income from the Child Support
Schedule Worksheet, line 6).
18
19
3.20
BACK CHILD SUPPORT.
20
No back child support is owed at this time.
21
3.21
BACK INTEREST.
22
No back interest is owed at this time.
23
3.22
OTHER:
24
The parties agree to establish a joint bank account for additional expenses
related to Silas. The account shall be used for such expenses as school clothing
25

_ ^ ^
__
_ TTTT

WPF DR 0 1.0500 (7/2006); RCW 2 6 .2 6 .132; 26.26.132(5)
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1
2
3
4
1 0 /3 1 /
and supplies, extracurricular activities, sports fees and equipment, and other
uses the parties might agree upon. It is not to be used as the primary source of
funds for expenses related to Silas.
Initially, Father shall deposit $150.00 per month into the account and Mothers
deposits shall be discretionary. Either party may individually withdraw funds
from this account and shall provide notice and copies of all relevant receipts to
the other party within ten (10) days.
5
DONE IN OPEN COURT this D O day
6
OcY
7
Ju^ge/Commissioner
8
9
PRESENTED BY:
10
FAUBION, JOHNS
EDER, P.S.
11
AM OCT3 02007
12
13
14
15
16
17

PRESENTMENT WAIVED:
18
19
20
21
22
23
24
25

WPF DR 01.0500 (7/2006); RCW 26.26.132; 26.26.132(5)
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ATTORNEYS AT LAW

(253) 581-0660
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count 'F cl I rk 'S

A.M.
o f f ic e
cr 3 02007
P.M.
T ^ GT*
By______STOC^
Cpunty c
Clerk
z
oepury
WASHINGTON STATE CHILD SUPPORT SCHEDULE WORKSHEETS

[ X p ro p o s e d by
[ ] Mother [ X ] Father [ ] State of WA [ ] O th e r_____________________________.(CSWP)

Or, [ ]Signed by the Judiciaf/Reviewing Officer. (CSW)
MOTHER SARA L. VAN DAM

COUNTY PIERCE
FATHER THOMAS L. VAN DAM

SUPERIOR COURT/OAH CASE NO.
07-3-02242-1
CHILD SUPPORT ORDER SUMMARY REPORT

A. The order [ ] does [ X ] does not replace a prior court or adminstrative order.
B. The STANDARD CALCULATION listed on line 15e of the W orksheet fo r the paying parent is:
$368.75.
C. The TRANSFER AMOUNT ordered by the Court from the Order of Child Support
1
is: $0.00 to be paid by the [ ] m other [ X ] father.
|D. The Court deviated (changed) from the STANDARD CALCULATION fo r the following reasons:
j
[ ] Does not apply
[ ] Nonrecurring income
[ ] Sources of income and tax planning
[ X ] Split custody
[ ) Residential schedule (including shared custody)
[ ] Children from other relationships for w hom the parent owes support
[ ] High debt not voluntarily incurred and high expenses for the child(ren)
[ ] Other (please describe):
E. Income for the Father is ( ] imputed [ X ] actual income.

Income for the Mother is [ ] imputed [ X ] actual income.
F. If applicable: [ ] All health care, day care and special child rearing expenses are included in the worksheets in
Part II.
WORKSHEETS
Children and Ages Silas Van Dam 5
P art I: B a sic S u p p o rt O b lig a tio n (See Instructions, page 1)
1. Gross Monthly Income
F a th e r
M o th e r
$4,420.00
$2,773.00
b. Interest and Dividend Income
$0.00
$0.00
c. Business Income
$0.00
$0.00
d. Spousal Maintenance Received
$0.00
$0.00
e. Other Income
$0.00
$0.00
$4,420.00
$2,773.00
a. W ages and Salaries
f. Total Monthly Gross Income (add lines 1a through 1e)

W SCSS-W orksheets - M andatory (CSW /CSW P) 7/2007 page 1 o f 5
Original
Faubion, Johnson & Reeder, P.S.

10/17/2007 4:08PM
80121
Father
2. Monthly Deductions from Gross Income
M o ther
a. Income Taxes (Federal and State)
$235.00
$251.00
b. F1CA (Social Security plus M edicare)/Self-Em pioym ent Taxes
$325.00
$212.00
$0.00
$0.00
$52.00
$0.00
$167.00
$0.00
f. Spousal Maintenance Paid
$0.00
$0.0Q
g. Normal Business Expenses
$0.00
$Q.OO
$779.00
$463.00
$3,641,00
$2,310.00
c. State Industrial Insurance Deductions

d. Mandatory Union/Professional Dues
e. Pension Plan Payments
h. Total Deductions from Gross Income (add lines 2a through 2g)

3. Monthly Net Income (line 1f minus line 2h)
4. Combined Monthly Net lncome(add father's and mother's net incomes from line 3)
^ g51 QQ
(If combined monthly net income is less than $600, skip to line 7.)
5. Basic Child Support Obligation (enter total am ount in box - > )
Silas Van Dam
$862
6. Proportional Share of Income

(each parent's net income from line 3 divided by line 4)
7. Each Parent's Basic Child Support Obligation
(multiply each number on line 6 by line 5)
(If combined net monthly income on line 4 is less than $600, enter each parent's support
(advisory)
38.82%
61.18%
$527.37
$334.63
obligation of $25 per child. Number of children: 1. Skip to line 15a and enter this amount)
Part II: Health Care, Day Care, and Special Child Rearing Expenses (See instructions, page 3)
8. Health Care Expenses
a. Monthly Health Insurance Premiums Paid fo r Child(ren)
b. Uninsured Monthly Health Care Expenses Paid for Child(ren)
c, Total Monthy Health Care Expenses (line 8a plus line 8b)
$131.00
$0.00
$0.00
$0.00
$131.00
$0.00
d. Combined Monthly Health Care Expenses

(add father's and mother's totals from line 8c)
e. Maximum Ordinary Monthly Health Care (m ultiply line 5 times 0.05)
$43,10
f. Extraordinary Monthly Health Care Expenses

(tine 8d minus 8e, if "0 or negative enter "0")
$87.90
9. Day Care and Special Child Rearing Expenses

a. Day Care Expenses
$0.00
$0.00
b. Education Expenses
$0.00
$0.00
c. Long Distance Transportation Expenses
$0.00
$0.00
$0.00
$0.00
d. Other Special Expenses (describe)
e. Total Day Care and Special Expenses (add lines 9a through 9d)
10. Combined Monthly Total of Day Care and Special Expenses
(add father's and mother's day care and special expenses from line 9e)
WSCSS-Worksheets - Mandatory (CSW/CSWP) 7/2007 page 2 of 5
$0.00
7774
1 1 , Total Extraordinary Health Care, Day Care, and Special Expenses
(line 8 f
d I us
line 1 0)
1 9 /3 1 /2 0 0 7
$87.90
F a th e r
M o th e r
$53.78
$34.12
$581.15
$368.75
$131.00
$0.00
$0.00
$0.00
$131.00
$0.00
12, Each Parent's Obligation for Extraordinary Health Care. D ay Care, and Special Expenses
(m ultiply each num ber on line 6 by line 11)
P art III: G ro ss C h ild S u p p o rt O b lig a tio n

13. Gross Child Support Obligation (line 7 plus line 12)
P art IV: C h ild S u p p o rt C re d its
(See instructions, page 3)
14. Child Support Credits

a. Monthly Health Care Expenses Credit
b. Day Care and Special Expenses Credit
c. Other Ordinary Expense Credit (describe)
d. Total Support Credits (add lines 14a through 14c)
Part V: S tan d a rd C a lc u la tio n /P re s u m p tiv e T ra n s fe r P aym ent (See Instructions, page 4)

15. Standard Calculation
$0.00
$0.00
$450.15
$368.75
c. Amount on line 15b adjusted to meet 45% net income limitation
$1,638.45
$1,039.50
d. Amount on line 15b adjusted to meet need standard limitation
$2,625.00
$1,294.00
$450.15
$368.75
a. Amount from line 7 if line 4 is below $600.
Skip to part VI.
b. Line 13 minus line 14d, if line 4 is over $600 (see below if applicable).
Limitation standards adjustments
e. Enter the lowest amount of lines 15b, 15c or 15d.

P art VI: A d d itio n a l F a c to rs fo r C o n sid e ra tio n
16. Household Assets
(See instructions, page 4)
(List the estim ated present value of all m ajor household assets.)
a. Real Estate
b. Stocks and Bonds
c. Vehicles
d. Boats
e. Pension/IRAs/Bank Accounts
f. Cash
g. Insurance Plans
h. Other (describe)
17. Household Debt (List liens against household assets, extaordinary debt)
Father's
Household
M other's
Household
60123
7774
(Household Debt continued)
18. Other H ousehold Income

a. Income of Current Spouse (If not the other parent o f this action.)
Name
Name
b. Income o f O ther Adults in Household
Name
Name
c. Income of Children (If considered extraordinary)
Name
Name
d. Income From Child Support
Name
Name
e. Income From A ssistance Programs
Program
Program
f. Other Income (describe)
19. Non-Recurring Income (describe)
20. Child Support Paid For Other Children

Name/Age
Name/Age
21. Other Children Living In Each Household (First names and ages)
Father's
Household
1 8 /3 1 /2 8 0 7
Mother's
Household
88124
7774
1 6 /3 1 V2887
This worksheet has been certified by the State of W ashinton Office of the A dm instrator fo r the Courts.
WSCSS-Worksheets' (CSW) 9/2000 page 5 of 5
2001-05 Thomas E. Jaffe
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07-3-02242-1
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10-31-07
2
3
4
iTr Deputy
5
6
7
9
10

THOMAS L. VAN DAM,
Petitioner,
11
FINDINGS OF FACT AND

CONCLUSIONS OF LAW
vs.
12
13
NO. 07-3-02242-1
SARA L. VAN DAM,
14
Respondent.I.
15
16
17
I. BASIS FOR FINDINGS

The findings are based on agreement.
II. FINDINGS OF FACT
18
19
Upon the basis of the court record, the court FINDS:
20
2.1
21
22
23
RESIDENCY OF PETITIONER.
The petitioner is a resident of the State of Washington.
2.2
NOTICE TO THE RESPONDENT.

The respondent accepted service on June 23, 2007.
24
25
CONCLUSIONS OF LAW - 1
WPF DR 04.0300 (6/2006); CR 52; RCW 26.09.030; .070(3)
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2.3
BASIS OF PERSONAL JURISDICTION OVER THE RESPONDENT.

The facts below establish personal jurisdiction over the respondent.
The respondent is presently residing in Washington.

The parties lived in Washington during their marriage and the petitioner
continues to reside, or be a member of the armed forces stationed, in
this state.
4
5
2.4
DATE AND PLACE OF MARRIAGE.
6
The parties were married on March 20, 1999 at Newport, Oregon.
7
2.5
STATUS OF THE PARTIES.
8
Husband and wife separated in April, 2006.
9
2.6
STATUS OF THE MARRIAGE.
10
The marriage is irretrievably broken and at least 90 days have elapsed since the
date the petition was filed and since the date the summons was served or the
respondent joined.
11
12
2.7
SEPARATION CONTRACT OR PRENUPTIAL AGREEMENT.
13
There is no written separation contract or prenuptial agreement.
14
2.8
COMMUNITY PROPERTY.
15
The parties have the following real or personal community property:
16
1.
2.
3.
17
18
4.
19
5.
20
6.
21
22
23
7.
2.9

in his possession;
possession;
in his name;
SEPARATE PROPERTY.
24
The husband has no real or personal separate property.
25
The wife has no real or personal separate property.

WPF DR 04.0300 (6/2006); CR 52; RCW 26.09.030; .070(3)
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2.10
iS l/3
COMMUNITY LIABILITIES.
The parties have incurred the following community liabilities:
2
3
Creditor
Amount
1. Any and all expenses associated with the vehicle in his/her possession to
include insurance, tabs and repairs; and
2. Any and all expenses associated with his/her residence;
3. Obligation owing to Alaska Federal Credit Union for 2005 Ford Focus;
6. Chase credit card
7. Unicom Financial for loan.
4
5
6
7
8
2.11
SEPARATE LIABILITIES.
9
The husband has no known separate liabilities.
10
The wife has no known separate liabilities.
11
2.12
MAINTENANCE.
12
Maintenance was not requested.
13
2.13
14
Does not apply.
15
2.14
PROTECTION ORDER.
16
Does not apply.
17
2.15
FEES AND COSTS.
18
There is no award of fees or costs.
19
2.16
PREGNANCY.
20
The wife is not pregnant.
21
2.17
DEPENDENT CHILDREN.
22
The children listed below are dependent upon either or both spouses.
23
24
Name of
of Child
Age
25
Silas R. Van Dam

WPF DR 04.0300 (6/2006); CR 52; RCW 26.09.030; .070(3)
S:\CASES9\VanDam\fmaI\lTcl.wpd
Mothers
Name
Fathers
Name
Sara Van Dam
Thomas Van Dam
FAUBION, JOHNSON
At t o r n e y s
& REEDER,
at
La w

U kew ood , WA 98499
(253) 581 -0660
P.S.
7774
2.18
JURISDICTION OVER THE CHILDREN.

This court has jurisdiction over the children for the reasons set forth below.
This state is the home state of the children because:
the children lived in Washington with a parent or a person acting

as a parent for at least six consecutive months immediately
preceding the commencement of this proceeding.
5
6
1 8 /3 1 ^2
2.19
PARENTING PLAN.
The parenting plan signed by the court on this date is approved and
incorporated as part of these findings.
8
This parenting plan is the result of an agreement of the parties.
9
2.20
CHILD SUPPORT.
10
There are children in need of support and child support should be set pursuant
to the Washington State Child Support Schedule. The Order of Child Support
signed by the court on this date and the child support worksheet which has been
approved by the court are incorporated by reference in these findings.
11
12
13
2.21
OTHER:
14
15
III. CONCLUSIONS OF LAW
16
The court makes the following conclusions of law from the foregoing findings of fact:
17
3.1
The court has jurisdiction to enter a decree in this matter.
18
19
3.2
3.3
22
23
24
25
GRANTING OF A DECREE.
The parties should be granted a decree,
20
21
JURISDICTION.
PREGNANCY.
Does not apply.
3.4
DISPOSITION.
The court should determine the marital status of the parties, make provision for
a parenting plan for any minor children of the marriage, make provision for the
support of any minor child of the marriage entitled to support, consider or

WPF DR 04.0300 (6/2006); CR 52; RCW 26.09.030; .070(3)
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approve provision for the maintenance of either spouse, make provision for the
disposition of property and liabilities of the parties, make provision for the
allocation of the children as federal tax exemptions, make provision for any
necessary continuing restraining orders, and make provision for the change of
name of any party. The distribution of property and liabilities as set forth in the
decree is fair and equitable.
2
3
4
3.5
5
Does not apply.
6
c OUNTVF CLER.s 0FF( c e
3.6
PROTECTION ORDER.
7
**
Does not apply.
C f 3 0 2007
p.m,
8
3.7
ATTORNEYS FEES AND COSTS.
----- oepury
Does not apply.

10
3.8
OTHER:
11
12
13
14
15
16
PRESENTED BY:
17
F A U ^ N , JO
REEDER, P.S.
18
19
20
By
CONT P. JOHNSON, WSBA# 14794
Of Attorneys for Paiitioner
21
22
23
24
25
CONCLUSIONS OF LAW -5
WPF DR 04.0300 (6/2006); CR 52; RCW 26,09.030; .070(3)
S:\CAS ES9W anDom\fina!\ffc [,wpd

Attorneys at Law
5 9 2 0 1 0 Ot h S treet S. W.. Suite 25
Lakew ood . WA 98499
(253) 581-0660
7774
1
2
10/31S2
STATE OF WASHINGTON )
) ss:
County of Pierce
)
THOMAS L. VAN DAM, being first duly sworn on oath, deposes and says:
I am the Petitioner in this case; and I have read the foregoing findings of fact and
have also read the conclusions of law, decree, and the support order and related
documents, if included herein; and they are true and accurate to the best of my
knowledge. I am not seeking any relief beyond that specifically requested in the
petition.
The Wife is not now pregnant.
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Findings of Fact and Conclusions of Law

Verification by Petitioner
S:'CASES9\Van DarrAflnafl ffd.wpd
A ttorneys at Law
(253)581-0660
???4
1
2
1 8 /3
STATE OF WASHINGTON )
) ss:
County of Pierce
)
SARA L. VAN DAM, being first duly sworn on oath, deposes and says:
I am the Respondent in this case; and I have read the foregoing findings of fact
and have also read the conclusions of law, decree, and the support order and related
documents, if included herein; and they are true and accurate to the best of my
knowledge. The support requested is in compliance with the Uniform Support
Guidelines. Neither of us have any other children except those mentioned herein. J am
not now pregnant.
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Findings of Fact and Conclusions of Law

Verification by Respondent
S:\CASES9WanDam\fmal\ncl wpd
A ttorneys at Law
(253)581-0660
7774
07-3-02242-1
28540462
DCD
10^3
10-31-07
IN CUNTyF t|D
OFFICE
3
p*"'
4
CJ 3 02007
p.Mi
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deputy
6
7
9
10

THOMAS L. VAN DAM,
Petitioner,
11
NO. 07-3-02242-1
DECREE OF DISSOLUTION
(DCD)
vs.
12
Clerks Action Required.

13
SARA L. VAN DAM,

Respondent.
14
15
I. JUDGMENT/ORDER SUMMARIES
16
17
1.1
Does not apply.
18
19
1.2
REAL PROPERTY JUDGMENT SUMMARY:

Does not apply.
20
21
RESTRAINING ORDER SUMMARY.
1.3
MONEY JUDGMENT SUMMARY.
22
Does not apply.
23
END OF SUMMARIES
24
25
DECREE OF DISSOLUTION (DCD) - 1

WPF DR 04.0400 (6/2006); RCW 26.09.030; .040; .070(3)
S:\CAS ESQWan Dam\finaMecrcc. wpd
A ttorneys at Law

(253) 581-0660
7774
II. BASIS
1
2
Findings of Fact and Conclusions of Law have been entered in this case.
III. DECREE
3
4
IT IS DECREED that:
3.1
6
7
lS /3
STATUS OF THE MARRIAGE.

The marriage of the parties is dissolved.
3.2
PROPERTY TO BE AWARDED THE HUSBAND.

The husband is awarded as his separate property the following property (list
real estate, furniture, vehicles, pensions, insurance, bank accounts, etc.):
9
10
1.
2.
11
3.
12
4.
13
5.
14
6.

in his possession;
possession;
in his name;
15
3.3
PROPERTY TO BE AWARDED TO THE WIFE.
16
The wife is awarded as her separate property the following property (list real
estate, furniture, vehicles, pensions, insurance, bank accounts, etc.):
17
1.
2.
18
19
3.
20
4.
21
5.
22
6.

Any and all household goods and furnishings presently in her
possession;
Any and all clothing, jewelry and personal effects in her
possession;
in her name;
earned during her employment; and her Social Security benefits
Any and all life insurance insuring her life.
23
3.4
LIABILITIES TO BE PAID BY THE HUSBAND.
24
The husband shall pay the following community or separate liabilities:
25

WPF DR 04,0400 (6/2006); RCW 26.09.030; .040; .070(3)
S.'.CASESQWanDam'.finaMecrct.wpd
A ttorneys at Law
(253) 581-0660
7774
Amount
Creditor
1 0 /3 1 ^
1. Any and all expenses associated with the vehicle in his possession to
2. Any and all expenses associated with his residence;
3. Obligation owing to Alaska Federal Credit Union for 2005 Ford
Focus;
2
3
4
5
Unless otherwise provided herein, the husband shall pay all liabilities incurred
by him since the date of separation.
6
7
3.5
LIABILITIES TO BE PAID BY THE WIFE.
8
The wife shall pay the following community or separate liabilities:
9
Creditor
Amount
10
1. Any and all expenses associated with the vehicle in her possession to
2. Any and all expenses associated with her residence;
3. Chase for credit card
4. Unicom Financial for loan
11
12
13
Unless otherwise provided herein, the wife shall pay all liabilities incurred by
her since the date of separation.
14
15
3.6
HOLD HARMLESS PROVISION.

Each party shall hold the other party harmless from any collection action
relating to separate or community liabilities set forth above, including
reasonable attorneys fees and costs incurred in defending against any attempts
to collect an obligation of the other party.
16
17
18
3.7
SPOUSAL MAINTENANCE.
19
Does not apply.
20
3.8
RESTRAINING ORDER.
21
Does not apply.

22
3.9
PROTECTION ORDER
23
Does not apply.
24
3.10
JURISDICTION OVER THE CHILDREN
25
DECREE OF DISSOLUTION (DCD) -3

WPF DR 04.0400 (6/2006); RCW 26.09.030; .040; .070(3)
SACASES9\VanDam\finaI\decrcc.wpd
At to r n e y s
5920 100
street
at
La w
s.w..
suite 25
WA 98499
(253) 581-0660
La k e w o o d .
7774
10^3
The court has jurisdiction over the children as set forth in the findings of Fact
and Conclusions of Law.
1
2
3.11
PARENTING PLAN.
3
The parties shall comply with the Parenting Plan signed by the court on this
date. The Parenting Plan signed by the court is approved and incorporated as
part of this decree.
4
5
3.12
CHILD SUPPORT.
Child support shall be paid in accordance with the order of child support signed
by the court on this date. This order is incorporated as part of this decree.
7
8
3.13
ATTORNEYS FEES, OTHER PROFESSIONAL FEES AND COSTS.

Does not apply.
9
10
3.14
NAME CHANGES.
Does not apply.
11
12

13
14
15
16
17
0ff\c
PETITIONER OR PETITIONERS
ATTORNEY (A signature below is actual notice
of this order):
18
19
Presented by:
[ ] Approved for entry: ^ \
[] Notice of presentation waived:
20
FAUB
REEDER, P.S.
21
22
By
23
24
25
THOMAS
Petitioner

WPF DR 04.0400 (6/2006); RCW 26.09.030; .040; .070(3)
S,'C AS ES9VVonDamVfinaMec rce.wpd
Attorneys
at
Law

(253)581-0660
7774
1
2
1 8 /3
RESPONDENT OR RESPONDENTS
ATTORNEY (A signature below is actual notice
of this order):
Presented by:
Approved for entry:
Notice of presentation waived:
3
4
5
6
By
7
Respondent
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
DECREE OF DISSOLUTION (DCD)
-5
WPF DR 04.0400 (6/2006); RCW 26.09.030; .040; .070(3)
S:\CAS ES 9\VanDim\fmatVdecrcc.wpd
A ttorneys at L aw
5920 100th S treet S, w ., Suite 25
(253) 581-0660

No. 07-3-02242-1
E-FILED
THOMAS L VAN DAM
June 12 2009 10:00 AM

KEVIN STO CK
COUNTY CLERK
ORDER SETTING CASE SCHEDULE
Petitioner(s)
Type of case:
Vs.
DIC
Estimated Trial (days):
Track Assignment:
Assignment Department:
Docket Code:
SARA L VAN DAM

Respondent(s)
Confirmation of Service
Modification of Custody
HICK
ORSCS
7/3/2009
Adequate Cause Hearing on Commissioner Calendar to be held. (If this hearing is not held by this date,
petition will be dismissed)
8/3/2009 9:30
Petitioner's Certificate of Parenting Class (Must be filed on or before)
8/14/2009
Respondent's Certificate of Parenting Class (Must be filed on or before)
8/14/2009
Set Settlement Conference Date with Judge/Commissioner H. EDWARD HAARMANN
8/26/2009
10/16/2009
Plaintiffs/Petitioner's Disclosure of Primary Witnesses
Week of 10/16/2009
Settlement Conference (To be held)
11/6/2009
Defendant's/Respondent's Disclosure of Primary Witnesses
11/20/2009
Disclosure of Rebuttal Witnesses

Deadline for Filing Motion to Adjust Trial Date
12/4/2009
Exchange of Witness and Exhibit Lists and Documentary Exhibits
1/22/2010
2/5/2010
Discovery Cutoff
2/18/2010 9:00
Trial
Unless otherwise instructed, ALL Attorneys/Parties shall report to the trial court at 9:00 AM on
the date of trial.
NOTICE TO PLAINTIFF/PETITION ER
If the case has been filed, the plaintiff shall serve a copy of the Case Schedule on the defendant(s) with the summons and
complaint/petition: Provided that in those cases where service is by publication the plaintiff shall serve the Case Schedule within five (5)
court days of service of the defendant's first response/appearance. If the case has not been filed, but an initial pleading is served, the Case
Schedule shall be served within five (5) court days of filing. See PCLR 1.
NOTICE TO ALL PARTIES
All attorneys and parties shall make themselves familiar with the Pierce County Local Rules, particularly those relating to case
scheduling. Compliance with the scheduling rules is mandatory and failure to comply shall result in sanctions appropriate to the
violation. If a statement of arbitrability is filed, PCLR 1 does not apply while the case is in arbitration.
Dated: June 12, 2009
Judge FAMILY COURT - 2

Department HICK
07-3-02242-1
32246942
SM
06-12-09
IN
cou^
rkJ
office
AH Jl(N 1 2 2009
P.M.
PIERCE COUNTY WASHINGTON

k I vjT
n STOCK, CouMy|erk
Superior Court of Washington

County of Pierce
In re:
^ T h o m c ts
no.
l& s iy r tfr ?
Petitioner,
and
Respondent.
To .
T H om
ly f-i-o 2 x H Z ' j
Summons(Modification/
Adjustment of Custody
Decree/Parenting Plan/
Residential Schedule)
ISM)__________________
L . l)A O D A t \
1.
An action has been started in the above court requesting that a custody decree/parenting
plan/residential schedule be modified/adjusted. Additional requests, if any, are stated in the
petition, a copy o f which is attached to this notice.
2.
You must respond to this notice and petition by serving a copy o f your written response on the
person signing this summons and by filing the original with the clerk of the court. If you do not
serve your written response within 20 days (or 60 days if you are served outside o f the state o f
Washington) after the date this summons was served on you, exclusive o f the day o f service, the
court may enter an order o f default against you, and the court may, without further notice to you,
enter an order regarding adequate cause and a decree to modify/adjust the custody
decree/parenting plan/residential schedule and providing for other relief requested in the petition
If you serve a notice o f appearance on the undersigned person, you are entitled to notice before
an order o f default or a decree may be entered.
3.
The court shall deny the petition unless it finds that adequate cause for hearing the petition is
established, in which case it shall set a date for hearing on an order to show cause why the
requested order or modification should not be granted.
[]
Temporary residential placement or custody is not being sought.

Temporary residential placement or custody is being sought. If adequate cause is found,
the court may proceed immediately to hear the motion for temporary placement/custody
or may continue the matter to a later time.
Summons Mod/Adj Parenting Plan (SM) - Page 1 o f 2

WPF DRPSCU 07.0120 Mandatory (7/2007) - CR 4.1; RCW 26.09.270; 26.10.020
33>4
S / ,i S / : z * a 9
4.
You may file an opposing declaration to show that there is not adequate cause to hold a full
hearing. If you do not file an opposing declaration or respond and the court finds that adequate
cause exists, the court may enter an adequate cause order and an order modifying/adjusting the
custody decree/parenting plan/residential schedule without notice to you pursuant to RCW
26.09.270,
5.
Your written response to the summons and petition must be on form WPF DRPSCU 07.0200,
Response to Petition for Modification/Adjustment o f Custody Decree/Parenting Plan/Residential
Schedule. This form may be obtained by contacting the clerk o f the court at the address below,
by contacting the Administrative Office o f the Courts at (360) 705-5328, or from the Internet at
the Washington State Courts homepage:
h ttp://www.courts.wa.gov/forms
6.
If this action has not been filed with the court, you may demand that the petitioner file this action
with the court. If you do so, the demand must be in writing and must be served upon the person
signing this notice. Within 14 days after you serve the demand, the petitioner must file this
action with the court, or the service on you o f this notice and motion will be void.
7.
If you wish to seek the advice o f an attorney in this matter, you should do so promptly so that
your written response, if any, may be served on time.
8.
One method o f serving a copy o f your response on the petitioner is to send it by certified mail
with return receipt requested.
This summons is issued pursuant to Superior Court Civil Rule 4. l o f the state o f Washington.
Dated: yC
Signature o f Movirfg Party or Lawyer/WSBA No.
Print Name
Fite o rig in a l o f y o u r r e s p o n s e w ith
the clerk o f the c o u rt a t
PIERCE COUNTY SUPERIOR COURT
S e r v e a c o p y o f y o u r r e s p o n s e on:
[jQMoving Party [You may list an address that is not

your residential address where you agree to accept
legal documents. Any time this address changes
while this action is pending, you must notify the
opposing parties in writing and file an updated
Confidential Information Form (WPF DRPSCU
09.0200) with the court clerk.]
[ ] Moving Partys Lawyer
IERCE COUNTY CLERK'S OFFICE

;CO UNTY-CITY BLDG--------i n . w J A AVES
ACOM A W A 98402-2711
[Address]
Jb/frOX. l/a r/2 > g, r T L
[Name]
Sojf 7 /Y 3
[Address]
<^Sonnp_Lj l tk t . LO fr
Summons Mod/Adj Parenting Plan (SM) - Page 2 of 2
WPF DRPSCU 07.0120 Mandatory (7/2007) - CR 4.1; R C W 26.09.270; 26.10.020
s s s s s
E-FILED
PIERCE COUNTY, W ASHING TO N
June 12 2009 10:14 AM
KEVIN STO CK
COUNTY CLERK
NO: 07-3-02242-1

THOMAS L VAN DAM
Petitioner(s),
NO. 07-3-02242-1
vs.
NOTE FOR COMMISSIONER'S CALENDAR
SARA L VAN DAM

Respondent(s)
TO THE C LER K OF THE SUPERIOR COURT AND TO:
NAME:
THOMAS L VAN DAM
ADDRESS' 20839 60TH ST EAST #A
BONNEY LAKE, WA 98391
PHONE: (253) 228-9268

Petitioner
Please take notice that an issue of law in this case will be heard on the date below and the clerk is directed to note this
issue on the appropriate calendar:
CALENDAR DATE Wednesday - July 15, 2009 at 9:30 AM
Nature of Case: Child Support/Parenting Plans

SELECT ONE BOX BELOW
[X] (MO) Show Cause/Family Law, Confirmation Required.................................................. (9:30 Mon.- Thurs.)
PARTY SETTING HEARING MUST CONFIRM BY CALLING (253)798-6697 BY NOON, TWO (2)
COURT/WORKING DAYS PRIOR TO HEARING OR HEARING WILL BE CANCELLED
(YY) Adoption, No Confirmation Required....................................
................................... (9:00 Fri.)
.................... (1:30 Mon.- Fri.)
(OE) Supplemental Proceedings, No Confirmation Required.........
(UD) Unlawful Detainer, No Confirmation Required.....................
...................... (1:30 Mon.- Fri.)
(GD) Probate/Gdnshp/Mnr Settlement, No Confirmation Required
................... (1:30 Mon.- Fri.)
w/Attorneys (3:00Mon.- Fri.)
(DD) Uncontested Dissolutions, No Confirmation Required..........
..... (1:30 Mon., Tues. & Thur.)
(FC) Paternity, No Confirmation Required.....................................
Dated: June 12, 2009___________________________

NAME:
SARA L VAN DAM
ADDRESS: P.O. BOX 7143
Signed:/s/ SARA L VAN DAM________

PHONE: (253) 298-9172
Respondent
THE ABOVE INFORM ATION MUST BE COM PLETED AND SIGNED
ntcsup-0007.pdf
page 1 o f 2

ADDITIONAL ATTORNEYS
NO. 07-3-02242-1_____________ NOTE FOR COMMISSIONERS CALENDAR______________
NAME:
CLINT P. JOHNSON
ADDRESS' 5920 100th St SW Ste 25
' L AKEWOOD, WA 98499-2751
NAME:
ADDRESS:
NAME:
ADDRESS:
NAME:
ADDRESS:
NAME:
ADDRESS:
NAME:
ADDRESS:
NAME:
ADDRESS:
NAME:
ADDRESS:
NAME:
ADDRESS:
NAME:
ADDRESS:
ntcsup-0007.pdf
page 2 o f 2
PHONE: (253) 581-0660

WSB#: 14794
39&4
O f - 3-02242-1
32246945
3PTIWOC
b S I S '2 0 0 9
06-12-09

County of PIERCE
In re:
No. 07-3-02242-1
Thomas L. Van Dam

Petitioner,
and
(PTMD)
Sara L. Van Dam

Respondent.
1.1
Petition for Modification/

Adjustment of Custody Decree/
Parenting Plan/Residential
Schedule
Para. 2.14: check box if petition is
attached for:
[ ] Order for protection DV (PTORPRT)
[ ] Order for protection UH (PTORAH)
Identification of Requesting Party/Parties
Name (first/last) Sara L. Van Dam____________________________ Birth date 09/22/1975.

Last known residence (county and state only) Pierce WA________________________ .
Name (first/last)_________________________________________ Birth date ________
Last known residence (county and state only)_________________________________ .
1.2
Identification of Other Party/Parties
Name (first/last) Thomas L. Van Dam_________________________ Birth date 10/21/1969

Last known residence (county and state only) Pierce WA_____________________.
Name (first/last)_________________________________________ Birth date_________
Last known residence (county and state only)_________________________________ .
Name (first/last)_________________________________________ Birth date_________
Pet for Mod/Adj Parenting Pin (PTMD) - Page 1 o f 12
WPF DRPSCU 07.Q100 Mandatory (6/2008) - CR 4.1; RCW 26.09.181; .260; .270
39b4
/i5 /2 0 S
B a s is
Last known residence (county and state only)

1.3
Dependent Children
Name (first/last) Silas R. Van Dam______________________________ Age6

Name (first/last)____________________________________________Age_
Name (first/last)_____________________________________ ~
Age _
II. Basis
2.1
Petition for an Order Modifying Custody Decree/Parenting Plan/Residential

Schedule
This is a petition for an order modifying the prior custody decree/parenting plan/residential
schedule in this matter and approving the proposed parenting plan/residential schedule, which is
filed with this petition.
2.2
Adequate Cause
There is adequate cause for hearing the petition for modification.
2.3
Child Support
[]
Does not apply.
[x] Child support should be modified or established if the court grants the petition to modify the
parenting plan or residential schedule. A child support worksheet and financial declaration
must be filed with this action. RCW 26.09.170.
2.4
Jurisdiction and Venue

The court has proper jurisdiction and venue.
The requesting party/parties reside(s) in (county and state only) _Pierce WA________
The children reside in (county and state only)
____________ Pierce_WA_______________________
The other party/parties reside(s) in (county and state only)
___________ PierceW A________________
Pet for Mod/Adj Parenting Pin (PTMD) - Page 2 of 12

WPF DRPSCU 07.0100 Mandatory (6/2008) - CR 4.1; RCW 26.09.181; .260; .270
.3 3 & '4
2.5
fc ^ !S /Z BBS
3811
Jurisdiction Over Proceeding

This court has jurisdiction over this proceeding for the reasons below:
[
This court has exclusive continuing jurisdiction. The court has previously made a child
custody, parenting plan, residential schedule or visitation determination in this matter and
retains jurisdiction under RCW 26.27.211.
This state is the home state of the children because:
[]
[J
[3
the children lived in Washington with a parent or a person acting as a parent for at
least six consecutive months immediately preceding the commencement of this
proceeding.
the children are less than six months old and have lived in Washington with a
parent or a person acting as parent since birth.
any absences from Washington have been only temporary.
Washington was the home state of the children within six months before the
commencement of this proceeding and the children are absent from the state but a
parent or person acting as a parent continues to live in this state.
The children and the parents or the children and at least one parent or a person acting as a
parent have significant connection with the state other than mere physical presence, and
substantial evidence is available in this state concerning the childrens care, protection,
training and personal relationships, and:
\Y ^
[]
The children have no home state elsewhere.

The childrens home state has declined to exercise jurisdiction on the ground that
this state is the more appropriate forum under RCW 26.27.261 or .271.
[]
All courts in the children's home state have declined to exercise jurisdiction on the ground
that a court of this state is the more appropriate forum to determine the custody of the
children under RCW 26.27.261 or .271.
[fY'
No other state has jurisdiction.
[]
This court has temporary emergency jurisdiction over this proceeding because the children
are present in this state and the children have been abandoned or it is necessary in an
emergency to protect the children because the children, or a sibling or parent of the
children is subjected to or threatened with abuse. RCW 26.27.231.
[]
There is a previous custody determination that is entitled to be enforced under this

chapter or a child custody proceeding has been commenced in a court of a state

WPF DRPSCU 07.0100 Mandatory (6/2008) - CR 4.1; R C W 26.09.181; .260; .270
3964
6^15^2B S S
B B S 12
having jurisdiction under RCW 26.27.201 through 26.27.221. The requirements

of RCW 26.27.231 (3) apply to this matter. This states jurisdiction over the
children shall last until (date)____________________________ .
[]
[]
2.6
There is no previous custody determination that is entitled to be enforced under

this chapter and a child custody proceeding has not been commenced in a court of
a state having jurisdiction under RCW 26.27.201 through 26.27.221. If an action
is not filed in (potential home state) __________________________ by the
time the child has been in Washington for six months,
(date)____________________________ , then Washington's jurisdiction will
be final and continuing.
Other:
Uniform Child Custody Jurisdiction and Enforcement Act Information

Name of Child
Silas R. Van Dam,
Parents Name
Sara L Van Dam
Parents Name
Thomas L Van Dam
During the last five years, the children have lived:
[]
in no place other than the state of Washington and with no person other than the requesting
party or the other party.
in the following places with the following persons (list each place the children lived,
including the state of Washington, the dates the children lived there and the names of the
persons with whom the children lived. The present addresses of those persons must be
listed in the required Confidential Information Form.):
Claims to custody or visitation:
[]
The requesting party does not know of any person other than the other party who has
physical custody of, or claims to have custody or visitation rights to, the children.
The following persons have physical custody of, or claim to have custody or visitation
rights to, the children (list their names and the children concerned below and fist their
present addresses in the Confidential Information Form. Do not list the other party.):
Involvement in any other proceeding concerning the children:

3964
[ t/
[]
15^2889
88813
The requesting party has not been involved in any other proceeding regarding the children.
The requesting party has been involved in the following proceedings regarding the children
(list the court, the case number, and the date of the judgment or order):
Other legal proceedings concerning the children:
[]
2.7
The requesting party does not know of, any other legal proceedings concerning the
children.
The requesting party knows of, the following legal proceedings that concern the children
(list the children concerned, the court, the case number, and the kind of proceeding):
Custody Decree or Parenting Plan/Residential Schedule

The Custody Decree/Parenting Plan/Residential Schedule was entered on (date)
10/30/07
_____ at (county and state)
____ Pierce_WA_______________________________. A certified copy of the Custody
Decree/Parenting Plan /Residential Schedule to be modified is filed with or attached to this petition,
if the decree or plan to be modified was entered in another county or state.
2.8
Modification Under RCW 26.09.260(1), (2)

Does not apply.
[]
The custody decree/parenting plan/residential schedule should be modified because a

substantial change of circumstances has occurred in the circumstances of the children or
the other party and the modification is in the best interests of the children and is necessary
to serve the best interests of the children. This request is based on the factors below.
[]
The parties agree to the modification.
[]
The children have been integrated into my family with the consent of the other
party in substantial deviation from the decree/parenting plan/residential schedule.
[]
The childrens environment under the custody decree/parenting plan/residential

schedule is detrimental to the childrens physical, mental or emotional health and
the harm likely to be caused by a change in environment is outweighed by the
advantage of a change to the children.

39 b 4
[]
2.9
2.10
The other party has been found in contempt of court at least twice within three
years because the party failed to comply with the residential time provisions in the
court-ordered parenting plan, or the parent has been convicted of custodial
interference in the first or second degree under RCW 9A.40.060 or 9A.40.070.
Modification or Adjustment Under RCW 26.09.260(4) or (8)

M'
Does not apply.
[]
The custody decree/parenting plan/residential schedule should be modified because the

reduction or restriction of the residential time for the person with whom the child does not
reside a majority of the time would serve and protect the best interests of the child using
the criteria in RCW 26.09.191, as described here:
[]
The custody decree/parenting plan/residential schedule should be adjusted because the

nonresidential party has voluntarily failed to exercise residential time for one year or more
and the adjustment is in the best interest of the children.
Adjustments to Residential Provisions Under RCW 26.09.260(5)(a) and (b)

[]
Does not apply.
[]
The custody decree/parenting plan/residential schedule should be adjusted because a

substantial change in circumstances of either parent or of the child has occurred and the
proposed modification to the custody decree/parenting plan/residential schedule is in the
best interest of the children and is a minor modification in the residential schedule that does
not change the residence the children are scheduled to reside in the majority of the time
and:
[]
is not more than 24 full days in a calendar year; or
[]
is based on a change of residence of the parent with whom the child does not reside
a majority of the time or an involuntary change in work schedule by a party which
makes the residential schedule in the parenting plan impractical to follow.

3Sfe4
2.11
& S1SS28& 9
00815
Adjustments to Residential Provisions Under RCW 26.09.260(5)(c), (7), (9)

[]
Does not apply.
T h is s e c t io n o n ly a p p lie s to a p e r s o n w ith w h o m the c h ild d o e s n o t re sid e a

m ajority o f the tim e w h o is s e e k in g to in c r e a se re sid e n tia l time.
2.11.1 Parent subject to limitations under RCW 26.09.191(2) or (3)
[]
[]
The residential time of (name)_____________________________________ is not

subject to limitations.
The residential time of (name)________________________________is subject to
limitations. This parent demonstrates a substantial change in circumstances specifically
related to the basis for the limitation.
2.11.2 Parent Required to Complete Evaluations, Treatment, Parenting or Other Classes
[]
[]
(Name)__________________________ is not required under the existing Parenting

Plan/Residential Schedule to complete evaluations, treatment, parenting or other classes.
(Name)_______________________ , is required by the existing Parenting
Plan/Residential Schedule to complete evaluations, treatment, parenting or other classes.
This parent has fully complied with such requirements as described here:
2.11.3 Adjustment to Residential Provision Under RCW 26.09.260(5)(c)
The Custody Decree/Parenting Plan/Residential Schedule should be adjusted because a

substantial change in circumstances of (parents name) TNQ/tfQS L. A N D/lfl)
or (child(ren)s name(s))____________________________________________
has occurred. The proposed modification to the Custody Decree/Parenting Plan/Residential
Schedule is in the best interest of the children. It is a minor modification in the residential
schedule that does not change the residence the children are scheduled to reside in the
majority of the time. The increase is more than 24 full days but less than 90 overnights per
year total. The Custody Decree/Parenting Plan/Residential Schedule does not provide
reasonable time with the nonprimary residential party.
2.12
Adjustments to Nonresidential Provisions Under RCW 26.09.260(10)

WPF DRPSCU 07.0100 Mandatory (6/2008) ~ CR 4.1; RCW 26.09.181; .260; .270
3364
ir
Does not apply.
[]
The following nonresidential provisions of the parenting plan should be adjusted because
there is a substantial change of circumstances of either party or of the children and the
adjustment is in the best interest of the children:
[]
[]
[]
[]
2.13
6 ^ IS - '2 e i1 9
BB816
Dispute resolution.
Decision making.
Transportation arrangements.
Other:
Substantial Change in Circumstance

(Y o u m u st co m p le te th is p a rt if y o u re q u e st a m o d ifica tio n o r a d ju stm e n t in
p a ra g ra p h s 2.8, 2.10, 2.11.1, 2.11.3 o r 2.12.)
The requested modification or adjustment of the custody decree/parenting plan/residential schedule

is based upon the following substantial change in circumstance:
The Respondent Sara Van Dam takes Silas Van Dam to school every morning to accommodate Petitioners
changing work schedule. Petitioners schedule has changed over 7 times in the past year and a half
The Respondent has had to always accommodate to his schedule every time without much notice.
The current Parenting plan is not applicable, and never has been followed. The minor child Silas Van Dam
is now in school and has been for 2 full years. Petitioners job and income has changed since the
current parenting plan was ordered. Thomas Van Dam schedule has so many variations that may
change at any time. It has become very difficult for the Respondent to accommodate all the time.
Respondent Sara Van Dam has to go work late every day of the week to accommodate Petitioners schedule.
Respondent feels that it would be in the best interest of the child to modify the current parenting
plan and child support. Both parties have never been able to abide by current parenting plan, due to
Petitioners work schedule. Respondent proposes a parenting plan that will work for both parties
even if Thomas work schedule changes once again.

3S&4
2.14
b S IS s Z S rd S
Protection Order
Does not apply.
There is a protection order between the parties filed in case number______________
court_______________________ , which expires on (date)_________________
The court should grant the [ ] domestic violence [ ] antiharassment petition for order for
protection:
[ ] attached to this petition.
[ ] filed separately under [ ] this case number [ ] case number___________________
If you need immediate protection, contact the clerk/court for RCW 26.50 Domestic Violence
forms or RCW 10.14 Antiharassment forms.
2.15
Servicemembers Civil Relief Act Statement

2,15.1 A. Service member status -- (name of other party)
Thomas L. Van Dam_____________________ :
[lîs not a service member;
[ ] is on active duty in the U.S. armed forces (excluding National Guard and
reserves);
[ ] is on active duty and is a National Guard member or a Reservist residing in
Washington;
[ ] is not on active duty in the U.S. armed forces (excluding National Guard and
reserves);
[ ] is not on active duty and is a National Guard member or a Reservist residing in
Washington;
[ ] lam unable to determine whether the other party is or is not on active duty in the
U.S. armed forces;
[ ] lam unable to determine whether the other party is or is not on active duty as a
National Guard member or a Reservist residing in Washington.
B. Factual basis:
\d/S e e the attached Defense Man Power Data Center Report obtained from
https://www.dmdc.osd.mil/scra/owa/home.
[ ] Other factual basis:
C. [ ] As indicated above, the other party is on active duty and (check all that apply):
[ ] The other party is represented by an attorney.
[ ] The court has appointed an attorney to represent the other party.
[ ] A stay of these proceedings [ ] has [ ] has not been entered by the court.

B0S3 7
33&4
& /1 S /2 8 S S
88818
2.15.2 A. Dependent of a service member status (name of other party)_______________

-TNOfr\*5 IM tib A rm
:
[ ] is a dependent of a resident of Washington who is on active duty and is a National
Guard member or a Reservist;
[ if is not a dependent of a resident of Washington who is on active duty and is a
National Guard member or a Reservist;
[ ] lam unable to determine whether the other party is a dependent of a resident of
Washington who is on active duty and is a National Guard member or a Reservist.
B. Factual basis:
[ ] The other party failed to respond to a notice to him or her as a dependent of a
person in Military Service that was [ ] served on [ ] mailed by first class mail on
(date)____________________________________ , therefore he or she
should be presumed not a dependent of a resident of Washington who is on active
duty and is a National Guard member or a Reservist.
[ ] Other factual basis:
C. [ ] As indicated above, the nonmoving party is a dependent of a resident of

Washington who is on active duty and is a National Guard member or a Reservist
and (check all that apply):
[ ] The nonmoving party is represented by an attorney.
[ ] The court has appointed an attorney to represent the nonmoving party.
[ ] A stay of these proceedings [ ] has [ ] has not been entered by the court.
2.16
Other
III. Relief Requested

The moving party requests that the court find that there is adequate cause for hearing this petition and
enter an order modifying the custody decree/parenting plan/residential schedule in this matter and
approving the proposed parenting plan/residential schedule, which is filed with this petition.
[*r
The moving party also requests that the court:
[]
[]
[]
Enter an order establishing child support in conjunction with the proposed parenting
plan/residential schedule. The child support worksheet and financial declaration are filed
with this petition.
Enter a domestic violence protection order.
Enter an antiharassment protection order.
Other:
(S k tv j A r f b
Pet for Mod/Adj Parenting Pin (P T M D )-faage 10 of 12
WPF DRPSCU 07.0100 Mandatory (&2008) - CR 4.1; RCW 26.09.181;.260; .270
f lq .
39S4
Date
Signature of Requesting Party or Lawyer/WSBA No. Print Name
Date
Signature of Requesting Party or Lawyer/WSBA No. Print Name
6 / 1 5 / 20B3 8 8 B I9
I declare under penalty of peijury under the laws of the state of Washington that the foregoing is true and
correct.
Signed at foitvW Lnj(o
_______(state) y
Signature of RequestangTarty
on (date) y 1$ ~V O*}
<
) n n t Name
\T a m o
Print
{ / c i n 'l
*
(state)__________on (date)
Signed at (city)
Signature of Requesting Party
Print Name
[]
J o in d e r
[]
I,_______________________ , join in the petition. I understand that by joining in the petition,

a decree or judgment and order may be entered in accordance with the relief requested in the
petition unless, prior to the entry of the decree or judgment and order, a response is filed and
served.
[]
[]
I waive notice of entry of the decree.

I demand notice of all further proceedings in this matter. Further notice should be sent to
the following address (you may list an address that is not your residential address where
you agree to accept legal documents):
Any time this address changes while this action is pending, you must notify the opposing parties in
writing and file an updated Confidential Information Form (WPF DRPSCU 09.0200) with the
court clerk.
Date
[]
Signature
Print Name
I,___________ ____________ , join in the petition. I understand that by joining in the petition,
served.
[]
[]

the following address (you may list an address that is not your residential address where

3 .9 6 4
9 .-8.0 8 2 S
court clerk.
Signature
Date
[]
Print Name
I,_______________________ , join in the petition. I understand that by joining in the petition,

served.
[]
[]

the following address (you may fist an address that is not your residential address where
court clerk.
Date
Signature
Print Name

Request for Military Status
https://\ar^to(ftnd6.d'sa.5wljS(^Skraj^p?(^:Select
Department of Defense Manpower Data Center
MAY-12-2009 18:15:11
Military Status Report

Pursuant to the Servicemembers Civil Relief Act
Last Name j First/Middlc
i VAN DAM
; Begin Date
| Active Duty Status
Service/Agency
i THOMAS LEE Based on the information you have furnished, the DMDC does not possess any information indicating that the
!individual is currently on active duty.
Upon searching the information data banks of the Department of Defense Manpower Data Center, based on the information that you provided, the
above is the current status of the individual as to all branches of the Military.
Yktopyk. S*A
Mary M. Snavely-Dixon, Director
Department of Defense - Manpower Data Center
1600 Wilson Blvd., Suite 400
Arlington, VA 22209-2593
The Defense Manpower Data Center (DMDC) is an organization of the Department of Defense that maintains the Defense Enrollment and Eligibility
Reporting System (DEERS) database which is the official source of data on eligibility for military medical care and other eligibility systems.
The Department of Defense strongly supports the enforcement of the Servicemembers Civil Relief Act [50 USCS Appx. 501 et seq] (SCRA)
(formerly the Soldiers' and Sailors' Civil Relief Act of 1940). DMDC has issued hundreds of thousands of "does not possess any information indicating
that the individual is currently on active duty" responses, and has experienced a small error rate. In the event the individual referenced above, or any
family member, friend, or representative asserts in any manner that the individual is on active duty, or is otherwise entitled to the protections of the
SCRA, you are strongly encouraged to obtain further verification of the person's active duty status by contacting that person's Military Service via the
"defenselink.mil" URL provided below. If you have evidence the person is on active-duty and you fail to obtain this additional Military Service
verification, provisions of the SCRA may be invoked against you.
If you obtain further information about the person ( e.g., an SSN, improved accuracy of DOB, a middle name), you can submit your request again at
this Web site and we will provide a new certificate for that query.
This response reflects current active duty status only. For historical information, please contact the Military Service SCRA points-of-contact.
See: http://www.defenselink.mil/faq/pis/PC09SLDR.html
WARNING: This certificate was provided based on a name and Social Security number (SSN) provided by the requester. Providing an erroneous name
or SSN will cause an erroneous certificate to be provided.
Report 1DBTFSYGOSTSZ
1 Of 1
5/12/2009 6:14 PM
394 * / '- l S ^ 2 8 8 9
07-3-02242-1
32247017
FNDCLR
06-12-09

County of 7fee< 2x
In re:
No. F ? ' 3
Thomas L. Van Dam

Petitioner,
and
Sara L. Van Dam
Respondent.
Financial Declaration
[ VPetitioner
M Respondent
(FNDCLR)
Sara L. Van Dam
Name:
Date of Birth: 9/22/75
I. Summary of Basic Information

Declarants Total Monthly Net Income (from 3.3 below)
$ ______
Declarants Total Monthly Household Expenses {from 5.9 below)
$ ______
Declarants Total Monthly Debt Expenses (from 5.11 below)
S ______
Declarants Total Monthly Expenses (from 5.12 below)
$ ______
Estimate o f the other partys gross monthly income (from 3.If below)
[ ] $ ______
[ ] unknown
II. Personal Information

2.1
Occupation: Dental Assistant
2.2
The highest year o f education completed: 2 yrs comm, college
2.3
Are you presently employed? [ x] Yes [ ] No

a. If yes:
(1)
Where do you work. Employer's name and address must be listed on the
Confidential Information Form.
Financial Declaration (FNDCLR) - Page 1 of 6

WPF DRPSCU 01.1550 (6/2006) - RCW 26.18.220(1)
BBB29
3364
b. If no:
(2)
When did you start work there (month/year)?
(1)
When did you Jast work (month/year)?
(2)
(3)
What were your gross monthly earnings?

Why are you presently unemployed?
6 /1 5 /2 6 8 9
III. Income Information

If child support is at issue, complete the Washington State Child Support W orksheets), skip Paragraphs 3.1 and 3.2.
If maintenance, fees, costs or debts are at issue and child support is N o t an issue this entire section should be
completed. (Estimate o f other partys income information is optional.)
3.1
Gross Monthly Income

If you are paid on a weekly basis, multiply your weekly gross pay by 4,3 to determine your monthly wages
and salaries. If you are paid every two weeks, multiply your gross pay by 2.15. If you are paid twice
monthly, multiply your gross pay by 2. If you are paid once a month, list that amount below.
o
O
3.2
v.
Name
VarTfrarr)
a.
Wages and Salaries
$2J25L3
b.
Interest and Dividend Income
s ^
c.
Business Income
d.
Spousal Maintenance Received

From
e.
Other Income
f.
Total Gross Monthly Income (add lines 3.1a throuah3.1e)
g-
Actual Gross Income (Year-to-date)
/ S O '-
$
$
&x> a g
Monthly Deductions From Gross Income
a.
Income Taxes
b.
FICA/Self-employment Taxes
c.
State Industrial Insurance Deductions
d.
M andatory Union/Professional Dues
e.
Pension Plan Payments
s
s ^
f.
Spousal Maintenance Paid
g-
Normal Business Expenses
h.
Total Deductions from Gross Income
(add lines 3.2a through 3.2g)
3.3
Name
a/ o- jL-
Monthly Net Income (Line 3.If minus line 3.2hor

line 3 from the Child Support Worksheets).)

WPF DRPSCU 01.1550 (6/2006) - RCW 26.16.220(1)
______
$
$
$
18 hr / /
800-3-8
$
$
00836
3964
3.4
6 / I S . / .2 8 0 9
Miscellaneous Income
a.
Child support received from other relationships
b.
Other miscellaneous income (list source and amounts)
c.
Total M iscellaneous Income (add Iines 3.4a through 3.4b) $
3.5
Income of Other Adults in Household
3.6
If the income of either party is disputed, state monthly income you believe is correct and explain below:
$1
IV. Available Assets

4.1
Cash on hand
4.2
On deposit in banks
4.3
Stocks and bonds, cash value of life insurance
$J
4.4
Other liquid assets:
S ___
V. Monthly Expense Information

Monthly expenses for myself and
1
dependents are: (Expenses should be calculated for the future,
after separation, based on the anticipated residential schedule for the children.)
5.1
Housing
Installment payments for other mortgages or encumbrances
s 9sz>s X)
Taxes & insurance (if not in monthly payment)
$ ^
Rent, l st mortgage or contract payments
Total Housing
5.2
Utilities
Heat (gas & oil)
Electricity

WPF DRPSCU 01.1550 (6&006) - RCW 26.18.220(1)
S>
33031
3964
Telephone
)S>
$ JZS*-
Cable
$ /
Other
Total Utilities
$ 2 5 -0 -
Water, sewer, garbage
5.3
2 - _____persons
Supplies (paper, tobacco, pets)

Meals eaten out
Other
Total Food Supplies
&
%4 n o s (n o * s /6 b ~
______
T> ~sZoo
* u s-n -
Children
Day Care/Babysitting
* t*ro ~
Other child-related expenses
s
s ~g?
s /DP'
Total Expenses Children
%S D Q M >
Clothing
Tuition (if any)
5.5
Food and Supplies

Food for
5.4
6 /1 5 /2 0 3 9
Transportation
Vehicle gas, oil, ordinary maintenance
s z* rc> %
TS* 1dA
Parking
s _ & _____
Other transportation expenses
$ _ ^ ______
Vehicle payments or leases

Vehicle insurance & license
Total Transportation
5.6
Health Care (Omit if fully covered)

Insurance
s V jQ *
Uninsured dental, orthodontic, medical, eye care expenses
$_5a
Other uninsured health expenses

Total Health Care
5.7
Personal Expenses (Not including children)

Clothing
Hair care/personal care expenses

WPF DRPSCU 01.1550 (6/2006) - RCW26.18.220(1)
/o p
's
fOD
88832
'-3S&4
5.8
Clubs and recreation
Education
Books, newspapers, magazines, photos
Gifts
Other
$ ^
Total Personal Expenses
Miscellaneous Expenses
Life insurance (if not deducted from income)
_____
Other_____________________________________________
_____
Other_____________________________________________
^ _____
Total Miscellaneous Expenses
V/>
5.9
Total Household Expenses (The total of Paragraphs 5.1 through 5.S)
5.10
Installment Debts Included in Paragraphs 5.1 Through 5.8

Creditor
5.11
>Si3S2.& & 3 :a B S 3 3
Description
of Debt
Balance
0(^-
Month of
Last Payment
Other Debts and Monthly Expenses not Included in Paragraphs 5.1

Through 5.8
Creditor
OkcuLi^
ii&btLs
CP)lflJr
Description
of Debt
(L c,.
C..&
0 . . L . _______
Balance
Month of
Last Payment
IM S co
CD m J l
Amount of
Monthly
Payment
(s>5~
.49*
V
s
$
$
Total Monthly Payments for Other Debts and Monthly Expenses

Financial Declaration (FNDCLR) - Page 5 o f 6
WPF DRPSCU 01.1550 (6/2006) - RCW 26.18.220(1)
$J3Q
39b4
5.12
Total Expenses (Add Paragraphs 5.9 and 5.11)
6 / l
&3,58S~- CO
VI. Attorney Fees

6.1
Amount paid for attorney fees and costs to date:
6.2
The source of this money was:
6.3
Fees and costs incurred to date:
6.4
Arrangements for attorney fees and costs are:
6.5
Other:
I declare under penalty o f perjury under the laws of the state of Washington that the foregoing is true and correct.
Signed at
i a i Ol ( a
, [City]
[State] on
6?
[Date].
\2 t
Signature of
Print or Type Name
The follow ing financial records are being provided to the other party and filed separately w ith the court.
Financial records pertaining to myself:
[ ] Individual [ ] Partnership or Corporate Income Tax returns for the years _______________
_____________________________________________________ including all W -2s and schedules;
[ ] Pay stubs for the dates o f _____________________________________________________________
[ ] O ther:________________________________________________________________________________
D o n o t a tta c h th e s e fin a n c ia l reco rd s to th e fin a n c ia l d e cla ra tio n . T h ese fin a n c ia l

reco rd s s h o u ld b e s e rv e d on th e o th e r p a rty a n d fifed w ith th e c o u rt s e p a ra te ly
u s in g th e s e a le d fin a n c ia l s o u rc e d o cu m en ts c o v e r s h e e t (W P F D R P S C U
09.0220). I f file d s e p a ra te ly u s in g th e c o v e r s h e e t, th e re c o rd s w ill be s e a le d to
p ro te c t y o u r p riv a c y (a lth o u g h th e y w ill b e a v a ila b le to a ll p a rtie s in th e case,
th e ir atto rn e ys, c o u rt p e rs o n n e l a n d ce rtain s ta te a g e n c ie s a n d b o ard s.) S ee G R
22 (C)(2).
Financial Declaration (FNDCLR) - Page 6 o f 6

WPF DRPSCU 01.1550 (6/2006) - R C W 26.18.220(1)
07-3-02242-1
32247018
06-12-09
PPP

County of Pierce
In re the Parenting and Support of:
Silas R. Van Dam
Child(ren)
Thomas L. Van Dam

Petitioner
and
No 07-3-02242-1
Parenting Plan
[x ] Proposed (PPP)
[ ] Temporary (PPT)
Final Order (PP)
Sara L. Van Dam

Respondent.
This parenting plan is:
[]
[]
[]
[x ]
the final parenting plan signed by the court pursuant to a judgment and order establishing
Residential Schedule/Parenting Plan/Child Support signed by the court on this date or
dated________________________________________ .
the final parenting plan signed by the court pursuant to an order signed by the court on this date or
dated_______________________________ , which modifies a previous parenting plan or custody
decree.
a temporary parenting plan signed by the court.
proposed by (name)____ Sara L. Van Dam____________________________ .
It is O rdered, A d ju d g e d a n d D e cre e d :
I. General Information
This parenting plan applies to the following children;
Name
Age
Silas R. Van Dam
Parenting Plan (PPP, PPT, PP) - Page 1 of 10

WPF PS 15.0600 Mandatory (6/2008) - R C W 26.26.375, 26.09.016, .181; .187; .194
3964
6 /1 5 /2 8 3 9
B3336
II. Bases for Restrictions

Under certain circumstances, as outlined below, the court may limit or prohibit a parents
contact with the child(ren) and the right to make decisions for the child(ren).
2.1
Parental Conduct (RCW 26.09.191(1), (2))

[x ]
[]
Does not apply.

The [ ] mothers [ ] fathers residential time with the child(ren) shall be limited or
restrained completely, and mutual decision-making and designation of a dispute resolution
process other than court action shall not be required because [ ] this parent
[ ] a person residing with this parent has engaged in the conduct which follows:
[]
[]
[]
2.2
Willful abandonment that continues for an extended period of time or substantial

refusal to perform parenting functions (this applies only to parents, not to a person
who resides with a parent).
Physical, sexual or a pattern of emotional abuse of a child.
A history of acts of domestic violence as defined in RCW 26.50.010(1) or an
assault or sexual assault which causes grievous bodily harm or the fear of such
harm.
Other Factors (RCW 26.09.191(3))

[x ]
[]
Does not apply.

The [ ] mothers [ ] fathers involvement or conduct may have an adverse effect on the
childs best interests because of the existence of the factors which follow:
[]
[]
[]
[]
[]
[]
[]
Neglect or substantial nonperformance of parenting functions.

A long-term emotional or physical impairment which interferes with the
performance of parenting functions as defined in RCW 26.09.004.
A long-term impairment resulting from drug, alcohol, or other substance abuse
that interferes with the performance of parenting functions.
The absence or substantial impairment of emotional ties between the parent and
child.
The abusive use of conflict by the parent which creates the danger of serious
damage to the childs psychological development.
A parent has withheld from the other parent access to the child for a protracted
period without good cause.
Other:
III. Residential Schedule

The residential schedule must set forth where the child(ren) shall reside each day o f the year,
including provisions for holidays, birthdays o f family members, vacations, and other special
occasions, and what contact the child(ren) shall have with each parent. Parents are
encouraged to create a residential schedule that meets the developmental needs o f the
child(ren) and individual needs o f their family. Paragraphs 3.1 through 3.9 are one way to
write your residential schedule. If you do not use these paragraphs, write in your own
Parenting Plan (PPP, PPT, PP) - Page 2 o f 10
3 .9 6 4
i>S I S S Z & B B
-B B S :

The residential schedule must set forth where the child(ren) shall reside each day of the year,
including provisions for holidays, birthdays of family members, vacations, and other special
occasions, and what contact the child(ren) shall have with each parent Parents are encouraged
to create a residential schedule that meets the developmental needs of the child(ren) and
individual needs o f their family. Paragraphs 3.1 through 3.9 are one way to write your
residential schedule. If you do not use these paragraphs, write in your own schedule in
Paragraph 3.13.
3.1
Schedule for Children Under School age.

[x]
[]
There are no children under school age.

Prior to enrollment in school, the child(ren) shall reside with the [ ] mother [ ] father,
except for the following days and times when the child(ren) will reside with or be with
the other parent:
from (day and time)__________________ to (day and time)__________________
[ ] every week [ ] every other week [ ] the first and third week of the month [ ] the second
and fourth week of the month [ ] other:
from (day and time)__________________ to (day and time)__________________

[ ] every week [ ] every other week [) the first and third week of the month [ ] the second
and fourth week of the month [ ] other:
3.2
School Schedule
Upon enrollment in school, the child(ren) shall reside with the [ ] mother [ ] father, except for the
following days and times when the child(ren) will reside with or be with the other parent:
from (day and time)___ Wed @ 4:30pm______________ to (day and time)
__ Sat_9pm____________
[ ] every week [ ] every other week [x] the first and third week of the month [ ] the
second and fourth week of the month [ ] other:
from (day and time)_______ Wed @ 4:30pm to

day and time)__ Thurs @ 4:30pm_
[]
every week [ ] every other week [ ] the first and third week of the month
[x]
the second and fourth week of the month [ ] other:
[]
The school schedule will start when each child begins [ ] kindergarten [ ] first grade
[x] other: Immediately

WPF PS 15.0600 Mandatory (6/2008) - RCW 26.26.375, 26.09.016, .181;. 187;. 194
39>4
/2 g B S
B883B
following days and times when the child(ren) will reside with or be with the other parent:
Same as in 3.2
3.4
Schedule for Other School Breaks
The children) shall reside with the [x ] mother [ ] father during other school breaks, except for the
following days and times when the children) will reside with or be with the other parent:
Same as in 3.2
3.5
Summer Schedule
Upon completion of the school year, the children) shall reside with the [ ] mother [ ] father,
except for the following days and times when the child(ren) will reside with or be with the other
parent:
[x ]
[]
3.6
Same as school year schedule.

Other:
Vacation With Parents
[]
Does not apply.
[x ]
The schedule for vacation with parents is as follows:
Each Parent is entitled to exercixe up to two weeks of consecutive vacation with the child over the summer,
during which time the other parents residential time will be suspended. A notification of 2
weeks needs to be made
3.7
Schedule for Holidays

The residential schedule for the child(ren) for the holidays listed below is as follows:
With Mother
(Specify Year
Odd/Even/Everv)
New Years Day
Presidents Day
even_____________________
odd_____________________
even_____________________
With Father
(Specify Year
Odd/Even/Everv)
odd
even
odd_

3 .9 6 4
Memorial Day
July 4th
Labor Day
Veterans Day
Thanksgiving Day
Christmas Eve
Christmas Day
A-
odd
even
odd
even
odd
odd
odd
L
______________
- 6 / '3 . 5 X 2 .8 8 9
even
odd
even
odd
even
even
even
OCifs
[]
For purposes of this parenting plan, a holiday shall begin and end as follows (set forth
times):
[x ]
[]
Holidays which fall on a Friday or a Monday shall include Saturday and Sunday.
Other:
Schedule for Special Occasions

The residential schedule for the child(ren) for the following special occasions (for example,
birthdays) is as follows:
With Mother
With Father
(Specify Year
(Specify Year
Odd/Even/Everv)
Odd/Even/Everv)
Every
Mothers Day
Every
Fathers Dav
Every
Fathers B/dav
Everv
Mothers B/dav
even
odd
Childs B/dav
[]
3.9
Other:
Priorities Under the Residential Schedule

[]
[x ]
Does not apply because one parent has no visitation or restricted visitation.
Paragraphs 3.3 - 3.8 have priority over paragraphs 3.1 and 3.2 in the following order:
Rank the order of priority, with 1 being given the highest priority:
winter vacation (3.3)
___ school breaks (3.4)
summer schedule (3.5)
[]
_1_holidays (3.7)
^ special occasions (3.8)
,3 vacation with parents (3.6)
Other:

WPF PS 15.0600 Mandatory (6/2008) - R C W 26.26.375, 26.09.016,. 181; .187;. 194
8 8 8 3 3
3964
3.10
3.11
fe /" 1 5 X 2 'S '9
B3B4S
Restrictions
[x ]
[]
Does not apply because there are no limiting factors in paragraphs 2.1 or 2.2.
The [ ] mothers [ ] fathers residential time with the children shall be limited because there
are limiting factors in paragraphs 2.1 and 2.2. The following restrictions shall apply when
the children spend time with this parent:
[]
There are limiting factors in paragraph 2.2, but there are no restrictions on the
[ ] mothers [ ] fathers residential time with the children for the following reasons:
Transportation Arrangements
Transportation costs are included in the Child Support Worksheets and/or the Order for Child
Support and should not be included here.
Transportation arrangements for the child(ren) between parents shall be as follows:
As agreed between parents
3.12
Designation of Custodian
The children named in this parenting plan are scheduled to reside the majority of the time with the [
x] mother [ ] father. This parent is designated the custodian of the children) solely for purposes of
all other state and federal statutes which require a designation or determination of custody. This
designation shall not affect either parents rights and responsibilities under this parenting plan.
3.13
Other
3.14
Summary of RCW 26.09.430 - 480, Regarding Relocation of a Child

This is a summary only. For the full text, please see RCW 26.09.430 through 26.09.480.
If the person with whom the child resides a majority of the time plans to move, that person shall
give notice to every person entitled to court ordered time with the child.
If the move is outside the childs school district, the relocating person must give notice by personal
service or by mail requiring a return receipt. This notice must be at least 60 days before the
intended move. If the relocating person could not have known about the move in time to give 60
days notice, that person must give notice within 5 days after learning of the move. The notice
must contain the information required in RCW 26.09.440. See also form DRPSCU 07.0500,
(Notice of Intended Relocation of a Child).

W PFPS 15.0600 Mandatory (6/2008) - RCW 26.26.375, 26.09.016, .181; .187; .194
3964
le v a 's B 3
ee@ 4i
If the move is within the same school district, the relocating person must provide actual notice by
any reasonable means. A person entitled to time with the child may not object to the move but may
ask for modification under RCW 26.09.260.
Notice may be delayed for 21 days if the relocating person is altering a domestic violence shelter
or is moving to avoid a clear, immediate and unreasonable risk to health and safety.
If information is protected under a court order or the address confidentiality program, it may be
withheld from the notice.
A relocating person may ask the court to waive any notice requirements that may put the health
and safety of a person or a child at risk.
Failure to give the required notice may be grounds for sanctions, including contempt.
If no objection is filed within 30 days after service of the notice of intended relocation, the
relocation will be permitted and the proposed revised residential schedule may be confirmed.
A person entitled to time with a child under a court order can file an objection to the childs
relocation whether or not he or she received proper notice.
An objection may be filed by using the mandatory pattern form WPF DRPSCU 07.0700,
(Objection to Relocation/Petition for Modification of Custody Decree/Parenting Plan/Residential
Schedule). The objection must be served on all persons entitled to time with the child.
The relocating person shall not move the child during the time for objection unless: (a) the delayed
notice provisions apply; or (b) a court order allows the move.
If the objecting person schedules a hearing for a date within 15 days of timely service of the
objection, the relocating person shall not move the child before the hearing unless there is a clear,
immediate and unreasonable risk to the health or safety of a person or a child.
IV. Decision Making
4.1
Day to Day Decisions

Each parent shall make decisions regarding the day-to-day care and control of each child while the
child is residing with that parent. Regardless of the allocation of decision making in this parenting
plan, either parent may make emergency decisions affecting the health or safety of the children.
4.2
Major Decisions
Education decisions
Non-emergency health care
[]
[]
[]
[]
[]
n
[]
mother
mother
mother
mother
mother
mother
mother
[3
[3
[]
[]
[]
[]
[]
father
father
father
father
father
father
father

WPP PS 15.0600 Mandatory (6/2008) - R C W 26.26.375, 26.09.016, .181;. 187;. 194
[x]
[x]
[x]
[]
[]
[]
[]
joint
joint
joint
joint
joint
joint
joint
[]
[]
4.3
mother
mother
[]
[]
father
father
[]
[]
joint
joint
Restrictions in Decision Making

[x ]
[]
Does not apply because there are no limiting factors in paragraphs 2.1 and 2.2 above.
Sole decision making shall be ordered to the [ ] mother [ ] father for the following reasons:
[]
[]
[]
A limitation on the other parents decision making authority is mandated by RCW

26.09.191 (See paragraph 2.1).
Both parents are opposed to mutual decision making.
One parent is opposed to mutual decision making, and such opposition is
reasonably based on the following criteria:
(a)
(b)
(c)
(d)
[]
The existence of a limitation under RCW 26.09.191;

The history of participation of each parent in decision making in each of
the areas in RCW 26.09.184(4)(a);
Whether the parents have demonstrated ability and desire to cooperate
with one another in decision making in each of the areas in RCW
26.09.184(4)(a); and
The parents geographic proximity to one another, to the extent that it
affects their ability to make timely mutual decisions.
There are limiting factors in paragraph 2.2, but there are no restrictions on mutual decision
making for the following reasons:
V. Dispute Resolution
The purpose o f this dispute resolution process is to resolve disagreements about carrying out
this parenting plan. This dispute resolution process may, and under some local court rules or
the provisions o f this plan must, be used before filing a petition to modify the plan or a motion
for contempt for failing to follow the plan.
[tf
Disputes between the parties, other than child support disputes, shall be submitted to (list person or
agency):
counseling by Cfco d f r J y OfLAlft BCACfiC_____ j or
[]
mediation by__________________________________ , if this box is checked and

issues of domestic violence or child abuse are present, then the court finds that the victim
requested mediation, that mediation is appropriate and that the victim is permitted to have
a supporting person present during the mediation proceedings, or
[]
arbitration bv
_______________________________ .
_% mother _
___% father.

39*> 4
[]
[]
k ,'IS /-2 8 8 9
-B B S 4 3
based on each partys proportional share of income from line 6 of the child support
worksheets.
as determined in the dispute resolution process.
The dispute resolution process shall be commenced by notifying the other party by [^written
request [ ] certified mail [ ] other:
(a)
(b)
[]

Unless an emergency exists, the parents shall use the designated process to resolve disputes
relating to implementation of the plan, except those related to financial support.
(c)
A written record shall be prepared of any agreement reached in counseling or mediation
and of each arbitration award and shall be provided to each party.
(d)
If the court finds that a parent has used or frustrated the dispute resolution process without
good reason, the court shall award attorney's fees and financial sanctions to the other
parent.
(e)
The parties have the right of review from the dispute resolution process to the superior
court.
No dispute resolution process, except court action is ordered.
VI. Other Provisions
[ .]
There are no other provisions.
[x]
There are the following other provisions:
Communication via e-mail on upcoming events or schedule changes.
Each parent is in charge of finding out about current events in childs schedule on his/her own.
VII. Declaration for Proposed Parenting Plan

[]
Does not apply.

(Only sign if this is a proposed parenting plan.) I declare under penalty of perjury under the laws
of the state of Washington that this plan has been proposed in good faith and that the statements in
KH
o f L$\u / t 'P p A * cofa
Date
ite and Place (City and State) of Signature
Date and Place (City and State) of Signature
VIII. Order by the Court
It is ordered, adjudged and decreed that the parenting plan set forth above is adopted and approved as an
order of this court.
WPF PS 15.0600 Mandatory (6/2008) - R C W 26.26.375, 26.09.016,. 181;. 187;. 194
3964
6 ^1 5 ^2 8 0 9
-8 8 8 4 4
Warning: Violation of residential provisions of this order with actual knowledge of its terms is punishable
by contempt of court and may be a criminal offense under RCW 9A.40.060(2) or
RCW 9A.40.070(2). Violation of this order may subject a violator to arrest.
When mutual decision making is designated but cannot be achieved, the parties shall make a good faith
effort to resolve the issue through the dispute resolution process.
If a parent fails to comply with a provision of this plan, the other parents obligations under the plan are
not affected.
Dated:______________________________
______________________________
Judge/Commissioner
Presented by:
Approved for entry:
Signature of Party or Lawyer/WSBA No.
Signature of Party or Lawyer/WSBA No.
Print Name
Print Name

39&4
07-3-02242-1
32247021
06-12-09
RTS

County of Pierce
In re:
No- 0 7 '3 '4 > 2 Z V .z - /

Petitioner,
and
Return of Service
(Optional Use)
(RTS)
Respondent.
/ D e c la re
1.
I am over the age o f 18 years, and I am not a party to this action.
2.
I served the following documents to (name)

Kl
[]
Pd
,P(|
XI
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
'T h o m a s
summons, a copy o f which is attached

petition in this action
proposed parenting plan or residential schedule
proposed child support order
proposed child support worksheets
sealed financial source documents cover sheet and financial documents
financial declaration
Notice Re: Dependent o f a Person in Military Service
notice o f hearing for____________________________________________
motion for temporary order
motion for and ex parte order
motion for and order to show cause re:____________________________
declarations o f __________________________________________________
temporary order
other:
Return of Service (RTS) - Page 1 of 2

WPF DRPSCU 01.0250 (6/2008) - CR 4(g), R C W 4.28.080(15)
SSS45
3 9 &4
3.
4.
The date, time and place o f service were (if by mail refer to Paragraph 4 below):
Date:
____________________________ Time: _________________________ a.m./p.m.
Address:
_________________________________ __________________
Service was made pursuant to Civil Rule 4(d):

[]
[]
[]
[]
5.
by delivery to the person named in paragraph 2 above.

by delivery to (name)___________________________________________ , a person o f
suitable age and discretion residing at the respondent's usual abode.
by publication as provided in RCW 4.28.100. (File Affidavit of Publication separately.)
(check only if there is a court order authorizing service by mail) by mailing two copies
postage prepaid to the person named in the order entered by the court on
(date)___________________________ . One copy was mailed by ordinary first class mail,
the other copy was sent by certified mail return receipt requested. (Tape return receipt
below.) The copies were mailed on (date)_________________________________ .
Service o f Notice on Dependent o f a Person in Military Service.

[]
[]
6.
fe /'- l'S > 2 0 8 9
The Notice to Dependent o f Person in Military Service was [ ] served on [ ] mailed by

first class mail on (date)______ ______________________________.
Other:
Other:
I declare under penalty o f perjury under the laws o f the state o f Washington that the foregoing is true and
correct.
Signed at (city)__________________________ , (state)___________on (date)________________________ .
Signature
Fees:
Service
Mileage
Total
Print or Type Name
____________________________
____________________________
____________________________
(Tape Return Receipt here, if service was by mail.)

File the original Return o f Service with the clerk. Provide a copy to the law enforcement agency where
protected person resides if the documents served include a restraining order signed by the court.
Return of Service (RTS) - Page 2 o f 2

WPF DRPSCU 01.0250 (6/2008) - CR 4(g), R C W 4.28.080(15)
ORIGINAL
PCOPC
32247022
c oivtyF!A o
Cl^ K S
06-12-09
Am
JUH i 2
2009
SUPERIOR COURT OF WASHINGTON FOR PIERCB COUNTY
INR&
Prtllinng/PUdBdH
Vfc
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)
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Signafun
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3964
Pierce County Superior C ourt N um ber: ________________________
T h is
Certificate ef attendance
is h e re b y a w a rd e d to
o
L. \!(Xin
CKW]
fo r a tte n d in g a n d c o m p le tin g th e
Jnvpact of tDiuorce
On, Children
Seminar
C o n d u cte d b y G a te w a y s fo r Y o u th and F a m ilie s
In P ie rce C o u n ty , W a s h in g to n o n th is d a y
SEPTEMBER 8,2007
6 /1 5 -^ 2 S 8 9
3043
3 3 6 .4
I
& > 'i 5 / 2 S S S
06-12-09
SUPERIOR COURT OF WASHINGTON

COUNTY OF PIERCE
In re
-7 *
Petitioner,
and
lA n P a r o
Respondent.
)
)
)
)
)
)
)
)
)
NO.
0 ? '3 ' ) Z 2 / z - /
CHILD SUPPORT WORKSHEETS

PROf OSED BY
lA r tpCtry)_________
S 2
3S & 4
- 6 ^ 1 'S > : 2 - 8 e S
Washington State Child Support Schedule Worksheets

[X]
Proposed by [X] M other [ ] Father

Or, [ ]
Mother: SARA L. VANDAM
County: PIERCE
[ ] State o f W A [ ] O ther
. (CSW P)
Signed by the Judicial/Reviewing O fficer. (CSW)
Father: THOMAS L. VANDAM
Superior Court/OAH Case No.: 07-3-02242-1
___________________ Child Support Order Summary Report__________________

A. The order [X] does [ ] does not replace a prior court or administrative order.__________________
B. The Standard Calculation listed on line 15e of the Worksheet for the paying parent is:
$473.95.______________________________________________________________________________
C. The Transfer Amount ordered by the Court from the Order of Child Support is:
$473.95 to be paid by [ ] mother [X] father.__________________________
D. The Court deviated (changed) from the Standard Calculation for the following reasons:
[X] Does not apply
[ ] Nonrecurring income
*
[ ] Split custody
[ ] Residential schedule (including shared custody)
[ ] Children from other relationships for whom the parent owes support
[ ] High debt not voluntarily incurred and high expenses for the child(ren)
[ ] Other (please describe):
E. Income for the Father is [X] imputed [ ] actual income.
Income for the Mother is [ ] imputed [X] actual income.
F. If applicable: [X] All health care, day care and special child rearing expenses are included in the
worksheets in Part II.
Worksheets
Children and Ages: SIE-AS R. VANDAM, 6
Parti: Basic Child Support Obligation (See Instructions, Page 1)
a.
b.
c.
d.
e.
f.
Wages and Salaries (Imputed for Father)

Business Income
Maintenance Received
Other Income
Total Gross Monthly Income
(add lines 1a through 1e)
WSCSS-Worksheets - Mandatory (CSW/CSWP) 6/2008 Page 1 o f 5
Father
Mother
$5,304.00
$2,825.30
$5,304.00
$2,825.30
% BBZ
3 S fc 4
6 2 1 5226S3
Father
$889.51
$405.76

a. Income Taxes (Federal and State) Tax Y e a r Manual
b. FICA (Soc.Sec.+Medicare)/Self-Employment Taxes
d. Mandatory Union/Professional Dues
e. Pension Plan Payments
f. Maintenance Paid
g. Normal Business Expenses
h. Total Deductions from Gross Income
(add lines 2a through 2g)
3. Monthly Net Income
(line 1f minus 2h)
4. Combined Monthly Net Income
(Line 3 amounts combined)
(If line 4 is less than $600, skip to line 7.)
5. BASIC CHILD SUPPORT OBLIGATION: Combined ^
SILAS R. VANDAM
$961.00
Mother
-
$1,295.27
$4,008.73
$2,825.30
$6,834.03
> ;x
r. \
..-i-r
$961.00
' . / - -1* "

(Each parent's net income from line 3 divided by line 4)
7. Each Parent's Basic Child Support Obligation
(Multiply each number on line 6 by line 5)
(If line 4 is less than $600, enter each parent's support
obligation of $25 per child. Number of children: 1
(Skip to line 15a and enter this amount.)
.587
.413
$564.11
$396.89
Part II: Health Care, Day Care, and Special Child Rearing Expenses (See Instructions, Page 3)

a. Childrens Monthly Health Insurance
b. Children's Uninsured Monthly Health Care
c. Total Monthly Health Care Expenses
(line 8a plus line 8b)
(add father's and mother's totals from line 8c)
e. Maximum Ordinary Monthly Health Care
(multiply line 5 times .05)
f. Extraordinary Monthly Health Care Expenses
(line 8d minus line 8e., if "0" or negative, enter "0")
d. Other Special Expenses (describe)
e. Total Day Care and Special Expenses

(Add tines 9a through 9d)
10. Combined Monthly Total Day Care and Special Expenses
(Combine amounts on line 9e)
$150.00
$150.00
$150.00
" \ S
$48.05
1 (V*'^**
$101.95
-
L-. l t Z ,-ic C
. '..
"V* \S -
08624
3S S 4
11. Total Extraordinary Health Care, Day Care, and Special

Expenses (line 8f plus line 10)
.SW;
Father
12. Each Parent's Obligation for Extraordinary Health Care,

Day Care, and Special Expenses
(Multiply each number on line 6 by line 11)
S 2 1 S /2 B B 9
$101 .95 i
Mother
$59.84
$42.11
$623.95 |
$439.00
Part HI: Gross Child S upport O bligation

Part IV: Child Support Credits (See Instructions, Page 3)

b. Day Care and Special Expenses Credit
c. Other Ordinary Expenses Credit (describe)
$150.00
$150.00
Part V: Standard C alculation/Presum ptive Transfer Payment (See Instructions, Page 4)

15. Standard Calculation
a. Amount from line 7 if line 4 is below
$600. Skip to Part VI.
b. Line 13 minus line 14d, if line 4 is over
$600 (see below if appl.)
Limitation standards adjustments
c. Amount on line 15b adjusted to meet 45%
net income limitation
d. Amount on line 15b adjusted to meet
need Standard limitation
Need Standard Year: 2009
e. Enter the lowest amount of lines 15b, 15c or 15d:
Father
Mother
-
$473.95
$439.00
$473.95
$439.00
Part VI: A dditional Factors fo r C onsideration (See Instructions, Page 4)

(List the Present estimated value of all major household assets.)
a. Real Estate
b. Stocks and Bonds
c. Vehicles
d. Boats
e. Pen sion s/l RAs/Ba nk Accou nts
f. Cash
g. insurance Plans
h. Other:
Fathers
Household
17. Household Debt

(List liens against household assets, extraordinary debt.)
a.
b.
c.
Mother's
Household
-
BBS 2 5
3S *>4
(Household Debt continued)
Father's
Household
d.
e.
f.
18! Other Household Income
a. Income Of Current Spouse or Domestic Partner
(if not the other parent of this action)
Name
Name
^1 5 ^2 ^8 9
Mother's
Household
b. Income of Other Adults in Household

Name
Name
c. Income of Children (if considered extraordinary)

Name
Name
d. Income from Child Support

Name
Name
e. Income From Assistance Programs

Program
Program
20. Child Support Paid For Other Children

Name/age:
Name/age:
Name/age:
21. Other Children Living In Each Household
(First names and ages)
WSCSS-Worksheets - Mandatory (CSW/CSWP) 6/2008 Page 4 of 5
BBBZb
39&4
1 5 /2 0 0 9
22. Other Factors For Consideration
Basis for Wages and Salaries for Mother: $2,825.33

$652.00 Weekly
Signature and Dates

I declare, under penalty of perjury under the laws of the State of Washington, the information
contained in these Worksheets is complete, true, and correct.
Fathers Signature
Mother's
tether's Signatui
Signature
78 0 9
Date
. o iA
Date
Judge/Reviewing Officer
City
Date
Worksheet certified by the State of Washington Administrative Office of the Courts.

Photocopying of the worksheet is permitted.
W S C S S -W orksheets - M andatory (CSW /CSW P) 6/2008 Page 5 of 5
n;..\statetemplates\waworksheet.dtf i:\Jegalplus\cindy-dave\vandafnWandam.scp05713/200911:56am
SupportCa/c 2009
86027
3964
fc v 1 S /2 3 S 9
33020
WORKSHEET SYNOPSIS
FATHER
MOTHER
COMBINED
$4,008.73
.587
$2,825.30
.413
$6,834.03
5. Total Basic Support Obligation

6. OBLIGATION for Extraordinary Health
Care, Day Care, and Special Exp.
$564.11
$59.84
$396.89
$42.11
$961.00
$101.95
7.
$623.95
$439.00
1. Monthly Net Income Tax Year: Manual

3. Basic Support:
SILAS R. VANDAM
4.
TOTAL
$961.00
$961.00
TOTAL OBLIGATION
8. CREDIT for Extraordinary Medical

9. CREDIT for Day Care and Special Exp.
10. CREDIT for Ordinary Expenses
$150.00
11.
TOTAL CREDITS
$150.00
12.
Father Pays Mother
$473.95
File Name: VANDAM.SCP

Page was printed on 5/13/2009 at 11:56 AM
CASE ALERT
INCOME EXCEEDS $5000

PRESUMPTIVE AMOUNT: $738.00
ADVISORY AMOUNT: $961.00
SupportCa/c 2009
3964
07-3-02242-1
32247070
6 ^1 5 ^2 8 8 3
3084
06-12-09
FILED
IN COUNTY C LER K 'S O FFIC E

a .m .

COUNTY OF PIERCE
In re
JU w
1 2 2009
PIERCE gmHm-yWSHINGTON
KEVIN STOCK. County Clerk
RY
T
DEPUTY
~ T h o M Z
L l/a+ ^Pkjry, Petitioner,
and
)
)
)
Respondent.
p .m .
NO. 0 7 ~ 3 - 6 Z 2 ^ Z ' {
CERTIFICATE OF COMPLETION
MANDATORY PARENTING
SEMINAR
33 84
> / I S ^ 2 S 3 9
C o u rt Cause N um ber:
THIS CERTIFIES THA T

V
^ D
a m
r a
Has successfully completed the four-hour class,
What Children o f Divorce Really N eed

Presented by Lesa Swanson, LICSW and Richard MacLeod,LICSW
Dated this 8th day o f October, 2007 at the City o f Tacoma, State o f Washington.
.B 3 8 S 3
3 9 t> 4
07-3-02242-1
32247073
NTHG
6 ^ 1 '5 - < 2 S 0 9
06-12-09

County of
No. o l- J - a Z Z Y J - f
In re:
P e titio n e rs N otice of
Hearing fo r Adequate Cause
D eterm ination
(O ptional Use)
(NTHG)
[ ] C lerks A ction R equired
Ihonncc Z .
Petitioner,
and
Respondent.
To the C le rk o f C o u rt a n d to:
l.
Please note that the court will be asked to determ ine if adequate cause exists to m odify/adjust the custody
decree/parenting plan/residential schedule as requested in the petition filed in this case.
2.
A hearing has been set for the follow ing date, time and place.
Date:
_______________________________________
Place:
________ pja^ C.minty Superior Court _________
Time:
9 :3 0
__
^ R o o rp/Department:
_^Tm^>.rn.
l O p f i f 7 / Q 7
3.
This request is b &S9dTflK>JWe fac

n ^ t l l ^ e t it ion for M odification/A djustm ent o f Custody
D ecree/Parenting Plan/R esidential Schedule [ ] and on the additional declarations served on the nonm oving
party.
4.
You may serve and file a response and opposing declarations prior to the hearing date. If the court determ ines
that adequate cause for hearing the petition is established by the declarations, it will set a date for hearing on an
order to show cause why the petition should not be granted.
5.
If you do not file a response to the petition, opposing declarations, or a notice o f appearance, an order may be
entered w ithout further notice to you finding you in default and granting the relief requested in the petition.
Dated: ^
________________________
%jfe v u i
Signature o f Party cfc-tawyer/W SBA No.
Notice to party: You may list an address that is not your

residential address w here you agree to accept legal
documents. A n y tim e th is a d d re s s c h a n g e s w h ile
th is ac tio n is p e n d in g , y o u m u st n o tify th e
o p p o sin g p a rtie s in w ritin g an d file an u p d a te d
C o n fid e n tia l In fo rm a tio n F o rm (W P F D R P S C U
v i n t n ** T i m a \ T a m a
Print
or Type Name
iP - d .Z o Y 7 / V 3 _________________
[Address]
0 9 .0 2 0 0 ) w ith the c o u rt c le rk .
Petitioner's Not o fH m g (Adequate Cause) (NTHG) - Page 1 o f 1

WPF DRPSCU 07.0250 (6/2006) - RCW 26.09.260; .270; 26.10.200
/U jlt;
7839/
394
3 5 /2 8 8 9

County of PIERCE
No. 07-3-02242-
Thomas. L Van Dam

Petitioner,
and
Sara L. Van Dam
Respondent.
Residential Time Summary

Report
(RTSR)
Clerks Action Required
Submit with final Parenting Plan, only. This form is for statistical reporting purposes only.
1. The Parenting Plan

The court signed the Parenting Plan on (Date)
It is: [ ] an original order
It was: [ ] by agreement o f the parties
[ ] after a contested hearing or trial
[ ] a modification of a prior order
[ ] by default
How many children under the parenting plan have the residential schedule summarized in paragraph 2,
below?
one
2. Residential Schedule from Part III of the Parenting Plan

if the same schedule does not apply to all children, fill out a separate Residential
Time Summary Report fo r each schedule.
Check the box that comes
closest to representing the
time spent with each parent:
[ ]
r]
[ ]
[ 3
[ 3
[ 3
[ 3
rxi
3
I 3
[
_______ U _______
% of time the
children spend
with the Mother
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% o f time the
children spend
with the Father
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Res. Time Summary Rpt (RTSR) - Page 1 of 2
WPF DR 01.0410 - Mandatory (4/2008) - R C W 26.09.231, 26.18.230
0BSS2
3984
8 ^ 1 5 /2 8 0 3
3. Information about the Parents

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:
[ x ] self-represented f l represented by an attorney

The court found under paragraphs 2 .1 and 2.2: [ ] does not apply, or
[ ] abused or neglected a child
the Mother [ ] committed domestic violence
[ ] has mental health issues
[ ] has chemical dependency issues
[ ] other:
4. Dispute Resolution from Part V. of the Parenting Plan

[ ] Arbitration
Prepared by:
[ ] Mediation
[ ] Counseling
[ ] No dispute resolution process except court action
on (Date)
Res. Time Summary Rpt (RTSR) - Page 2 o f 2

WPF DR 01.0410 - Mandatory (4/2008) - R C W 26.09.231, 26.18.230
80053
4286
07-3-02242-1
32328499
AFSR
6 ^2 5 ^2 8 8 3
629223
06-25-09
1
2
IN COUNTYF CLERK'S OFFICE
A-m.
JUN 2/5 2009
p.b.
p'EjlCE U/utf/Y, WASHINGTON

KE\NN ftlOCK, County CJsrk
Br.
DEPUTY
6
7
SUPERIOR COURT, IN AND FOR THE COUNTY OF PIERCE, STATE OF

WASHINGTON
11
Declaration of Service of:

VS.
SARA L. VAN DAM,
Defendant/Respondent
12
13
16
17
18
19
20
SUMMONS AND PETITION FOR MODIFICATION/

ADJUSTMENT OF CUSTODY DECREE/ PARENTING
PLAN/RESIDENTIAL SCHEDULE: FINANCIAL
DECLARATION PETITIONER; PARENTING PLAN
PROPOSED; CHILD SUPPORT WORKSHEETS PROPOSED
BY SARA VAN DAM; CERTIFICATE OF COMPLETION
MANDATORY PARENTING SEMINAR; RESIDENTIAL TIME
SUMMARY REPORT; NOTE FOR COMMISSIONER'S
CALENDAR;
Hearing Date: Jul 15 2009
14
15
07-3-02242-1
Plaintiff/Petitioner
10
Cause#:
THOMAS L. VAN DAM,
Declaration:
T he undersigned hereby declares: That s(he) is now and at all times herein mentioned, a citizen o f the United
States and a resident o f the State o f Washington, over the age o f eighteen, not an officer o f a plaintiff
corporation, not a party to nor interested in the above endded action, and is com petent to be a witness
therein.
O n the date and time o f Jun 21 2009 8:25PM at the address o f 20839 60TH ST E # A B O N N E Y LAKE,
within the County o f PIER CE, State o f W A SH IN G TO N , the declarant duly served the above described
docum ents upon THOM AS L. VAN DAM by then and there personally delivering 1 true and correct
copy(ies) thereof, by then presenting to and leaving the same with THOM AS L. VAN DAM (20'S, 180, 5'9,
C/M ).
N o inform ation was provided that indicates that the subjects served are members o f the U.S. military.
21
22
I hereby declare under penalty o f perjury under the laws o f the State o f W ashington that the foregoing is true
and correct.
23
Dated: June 23, 2009 at Tacoma, WA
24
25
by.
Service Fee Total* $ 85.00
B. Dunayski
PCR 7003
26
27
28
ABC Legal Services, Inc.

206 521-9000
Tracking#: 5918417
iin fiin ii
ORIGINAL
PROOF OF SERVICE
Page 1 of I
SARA VAN DAM

P.O. BOX 7143
253-298-9172
4236
523238

County of Pierce
In re:
No.
"T hom as / .
Petitioner,
and
Respondent.
To.
L.
i)
O'? 3 - OZZTZ-1
Summons(Modifi cation/
Adjustment of Custody
Decree/Parenting Plan/
1M)___________________
4 C D A *\
1.
An action has been started in the above court requesting that a custody decree/parenting
plan/residential schedule be modified/adjusted. Additional requests, if any, are stated in the
petition, a copy of which is attached to this notice.
2.
You must respond to this notice and petition by serving a copy of your written response on the
person signing this summons and by filing the original with the clerk of the court. If you do not
serve your written response within 20 days (or 60 days if you are served outside of the state of
Washington) after the date this summons was served on you, exclusive of the day of service, the
court may enter an order of default against you, and the court may, without further notice to you,
enter an order regarding adequate cause and a decree to modify/adjust the custody
decree/parenting plan/residential schedule and providing for other relief requested in the petition
If you serve a notice of appearance on the undersigned person, you are entitled to notice before
an order of default or a decree may be entered.
3.
The court shall deny the petition unless it finds that adequate cause for hearing the petition is
established, in which case it shall set a date for hearing on an order to show cause why the
requested order or modification should not be granted.
[]
Temporary residential placement or custody is not being sought.

Temporary residential placement or custody is being sought. If adequate cause is found,
the court may proceed immediately to hear the motion for temporary placement/custody
or may continue the matter to a later time.

WPF DRPSCU 07.0120 Mandatory (7/2007) - CR 4.1; RCW 26.09.270; 26.10.020
4285
Ttim c L &
- 1
h w
p o r tx
c)CUjA S fri) S k r tj fO a r i ,
jocrm *-
un
M f)/n & s
Q cJ '
cm*' 'fa u l. U)jld ? J'r^-r S>

Q fitf
(j> '3 d f> r r )
.fc /.2 -S /2 8 B 3
5282
FILED

a .m .
07-3-02242-1
32409910
J U L - 8 2009
In re:
No. 07-3-02242-1
Thomas L Van Dam
Response to Petition for

Modification/Adjustment of
Custody Decree/Parenting
Plan/Residential Schedule
(RSP)
Check box if petition is attached for:
[ ] Order for protection UH (PTORAH)
Petitioner,
and
Sara L Van Dam
Respondent.
To:
I. Response
Admissions and Denials
The allegations of the petition in this matter are admitted or denied as follows (check only one for
each paragraph):
Paragraph of the Petition
1.1
1.2
1.3
2.1
2.2
2.3
2.4
2.5
2.6
2.7
2.8

K F .vtN f t T o n K C u i\ty C(orW
rv ____________ ae>uT

County of Pierce
1.1
pj
07-09-09
RSP
[x]
[x]
[]
[J
[x]
[x]
[x]
[x]
[x]
Admitted
Admitted
Admitted
Admitted
Admitted
Admitted
Admitted
Admitted
Admitted
Admitted
Admitted
[]
[]
[]
[]
[x]
M
[]
[]
[]
n
[]
Denied
Denied
Denied
Denied
Denied
Denied
Denied
Denied
Denied
Denied
Denied
[]
[]
[]
[]
[]
n
[]
[]
[]
n
[]
Resp to Pet for Mod/Adj (RSP) - Page 1 of 3

WPF DRPSCU 07.0200 Mandatory (6/2008) - RC W 26.09.260; .270; 26.10.200
Lacks Information
Lacks Information
Lacks Information
Lacks Information
Lacks Information
Lacks Information
Lacks Information
Lacks Information
Lacks Information
Lacks Information
Lacks Information
2.9
2.10
2.11
2.11.1
2.11.2
2.11.3
2.12
2.13
2.14
2.15
2.16
M
[]
[]
[]
[]
[]
[x]
[]
[x]
[x]
[]
Admitted
Admitted
Admitted
Admitted
Admitted
Admitted
Admitted
Admitted
Admitted
Admitted
Admitted
[]
[3
[]
[3
[3
[x]
[3
[x]
[J
[]
[x]
Denied
Denied
Denied
Denied
Denied
Denied
Denied
Denied
Denied
Denied
Denied
[3
[x]
[x]
W
[x3
[]
[]
[]
[]
[]
[]
Lacks Information
Lacks Information
Lacks Information
Lacks Information
Lacks Information
Lacks Information
Lacks Information
Lacks Information
Lacks Information
Lacks Information
Lacks Information
Each allegation of the petition that is denied, is denied for the following reasons (list separately):
2.2 Both the petitioner and respondent have since changed and agreed upon a revised schedule that is fair
for both parties.
2.3 Petitioner Thomas L Van Dam gives the respondent $ 150.00/month as well as paying for school
lunches and hair cuts.
2.11.3 Same as in 2.2
2.13 Same as in 2.2. Also, as stated in the respondents petition, we have not and cannot follow a schedule
that is rigid. Both parties have been flexible in meeting each others change in plans and have always
agreed upon a revised schedule that works for both. The current residential schedule is as follows:
The Petitioner has minor child Thursday night from 6:30 p.m. to 7:30 p.m. Monday night. Every
other weekend, the minor child will be with the Petitioner Thursday night form 6:30 p.m. to Friday
afternoon around 4:00 p.m. and then again on Sunday night from 7:30 p.m. to 7:30 p.m. on
Monday. Holidays are still followed per the Original parenting plan set forth.
2.16 Same as in 2.3. Petitioner Thomas L Van Dam not only meets all legal requirements, but also goes
beyond them as agreed upon by both parties.
1.2
Notice of Further Proceedings

WPF DRPSCU 07.0200 Mandatory (6/2008) - R C W 26.09.260; .270; 26.10.200
Notice of all further proceedings in this matter should be sent to the address below
1.3
Other
II. Requests
2.1
Request for Dismissal

[]
[x]
2.2
Does not apply.

The nonrequesting party requests that the petition be dismissed.
Request for Modification or Adjustment

[x]
[]
Does not apply.

The nonrequesting party requests that the court enter an order modifying or adjusting the
custody decree/parenting plan/residential schedule in this matter and approving the
proposed parenting plan/residential schedule, which is filed with or attached to this
response. The nonrequesting party also requests that the court:
[]
[]
[]
Find there is adequate cause for hearing this matter.

Enter an order establishing child support in accordance with the proposed
parenting plan/residential schedule. The child support worksheet and financial
declaration are filed with this response.
Other:
2.3
Protection Order
[]
There is a protection order between the parties filed in case number______________

court________________________, which expires on (date)__________________
The court should grant the [ ] domestic violence [ ] antiharassment petition for order for
protection:
[ ] attached to this response.
[ ] filed separately under [ ] this case number [ ] case number___________________
[]

WPF DRPSCU 07.0200 Mandatory (6/2008) - RCW 26.09.260; .270; 26.10.200
d t.c . t ,
~7 /
th
1 1 1 .S 2 T 2
If you need immediate protection, contact the clerk/court for RCW 26.50 Domestic
Violence forms or RCW 10.14 Antiharassment forms.
_
Dated:
07/08/2009_______________
Notice to party: you may list an address

that is not your residential address where
you agree to accept legal documents.
Any time this address changes while this
action is pending, you must notify the
opposing parties in writing and file an
updated Confidential Information Form
(WPF DRPSCU 09.0200) with the court
clerk.
Signature of Nonrequesting Parf/or Lawyer/WSBA No.

Print or Type Name
Thomas L Van Dam
(Address)
20839 60thSt E. #A Bonnev Lake. WA. 98391

WPF DRPSCU 07.0200 Mandatory (6/2008) - RC W 26.09.260; .270; 26.10.200
FILED
07-3-02242-1
32409^11
AFPT
A.H.
07-09-09
JUL - 8 2009
p.m.
PIC
deputy
ft
r

County of Pierce
In re:
No. 07-3-02242-1
Declaration of
Thomas L. Van Dam
Petitioners),
and
Sara L. Van Dam
Thomas L. Van Dam

(Optional Use)
(DCLR)
Respondent(s).
This declaration is made by:
Name:
_________________
Age:
_________________
Relationship to the parties in this action:

I Declare:
Response to 2:13 Substantial Change in Circumstances:

The Petitioner Thomas Van Dam, since the date of the Marriage Dissolution, has abided by all
terms, and has exceeded what was required by the court order.
The current Parenting plan as ordered is shared joint custody. The time of the minor child Silas
Van Dam is currently divided equally between the Petitioner and the Respondent. For the last 2
years it has been agreed upon and accommodations have been made for the work schedule of
the Petitioner as well as the Respondent, Sara Van Dam. Currently the residential schedule
would allow for the minor child equal time between the Petitioner and Respondent and also
allowing the Petitioner to take the minor child to school 2 to 3 days per week.
Additionally accommodations have been made for the Respondent's ever changing work
schedule as well - even when it included becoming re-educated in a career as a Realtor.
Flexibility by the Petitioner is made for the Respondent's nights and weekends and varying
vacation schedule.
Declaration (DCLR) - Page 1 o f __ _
WPF DRPSCU 01.0100 (6/2006)
"7 /
v o /2 tt3
i'ilS 2 ? 4
The Respondent refused to utilize Dispute Resolution with a professional marriage counselor
Craig Black. The Petitioner has currently offered, in regards to the work schedules, to utilize
Dispute Resolution through Peace Makers Organization which the Responded again has
refused. The Petitioner requests that original order stand since the time of the minor child is
divided equally.
I declare under penalty of perjury under the laws of the state of Washington that the foregoing
is true and correct.
Signed at
Bonnev I.ak
[City]
WA
TStatel on.
07/08/2009
[Date].
Thomas L. Van Dam

Print or Type Name
D o n o t a tta c h fin a n c ia l reco rd s, p e rs o n a l h e a lth c a re reco rd s o r c o n fid e n tia l
re p o rts to th is d e c la ra tio n . S u c h re c o rd s s h o u ld b e s e rv e d on th e o th e r p a rty a n d
file d w ith th e c o u rt u s in g on e o f th e s e c o v e r sh eets:
1) S ealed Financial Source D ocum ents (W P F D R PSC U 09.0220) fo r fin an cial records
2 ) S ealed Personal Health Care R ecords (W P F D R PSC U 09.0260) fo r health records
3 ) S ealed C onfidential Report (W P F D R PS C U 09.270) fo r confidential reports
I f file d s e p a ra te ly u s in g a c o v e r sh eet, th e re c o rd s w ill b e s e a le d to p r o te c t y o u r
p riv a c y (a lth o u g h th e y w ill b e a v a ila b le to a ll p a rtie s in the case, th e ir atto rn e ys,
c o u rt p e rs o n n e l a n d ce rtain s ta te a g e n c ie s a n d b o ard s.) S e e G R 22 (C )(2 ).
Declaration (DCLR) - Page 2 of _

WPF DRPSCU 01.0100 (6/2006)
'
4 B -3 3
7 yr
.- * * i c
FILED
o71609
07-.3-02242-1
32451053
COURT OF THE STATE OF W A S H I N ^ C

AND FOR PIERCE COUNTY
CME
opw courT
"
JUL 1 5 2009
THOMAS L VAN DAM L/"
No. 07-3-02242-1
Petitioner(s),
PIERCE COUNTY, Clerk

bv
m
DEPUTY
Memorandum o f Journal Entry,
vs.
] Show Cause
SARA L VAN DAM ^
(ADM02)
Respondent(s)
Pro 5
Pro
For Petitioner
For Respondent
RE:.
k
1 5 'Q .f
tv. r \
W\IL.a "V
_Pe Vt Vs ur\(Lc
S'OlÔ
rtn .
Uw P p CO\si cfd p
G^r\ J
(Lk;lJ
S. e k e A t y l 6
S i,.p p c r t
____________
r t,^ p on ci.w 4r /
S ' JiKU S .
P c^c Vi H >
^
rr\
C^W.r'V .
yV
^ IU
J l Ajivg ty
July 15, 2009 9:30 AM
/J
m e Ai
\>(L i^ K r c ^ ^ k
j
gygrdgj
3 rgt p t ^ r i y )
Show Cause
JAMES M. MARSHALL
Clerk:
Courtroom number: 100
Calendar: C1- SHOW CAUSE/FAMILY LAW
Run date/time 07/15/09 8:09

Ixcrtrpt.pbl d Joum al_entry_show cause_report
h*.<i lc
07-3-02242-1
32910842
CME
09-28-09

THOMAS L VAN DAM
Cause Number: 0 7 -3 -0 2 2 4 2 -1
Petitioner(s)
MEMORANDUM OF JOURNAL ENTRY
vs.
Page 1 of 2
SARA L VAN DAM

Respondent(s)
Judge/Commissioner: JOHN R. HICKMAN
Court Reporter: NOT ON RECORD
Judicial Assistant/Clerk: Connie Mangus
VAN DAM, THOMAS LEE
C U N T P. JO HNSO N
Attorney fo r Plaintiff/Petitioner
VAN DAM, SARA LOUISE

VAN DAM, SILAS R
Proceeding Set: Exparte Action

Proceeding Outcome: Dismissed
Outcome Date: 09/25/2009 15:05
Resolution:
Clerk's Scomis Code:DSMHRG

Proceeding Outcome code:DISM
Resolution Outcome code:
Amended Resolution code:
Report run date/tim e: 09/25/09 3:05 PM

Ixcalcivil.pbl. d_civiljoum al_report_cover
4668
9 2 2 8 /2 0 0 9
270114

THOMAS L VAN DAM
Cause Number: 07-3-02242-1
MEMORANDUM OF
JOURNAL ENTRY
vs.
Page: 2 of 2
Judge/Commissioner:
JOHN R. HICKMAN
SARA L VAN DAM
__ ___________________________________ MINUTES OF PROCEEDING____________________

Judicial Assistant/Clerk: Connie Mangus
Court Reporter: NOT ON RECORD
Start Date/Time: 09/25/09 3:05 PM
September 25, 2009 03:04 PM The Court signs off on Order of Dismissal for failure to
appear at adequate cause hearing.
End Date/Time: 09/25/09 3:05 PM
JUDGE/COM M ISSIONER: JOHN R. HICKMAN
Year 2009
4&68
9^2822809
1
07-3-02242-1
32910046
ORDSMD
09-28-09
2
3
4
5
6
7
IN THE SUPERIOR COURT OF WASHINGTON, COUNTY OF PIERCE
8
THOMAS L VAN DAM,
Case No. 07-3-02242-1
9
Petitioner,
10
11
12
ORDER OF DISMISSAL
vs.
ORDSMD
SARA L VAN DAM,
Respondent.
13
14
THIS MATTER, having come on regularly for Adequate Cause Hearing on August 3, 2009,
15
and the Petitioner failed to appear personally or through counsel, and the Respondent having not
16
appeared personally or through counsel, And Adequate Cause had not previously been granted .Now,
17
18
Therefore, it is hereby
ORDERED that the Petition for Modification filed June 12, 2009, is hereby Dismissed without
Prejudice in accordance with the case schedule generated when Petition was filed.
19
20
DATED this
21
22
23
24
25
E-FILED
Septem ber 23 2014 4:10 PM
KEVIN STO CK
COUNTY CLERK
NO: 07-3-02242-1

THOM AS L V A N D A M
P etitioner(s),
vs.
N O . 07-3-02242-1
N O T IC E OF A P P E A R A N C E
SA R A L V A N D A M
__________________ R espondent(s)
TO: C lerk o f the C ourt
A N D TO: C L IN T P. JO H N SO N , attorney for Petitioner, SILA S R V A N D A M , SA R A L O U IS E
VAN DAM
P L E A S E T A K E N O T IC E th at D aniel N C ook, appears herein on b e h a lf o f the

P etitioner/P laintiff(s) T H O M A S L E E V A N D A M and requests th a t all furth er pleadings and
paper, except original process, be served upon said attorney at the address listed below .
D A T E D - S eptem ber 23, 2014
ntaprsup-0001.pdf
/s/ D aniel N C ook

D aniel N C ook, #34866
A ttorney fo r P etitioner/P laintiff(s)
Faubion, Reeder, Fraley and Cook, PS

5920 100th St SW Ste 25
LAKEWOOD, WA 98499-2751
(253) 581-0660
E-FILED
IN COUNTY CLERK'S OF
PIERCE COUNTY, WASHIN
O ctober 15 2014 3:41 P
KEVIN STO CK
COUNTY CLERK
NO: 07-3-02242' 1
3
4
5
6
7

10
11
No. 07-3-02242-1
In re:
THOMAS L. VAN DAM,
Petitioner,
12
and
13
SARA L. VAN DAM,

Respondent.
14
15
Petition for Modification/ Adjustment of

Custody Decree/ Parenting
Plan/Residential Schedule
(PTMD)
Para. 2.14: check box if petition is
attached for:
[/(Order for protection UH (PTORAH)
16
17
1.1
Identification of Requesting Party/Parties
18
Name (first/last) THOMAS VAN DAM
19
Last known residence PIERC COUNTY, WASHINGTON.
20
1.2
Identification of Other Party/Parties
21
Name (first/last) SARA VAN DAM
22
Last known residence PIERCE COUNTY, WASHINGTON
23
1.3
Dependent Child
24
Name SILAS VAN DAM
Age 12
25
WPF DRPSCU 07.0100 Mandatory (07/2011) - CR 4.1; RCW 26.09.181;
.260; .270, R C W 26.26.130(7)(b)
Van Dam, Thomas and Van Dam, Sara

S:\CASES1Wan Dam\DRAFTS\Pleadings\Petition for Modification of Parenting Plan.doc
FAUBION, REEDER, FRALEY &

COOK, P.S.
5920-1 00th Street SW, Ste 25
Lakewood, WA 98499
253-581-0660
II. B asis
2
2.1
3
4
This is a petition for an order modifying the prior custody decree/parenting

plan/residential schedule/judgment establishing parentage and approving my
proposed parenting plan/residential schedule, which is filed with this petition.
Petition for an Order Modifying Custody Decree/Parenting Plan/Residential

Schedule
2.2
Adequate Cause
There is adequate cause for hearing the petition for modification.

8
2.3
Child Support
Child support should be modified or established if the court grants the petition to
modify the parenting plan or residential schedule. A child support worksheet and
financial declaration must be filed with this action. RCW 26.09.170.
10
11
12
2.4
Jurisdiction and Venue
The court has proper jurisdiction and venue.
13
The requesting party/parties reside(s) in Pierce County, WA.
14
The child reside in Pierce County, WA.

15
16
The other party/parties reside(s) in Pierce County, WA.

2.5
Jurisdiction Over Proceeding
17
This court has jurisdiction over this proceeding for the reasons below:
18
This court has exclusive continuing jurisdiction. The court has previously
made a child custody, parenting plan, residential schedule or visitation
determination in this matter and retains jurisdiction under RCW 26.27.211.
19
20
21
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2.6
Uniform Child Custody Jurisdiction and Enforcement Act Information
Name of Child
SILAS VAN DAM
Parents Name
THOMAS VAN DAM
Parents Name
SARA VAN DAM
23
During the last five years, the child has lived:

24
25
in no place other than the state of Washington and with no person other
than the requesting party or the other party.
WPF DRPSCU 07.0100 Mandatory (07/2011)
.260; .270, RCW 26.26.130(7)(b)
CR 4.1; RCW 26.09.181;


COOK, P.S.
5920-100 Street SW, Ste 25
Lakewood, WA 98499
253-581-0660
Claims to custody or visitation:

2
The requesting party does not know of any person other than the other
party who has physical custody of, or claims to have custody or visitation
rights to, the child.
3
4
Involvement in any other proceeding concerning the child:
The requesting party has not been involved in any other proceeding
6
7
Other legal proceedings concerning the child:

8
The requesting party does not know of, any other legal proceedings
concerning the child.
9
10
2.7
11
Custody Decree or Parenting Plan/Residential Schedule
The Custody Decree/Parenting Plan/Residential Schedule was entered October

30, 2007, in Pierce County Superior Court. A certified copy of the Custody
Decree/Parenting Plan /Residential Schedule to be modified is filed with or
attached to this petition, if the decree or plan to be modified was entered in another
county or state.
12
13
14
2.8
Modification Under RCW 26.09.260(1), (2)
15
The custody decree/parenting plan/residential schedule should be modified

because a substantial change of circumstances has occurred in the circumstances
of the child or the other party and the modification is in the best interests of the
child and is necessary to serve the best interests of the child. This request is
based on the factors below.
16
17
18
The child has been integrated into my family with the consent of the other
party in substantial deviation from the decree/parenting plan/residential
schedule.
19
20
21
The childs environment under the custody decree/parenting plan/residential

schedule is detrimental to the childs physical, mental or emotional health
and the harm likely to be caused by a change in environment is outweighed
by the advantage of a change to the child.
22
23
24
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2.9
Modification or Adjustment Under RCW 26.09.260(4) or (8)
Does not apply.

.260;.270, R C W 26.26.130(7)(b)


COOK, P.S.
Lakewood, WA 98499
253-581-0660
2.10
Adjustments to Residential Provisions Under RCW 26.09.260(5)(a) and (b)
Does not apply.

3
4
2.11
Adjustments to Residential Provisions Under RCW 26.09.260(5)(c), (7), (9)
Does not apply.
T h is s e c t io n o n ly a p p lie s to a p e r s o n w ith w h o m the c h ild d o e s n o t r e s id e a

m a jo rity o f th e tim e w h o i s s e e k in g to in c r e a s e re sid e n tia l time.
7
2.12
Adjustments to Nonresidential Provisions Under RCW 26.09.260(10)
The following nonresidential provisions of the parenting plan should be adjusted

because there is a substantial change of circumstances of either party or of the
child and the adjustment is in the best interest of the child:
9
10
Dispute resolution.
Decision making.
Transportation arrangements.
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2.13
Substantial Change in Circumstance

(Y o u m u s t c o m p le te th is p a rt if y o u r e q u e s t a m o d ific a tio n o r a d ju stm e n t in
p a r a g r a p h s 2.8, 2.10, 2.11.1, 2 .1 1 .3 o r 2.12.)
The requested modification or adjustment of the custody decree/parenting

plan/residential schedule is based upon the following substantial change in
circumstance:
We have not followed the prior parenting for the last 4-5 years. We have
modified the residential schedule by mutual agreement to provide for Silas
to reside equally with both parents. We have followed an alternating and
repeating two week schedule with Silas sending overnights as follows:
Sunday
1 Father
2 Father
Monday
Father
Father
Tuesday
Father
Father
Wednesday
Mother
Mother
Thursday
Mother
Mother
Friday
Mother
Mother
Saturday
Mother
Father
I work Thursday, Friday and Saturday. I have every Sunday, Monday,

Tuesday and Wednesday off.
23
24
Sara works Monday through Thursday. Sara has every Friday, Saturday
and Sunday off.
25
.260; .270, RCW 26.26.130(7)(b)


COOK, P.S.
Lakewood, WA 98499
253-581-0660
We developed this schedule to maximize the time Silas spends with each of
us on days we have off while still alternating some weekend time. We split
the weekends and simply alternate exchanging Silas on Saturday night or
Sunday morning.
3
4
2.14
The court should grant the antiharassment petition for order for protection attached to
this petition.
7
8
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10
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Protection Order
2.15
Servicemembers Civil Relief Act Statement
2.15.1 A. Service member status -- SARA VAN DAM is not a service member;
B. Factual basis:
See the attached Defense Man Power Data Center Report obtained from
https://www.dmdc.osd.mil/scra/owa/home.
2.15.2 A. Dependent of a service member status -- SARA VAN DAM is not a
dependent of a resident of Washington who is on active duty and is a
National Guard member or a Reservist;
B. Factual basis:
The other party failed to respond to a notice to him or her as a
dependent of a person in Military Service that was served on with
this petition, therefore he or she should be presumed not a
dependent of a resident of Washington who is on active duty and is
a National Guard member or a Reservist.
17
18
19
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III. Relief Requested
The moving party requests that the court find that there is adequate cause for hearing
this petition and enter an order modifying the custody decree/parenting plan/residential
schedule in this matter and approving the proposed parenting plan/residential schedule,
which is filed with this petition.
22
The moving party also requests that the court enter an order establishing child support in
conjunction with the proposed parenting plan/residential schedule. The child support
worksheet and financial declaration are filed with this petition.
23
Dated September 30, 2014.
21
FAUBION, REEDER, FRALEY & COOK P.S.
24
By: DANIEL N. COOK, WSBA #34866
Of Attorneys for Petitioner
25

WPF DRPSCU 07.0100 Mandatory (07/2011)
.260;.270, R C W 26.26.130(7)(b)
CR 4.1; RCW 26.09.181;


COOK, P.S.
Lakewood, WA 98499
253-581-0660
1
2
3
4
I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE

STATE OF WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
Signed at Lakewood, WA on September 3 ^*, 2014.
L jy M U
THOMAS VAN'DAM
I
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WPF DRPSCU 07.0100 Mandatory (07/2011) CR 4.1; RCW 26.09.181;
.260; .270, RCW 26.26.130(7)(b)
S:\C A SE S1 W a n Dam\DRAFTS\Pleadings\Petition for Modification of Parenting Pian.doc

COOK, P.S.
5920-100th Street SW, Ste 25
Lakewood, WA 98499
253-581-0660
Superior Court o f W ashington

For Pierce County
THOMAS L. VAN DAM

Petitioner,
vs.
SA R A L. VAN DAM
No
Petition for an Order for Protection 0 Harassment (PTORAH) and/or

Stalking (PTORSTK)
Respondent.
> This is a Petition for an Order for Protection against Harassment

and/or Stalking as checked in the caption.
[X] I am, or the minor I am petitioning for is, a victim of unlawful harassment because the
respondents actions toward me have seriously alarmed, annoyed or harassed me, or are
detrimental to me and they serve no legitimate or lawful purpose. The respondents
actions have caused me substantial emotional distress or caused me to fear for the well
being of my child.
13 The respondent and I:
13 are or have been related by blood or marriage, lived together, or been in a dating
relationship
I have given a detailed explanation below.
1. Who is the petitioner?

My name is THOMAS VAN DAM. I am the petitioner
3
I am 18 or older and I am petitioning on my own behalf.
2. Who is the respondent?

The Respondent/s is/are 18 years of age or older.
3. Where do the parties live?

Petitioner lives in King County.
Respondent lives in Pierce County.
Pt for an Or for Protection - Harassment/Stalking (PTORAH, PTORSTK*) - Page 1 of 5
WPF UHST-02.0200 (06/2014) - RCW 10.14.040, .800, RCW 7.92.030
4. Where did the Conduct take place?

The conduct took place in King and Pierce counties.
5. Describe what the Respondent did or said that you think is harassment or stalking.
The respondent has com m itted acts of harassment or stalking as follow s:
A . Describe the most recent incident of harassment or stalking.
Date and time (on or around): In August 2014

Location: My house in Auburn - 2817 67th Street Court SE, Auburn, WA 98092
What did the respondent do or sav that you believe to be harassing or stalking behavior?
Sara Van Dam had a sked m e fo r m oney to p a y a school related bill fo r Silas a few
weeks p rio r to the incident. On the day o f the incident she cam e to m y house a nd again
dem anded money. I h a d checked with the school and found that not as much was owed
as she h a d o riginally sa id so I told h e r ha d pa id o r would p a y m y h a lf to the school
directly. Sara Van Dam g o t extrem ely angry I w ould not give h e r the money. Sara
scream ed a t me, sh o u te d obscenities and called me disparaging nam es (e.g.,
deadbeat). I told Sara I w ould not allow h e r to talk to me like that and I closed and
locked the front door. Sara then ran around to the garage and forced h e rse lf into m y
house a n d continued scream ing and yelling at me in front o f m y fam ily (m y current
spouse, two children o f m y current spouse from a p rio r relationship, and m y c hild in
com m on with Sara).
How did the respondent make these statements? 3 in person mail/written notes
e-mail text phone social media (such as facebook and twitter)
other (describe):_______________________________________________________________ .
Date and time (on or around): In Fall 2013
Location: My house in Auburn - 2817 67th Street Court SE, Auburn, WA 98092
What did the respondent do or sav t hat you believe to be harassing or stalking behavior?
Sara Van Dam h a d was angry and violent tow ard me a fte r I disagreed with h e r about
financial issues related to o u r child in common. It was late at night, app ro xim a te ly _____
p.m. and the children in m y hom e were asleep. I term inated the conversation and shut
the front d oor and Sara began kicking and pounding on the do o r in a loud and obnoxious
way. Sara took landscaping rocks and began throwing them at the house in a loud and
dangerous way. The children in the house woke up and were afraid. I was at a loss to
know what to do.
How did the respondent make these statements? ^ in person mail/written notes
e-mail text phone social media (such as facebook and twitter)
other (describe):_______________________________________________________________ .
B. Describe other incidents of harassment or stalking. For each incident, include the date, time
(on or about), location, what was said, how statements were made, and what was done to a
victim.
Sara is very rude, b elligerent and uses frequent p rofanity in h e r conversations with me.
She is dem anding and does not respect boundaries. H e r text m essages are very
harassing.
WPF UHST-02.0200 (06/2014) - RCW 10.14.040, .800, RCW 7.92.030
6.
How did the incidents you describe above make you, the minor, or the vulnerable adult feel?
It w a s e x tre m e ly h a ra ssin g a n d s o m e w h a t s c a ry - p a rtic u la rly a fte r sh e fo rc e d h e r w a y

in to th e house. It was v e ry tra u m a tic fo r m y e n tire fa m ily to w itn e s s the s c e n e th a t she
cre a te d . I w a s afraid, e m b a rra s s e d a n d fe lt help le ss. S a ra 's a c tio n s w e re e x tre m e ly
hara ssin g .
7.
Has the respondent used, displayed, or threatened to use a firearm or other dangerous
weapon in a felony? Please describe:
No.
8.
Has the respondent previously committed an offense that makes him or her ineligible to
possess a firearm under the provisions of RCW 9.41.040? Please describe:
N o t to m y kn o w le d g e .
9.
Does possession of a firearm or other dangerous weapon by the respondent present a

serious and imminent threat to public health or safety, or to the health or safety of a victim?
Please describe:
10. Do you have any evidence of the harassment or stalking conduct other than testimony?
No
M Yes.
11. Has/have the victim /s or the respondent ever requested or obtained protection from the
other person in a restraining order, civil protection order, or criminal no-contact order?
If yes, list the type of order, the name of the court and the approximate date, and whether
the request was granted:

WPF UHST-02.0200 (06/2014) - RCW 10.14.040, .800, RCW 7.92.030
12. Is there any other litigation between the victim/s and the respondent? This includes all
matters - pending or past - such as parenting plans, landlord-tenant disputes, employment
disputes, or property disputes. If yes, provide case number/s if known, type of case, and
name o f court:
The p a re n tin g p la n m o d ific a tio n a s s o c ia te d w ith th is case.
>
Requests
13. I a sk th e C o u rt fo r an o rd e r a p p ro v in g th e fo llo w in g re q u e sts fo r p ro te c tio n :

I Request an O rd e r fo r P ro te c tio n following a hearing that will:
N o-Contact: restrain the respondent from making any attempts or having any contact,
including nonphysical contact, with the person/s to be protected, directly, indirectly, or
through third parties regardless of whether those third parties know of the order, except
for mailing of court documents.__________________________
_____________
________
S urveillance: prohibit or restrain the respondent from making any attempt to keep or
from keeping the person/s to be protected under surveillance, including electronic
surveillance.____________________ ___________________________________________________
E E xclude fro m places: exclude the respondent from the E residence workplace
school day care of the person/s to be protected.
E Stay Away: Prohibit or restrain the respondent from entering or being within, or from
knowingly coming within, or knowingly remaining within 50 feet of the
E l residence workplace school day care of the person/s to be protected.
other locations:
__________
Other:
Evaluation: Order the respondent to have a mental health chemical dependency

evaluation.
other:_________________________________________________________________________
Pay Fees and Costs: Require the respondent to pay fees and costs of this action, which
may include administrative court costs and service fees and petitioners costs including
attorneys fees._______________________________________________________________________
Surrender Firearms: Require the respondent to surrender any firearm or other

dangerous weapon, or any concealed pistol license and prohibit the respondent from
obtaining or possessing a firearm or other dangerous weapon, or a concealed pistol
license.______________________________________________________________________________
E Duration: Remain effective longer than one year because respondent is likely to resume
acts of unlawful harassment or stalking conduct against the persons to be protected if
the order expires in a year.
WPF UHST-02.0200 (06/2014) - RCW 10.14.040, .800, RCW 7.92.030
Emergency temporary protection (up to 14 days) until the court hearing:
An emergency exists as described below. I request that a Temporary Stalking

Protection Order granting the relief I requested above for a no-contact, surveillance,
exclude from places, or stay away order be issued immediately, without prior notice to
the respondent, to be effective until the hearing.
I also request a temporary surrender of a firearm or other dangerous weapon without

notice to the other party because irreparable injury could result if an order is not issued
until the hearing.
What irreparable harm would result if an order is not issued immediately without prior notice
to the respondent?
I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF

WASHINGTON THAT THE FOREGOING IS TRUE AND CORRECT.
Dated:__________________________________a t __________________________________ Washington.
Petitioner
Print or type name
My address for the purpose of receiving service of legal documents is:

C/O my attorney:
Faubion, Reeder, Fraley & Cook PS
Daniel Cook
5920 100th Street SW, #25
Lakewood, WA 98499
This is not my residence address. My family, household or I would be at risk of abuse by

respondent if I disclosed my residence address. I agree to receive service o f process at this
address.
WPF UHST-02.0200 (06/2014) - RCW 10.14.040, .800, RCW 7.92.030
Emergency temporary protection (up to 14 days) until the court hearing:
An emergency exists as described below. I request that a Temporary Stalking

Protection Order granting the relief I requested above for a no-contact, surveillance,
exclude from places, or stay away order be issued immediately, without prior notice to
the respondent, to be effective until the hearing.
I also request a temporary surrender of a firearm or other dangerous weapon without

notice to the other party because irreparable injury could result if an order is not issued
until the hearing.
What irreparable harm would result if an order is not issued immediately without prior notice
to the respondent?
I CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF

WASHINGTON THAT HE FOREGOING IS TRUE AND CORRECT.
Dated:______ jj
iM
________ at
s e cvV M e._______
___ , Washington.
~TlU Wi /Y"'Hf'V i
Petitioner
{V o wi
\ i O.K) Vs) o /y\
Print or type name
My address for the purpose of receiving service of legal documents is:

C/O my attorney:
Faubion, Reeder, Fraley & Cook PS
Daniel Cook
5920 100,h Street SW, #25
Lakewood, WA 98499
This is not my residence address. My family, household or I would be at risk of abuse by

respondent if I disclosed my residence address. I agree to receive service of process at this
address.

WPF UHST-02.0200 (06/2014) - RCW 10.14.040, .800, RCW 7.92.030
1
2
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IN THE S U P E R IO R C O U R T OF THE ST A T E OF W A SH IN G T O N
IN A N D F O R T H E C O U N T Y OF P IE R C E
In re:
No. 07-3-02242-1
10
T H O M A S L. V A N DAM,
11
and
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15
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17
18
Petitioner,
D E C L A R A T IO N P U R S U A N T TO G R 17
(FILING OF E -M A IL E D SIG N A T U R E )
S A R A L. V A N DAM,
Respondent.
I, Sally DuCharme, declare under penalty of perjury under the laws of the State
of Washington that the following is true to the best of my knowledge.
I am the person responsible for filing of the e-mailed signature page of the
PETITION FOR MODIFICATION OF PARENTING PLAN AND ATTACHED PETITION
FOR ORDER OF PROTECTION.
19
I have examined the document and determined that it consists of 12 pages,

20
including this declaration page (but not including attachments), and is a complete and
21
22
23
24
legible image that I have examined personally and that was received by me via e-mail at
[email protected].
Signed at Lakewood, WA on October 15, 2014.
25
' Sally DuCharme, Legal Assistant

Declaration Pursuant to GR 17 - Page 1 o f 1
S:\CASES1Wan Dam\DRAFTS\Pleadings\Declaration re Emailed Signature.doc
FAUBION, REEDER,
FRALEY & COOK, P.S.
5920 100th Street SW, Suite 25
Lakewood, WA 98499
Phone: (253) 581-0660
E-FILED
IN COUNTY CLERK'S OFFICI
PIERCE COUNTY, WASHINGT
O ctober 15 2014 3:41 PM
KEVIN STO CK
COUNTY CLERK
NO: 07-3-02242-1
3
4
5
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7
8
COUNTY OF PIERCE
10
11
12
In re:
No. 07-3-02242-1
THOMAS L. VAN DAM,
Summons(Modification/ Adjustment of
Custody Decree/Parenting Plan/
(SM)
Petitioner,
13
and
14
SARA L. VAN DAM,

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Respondent.
To:
S a ra Van D a m
1.
An action has been started in the above court requesting that a custody
decree/parenting plan/residential schedule be modified/adjusted. Additional
requests, if any, are stated in the petition, a copy of which is attached to this
notice.
2.
You must respond to this notice and petition by serving a copy of your written
response on the person signing this summons and by filing the original with the
clerk of the court. If you do not serve your written response within 20 days (or 60
days if you are served outside of the state of Washington) after the date this
summons was served on you, exclusive of the day of service, the court may
enter an order of default against you, and the court may, without further notice to
you, enter an order regarding adequate cause and a decree to modify/adjust the
custody decree/parenting plan/residential schedule and providing for other relief
requested in the petition. If you serve a notice of appearance on the undersigned
person, you are entitled to notice before an order of default or a decree may be
entered.
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W P F D R P S C U 0 7 .012 0 M a n d a to ry (7/2007) - CR 4.1; R C W 26.09.270;
2 6 .1 0 .0 2 0

S : \ C A S E S 1 W a n D a m \D R A F T S \P le a d in g s\S u m m o n s.d o c x
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
253-581-0660
3.
2
3
4
Temporary residential placement or custody is being sought. If adequate

cause is found, the court may proceed immediately to hear the motion for
temporary placement/custody or may continue the matter to a later time.
The court shall deny the petition unless it finds that adequate cause for hearing
the petition is established, in which case it shall set a date for hearing on an
order to show cause why the requested order or modification should not be
granted.
4.
You may file an opposing declaration to show that there is not adequate cause to
hold a full hearing. If you do not file an opposing declaration or respond and the
court finds that adequate cause exists, the court may enter an adequate cause
order and an order modifying/adjusting the custody decree/parenting
plan/residential schedule without notice to you pursuant to RCW 26.09.270.
5.
Your written response to the summons and petition must be on form WPF
DRPSCU 07.0200, Response to Petition for Modification/Adjustment of Custody
Decree/Parenting Plan/Residential Schedule. This form may be obtained by
contacting the clerk of the court at the address below, by contacting the
Administrative Office of the Courts at (360) 705-5328, or from the Internet at the
Washington State Courts homepage:
8
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10
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http://www.courts.wa.gov/forms
14
6.
If this action has not been filed with the court, you may demand that the petitioner
file this action with the court. If you do so, the demand must be in writing and
must be served upon the person signing this notice. Within 14 days after you
serve the demand, the petitioner must file this action with the court, or the service
on you of this notice and motion will be void.
7.
If you wish to seek the advice of an attorney in this matter, you should do so
promptly so that your written response, if any, may be served on time.
8.
One method of serving a copy of your response on the petitioner is to send it by

certified mail with return receipt requested.
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This summons is issued pursuant to RCW 4.28.100 and Superior Court Civil Rule 4.1 of
the state of Washington.
DATED this ' 0
day of-September 2014.
FAUBION, REEDER, FRALEY
24
Daniel N. Cook, WSBA 34866

Attorney for Petitioner
25

W P F D R P S C U 0 7 .012 0 M a n d a to ry (7/2007) - CR 4.1; R C W 26.09.270;
2 6 .10.0 20

S : \ C A S E S 1\Van D a m \D R A F T S\P le a d in g s\Su m m o n s. docx
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
253-581-0660
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F ile o rig in a l o f y o u r re s p o n s e w ith

th e c le rk o f th e c o u rt at:
Serve a c o p y o f y o u r re s p o n s e o n :
Clerk of the Superior Court

Pierce County Court
County-City Building
930 Tacoma Ave. S., Rm 110
Tacoma, WA, 98402
Daniel N. Cook
FAUBION, REEDER, FRALEY & COOK, P.S.
Lakewood, WA 98499
Telephone: 253-581-0660
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W P F D R P S C U 0 7 .0 1 2 0 M a n d a to ry (7/2007) - CR 4.1; R C W 26.09.270;
2 6 .1 0 .0 2 0

S : \ C A S E S 1 W a n D a m \D R A F T S \P le a d in g s\S u m m o n s.docx
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
253-581-0660
E-FILED
O ctober 15 2014 3:41 PM
KEVIN STO CK
COUNTY CLERK
NO: 07-3-02242-1

THOMAS L VAN DAM

No. 07-3-02242-1
Petitioner(s),
vs.
SARA L VAN DAM

Respondent(s)
TO THE CLERK OF THE SUPERIOR COURT AND TO:

Name: SARA LOUISE VAN DAM
Address: 3310 214TH AVE E BONNEY LAKE, WA 98391
Phone:
Respondent
Please take notice that an issue of law in this case will be heard on the date and time shown below:
Pierce County Superior Court, County-City Building - 930 Tacoma Ave S - Tacoma, WA 98402
M otion - Tem porary O rder
Calendar: Show Cause/Family Law
CALENDAR DATE: Wednesday, December 10, 2014 9:00 AM

WORKING COPIES SHALL BE SUBMITTED TO COMMISSIONERS SERVICES ROOM 140,
BEFORE 12:00 NOON TWO COURT DAYS PRIOR TO HEARING
DATED:
October 15, 2014.
Signed:
/s/ Daniel N Cook
NAME:
Daniel N Cook
Phone:
(253) 581-0660
WSBA#:
For:
34866
ADDRESS:
5920 100th St SW Ste 25

LAKEWOOD, W A 98499-2751
Note for Commissioners Calendar (ntc.rptdesign)
1 of
E-FILED

O ctober 15 2014 4:10 PM

KEVIN STO CK
COUNTY CLERK
No. 07-3-02242-1
NO: 07-3-02242-1
ORDER SETTING CASE SCHEDULE
THOMAS L VAN DAM

Petitioner(s)
Type of case:
DIC
Estimated Trial (days):
Vs.
Track Assignment:
Assignment Department:
Docket Code:
SARA L VAN DAM

Respondent(s)
Modification of Custody
TOLL
ORSCS
Notice of Adequate Cause & Note for Comm Cal filed w/Petition or no later than
Confirmation of Service
10/22/2014
Adequate Cause Hearing on Commissioner Calendar to be held. (If this hearing is not held by this date,
petition will be dismissed)
Set Settlement Conference Date with Judge/Commissioner VICKI L. HOGAN
12/17/2014
Certificate of Parenting Class - Petitioner's (Must be filed on or before)
12/17/2014
Certificate of Parenting Class - Respondent's (Must be filed on or before)
12/17/2014
11/5/2014
12/17/2014
Requesting Party's Disclosure of Primary Witnesses
2/18/2015
Non-Requesting Party's Disclosure of Primary Witnesses
3/11/2015
Disclosure of Rebuttal Witnesses
3/25/2015
4/8/2015
Deadline for Filing Motion to Adjust Trial Date
Week of 5/20/2015
Settlement Conference (To be held)

Discovery Cutoff
5/27/2015
Exchange of Witness and Exhibit Lists and Documentary Exhibits
6/10/2015
6/24/2015 9:00
Trial
Unless otherwise instructed, ALL Attorneys/Parties shall report to the trial court at 9:00 AM on
the date of trial.
NOTICE TO PLAINTIFF/PETITION ER
If the case has been filed, the plaintiff shall serve a copy of the Case Schedule on the defendant(s) with the summons and complaint/
petition: Provided that in those cases where service is by publication the plaintiff shall serve the Case Schedule within five (5) court days
of service of the defendant's first response/appearance. If the case has not been filed, but an initial pleading is served, the Case Schedule
shall be served within five (5) court days of filing. See PCLR 3.
NOTICE TO ALL PARTIES
All attorneys and parties shall make themselves familiar with the Pierce County Local Rules, particularly those relating to case
scheduling. Compliance with the scheduling rules is mandatory and failure to comply shall result in sanctions appropriate to the
violation. If a statement of arbitrability is filed, PCLR 3 does not apply while the case is in arbitration.
Dated: October 15, 2014
Judge FAMILY COURT - 2

Department TOLL
E-FILED
IN COUNTY CLERK'S OFFIC
O ctober 15 2014 3:41 PM
KEVIN STO CK
COUNTY CLERK
NO: 07-3-02242-1
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COUNTY OF PIERCE
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No. 07-3-02242-1
In re:
Notice Re: Dependent of a Person in

Military Service
(NTDMP)
THOMAS L. VAN DAM,

Petitioner,
and
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SARA L. VAN DAM,
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Respondent.
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State and federal law provide protections to defendants/respondents who are on
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N o tice.
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active duty in the military service, and to their dependents. This notice only pertains to a
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defendant/respondent who is a dependent of a member of the National Guard or a military
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reserve component under a call to active service for a period of more than thirty (30)
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consecutive days. Other defendants/respondents in military service also have protections

against default judgments not covered by this notice. Dependents of a service member are
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the service members spouse, a service members minor child, or an individual for whom the
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service member provided more than one-half of the individuals support for one hundred
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eighty days (180) days immediately preceding an application for relief.
Notice re: Dep. of Person in Military Service (NTDMP) Page 1 of 2

W P F D R P S C U 0 1 .0 1 8 5 (6/2006) - L a w s o f 2006, ch. 8 0 1(3)

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Dependent,docx
FAUBION, REEDER,
FRALEY & COOK, P.S.

Lakewood, WA 98499
253-581-0660
One protection provided is the protection against the entry of a default judgment in
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certain circumstances. If you are the dependent of a member of the National Guard or a
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military reserve component under a call to active service for a period of more than thirty (30)
consecutive days, you should notify the plaintiff/petitioner or, if the plaintiff/petitioner is
represented by an attorney, the plaintiff/petitioners attorney in writing of your status as such
within twenty (20) days of the receipt of this notice. If you fail to do so, then a court or an
administrative tribunal may presume that you are not a dependent of an active duty member
of the National Guard or reserves, and proceed with the entry of an order of default and/or a
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default judgment without further proof of your status. Your response to the plaintiff/petitioner
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or plaintiff/petitioners attorney about your status does not constitute an appearance for
jurisdictional purposes in any pending litigation, a waiver of your rights or a response to the
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petition, complaint or other application for relief that was filed against you.
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Dated October 15, 2014.
FAUBION, REEDER, FRALEY & COOK P.S.
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By: DANIEL N. COOK, WSBA #34866

Of Attorneys for Petitioner
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Notice re: Dep. o f Person in M ilitary Service (NTDMP) Page 2 o f 2

W P F D R P S C U 0 1 .0 1 8 5 (6/2006) - L a w s o f 20 0 6 , ch. 8 0 1(3)
S : \ C A S E S 1 W a n D a m \D R A F T S\P le a d in gs\N o tice re Military Dependent.docx
FAUBION, REEDER,
FRALEY & COOK, P.S.

Lakewood, WA 98499
253-581-0660
E-FILED
O ctober 15 2014 3:41 P
KEVIN STO CK
COUNTY CLERK
NO: 07-3-02242-
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COUNTY OF PIERCE
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In re:
No. 07-3-02242-1
THOMAS L. VAN DAM,
PROPOSED
PARENTING PLAN
(PPP)
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Petitioner,
and
SARA L. VAN DAM,
Respondent.
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This parenting plan is proposed by THOMAS VAN DAM.
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It Is Ordered, Adjudged and Decreed:
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I. General Information
This parenting plan applies to the following child:
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Name
SILAS VAN DAM
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II. Basis for Restrictions
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Age
12
Under certain circumstances, as outlined below, the court may limit or prohibit a
parents contact with the child and the right to make decisions for the child.
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2.1
Parental Conduct (RCW 26.09.191 (1), (2))

Does not apply.

W P F D R 0 1 .0 4 0 0 M a n d a to r y (6 /2 0 0 8 ) - R C W 2 6 . 0 9 .0 1 6 , . 1 8 1 ; . 1 8 7 ;. 194

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FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
253-581-0660
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2.2
Other Factors (RCW 26.09.191 (3))
Does not apply.
The residential schedule must set forth where the child shall reside each day of the
year, including provisions for holidays, birthdays of family members, vacations, and
other special occasions, and what contact the child shall have with each parent. Parents
are encouraged to create a residential schedule that meets the developmental needs of
the child and individual needs of their family. Paragraphs 3.1 through 3.9 are one way
to write your residential schedule. If you do not use these paragraphs, write in your own
schedule in Paragraph 3.13.
3.1
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Schedule for Children Under School Age
There are no children under school age.

3.2
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School Schedule
Upon enrollment in school, the child shall reside equally with both parents on the
following alternating weekly schedule:
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Sunday
1 Father
2 Father
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Monday Tuesday
Father
Father
Father
Father
Wednesday
Mother
Mother
Thursday
Mother
Mother
Friday Saturday
Mother Mother
Mother Father
Exchanges shall occur on Sunday at 8 p.m., Wednesday at 8 p.m., and Saturday

at noon.
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All exchanges shall take place curbside. Neither parent shall come onto the
other parents property or enter the other parents home to exchange the child.
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3.3
Schedule for Winter Vacation
The child shall reside with each parent during winter vacation as follows:
Winter Vacation shall be defined as commencing the day after school lets out for
the Winter Vacation Break and concluding on the day before school resumes.
In even numbered years, the mother shall have the child for the first
half of the Winter Vacation. Visitation shall begin the day after
school lets out at 9:00 a.m. until December 27th at 8:00 p.m. In odd
numbered years, the mother shall have the child from December
27th 8:00 p.m. through the day before school resumes at 6:00 p.m.
WPF DR 01.0400 Mandatory (6/2008) - RCW 26.09.016, . 181;. 187;. 194

FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
253-581-0660
1
In odd numbered years the father shall have the child for the first
half of the Winter Vacation. Visitation shall begin the day after
school lets out at 9:00 a.m. and conclude on December 27th at
8:00 p.m. In even numbered years the father shall have the child
from December 27th at 8:00 p.m. through the day before school
resumes at 6:00 p.m.
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3.4
Schedule for Other School Breaks
The child shall reside with each parent during spring break as follows:
Same as 3.2.
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3.5
Summer Schedule
Upon completion of the school year the child shall reside with each parent as follows:
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Same as school year schedule.
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3.6
Vacation With Parents
Each parent shall have two weeks uninterrupted with the child for vacation during
the summer months when the child are off from school.
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Each parent shall notify the other parent in writing of his or her two weeks
of vacation no later than May 1 of each year. If there is a conflict in
vacation dates the fathers choice will control in odd years and the
mothers choice will control in even years.
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3.7
Schedule for Holidays
The residential schedule for the child for the holidays listed below is as follows:
With Mother
With Father
(Specify Year
(Specify Year
Odd/Even/Everv)
Odd/Even/Everv)
See Par. 3.3
See Par. 3.3
New Years Day
Presidents Day
Memorial Day
Easter
Even
Odd
July 4th
Even
Odd
*
Labor Day
Even
Veterans Day
Odd
Thanksgiving Day
Even
Odd
See Par. 3.3
Christmas Eve
See Par. 3.3
WPF DR 01.0400 Mandatory (6/2008) - RCW 26.09.016,. 181;. 187;. 194
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FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
253-581-0660
Christmas Day
See Par. 3.3
See Par. 3.3
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Holidays marked with an asterisk (*) shall be spent with the parent who is entitled to
the preceding weekend under the alternating week schedule.
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Unless otherwise noted, Holidays shall be the night before at 6:00 p.m. until the day of
the Holiday at 8:00 p.m.
July 4th will be from 10:00 a.m. on July 4 until 12:00 p.m. on July 5.
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3.8
Schedule for Special Occasions

The residential schedule for the child for the following special occasions (for
example, birthdays) is as follows:
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Mothers Day
Fathers Day
Fathers Birthday
Mothers Birthday
Childs Birthday
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With Mother
(Specify Year
Odd/Even/Everv)
Every
With Father
(Specify Year
Odd/Even/Everv)
Every
Every
Every
Odd
Even
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If the Special Occasion is on a non-school day, the Special Occasion shall be the
night before at 6:00 p.m. until the day of the Special Occasion at 8:00 p.m.
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If the Special Occasion is on a a school day, the Special Occasion shall be from after
school on the day of the Special Occasion until the8:00 p.m. on the day of the Special
Occasion.
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3.9
Priorities Under the Residential Schedule
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Paragraphs 3.31 - 3.8, have priority over paragraphs 3.1 and 3.2, in the following order:
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Rank the order of priority, with 1 being given the highest priority:
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2
school breaks (3.4)
holidays (3.7)
summer schedule (3.5)
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special occasions (3.8)
vacation with parents (3.6)
winter vacation (3.3)
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Restrictions
Does not apply.
WPF DR 01.0400 Mandatory (6/2008) - RCW26.09.016, . 181;. 187;. 194

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FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
253-581-0660
1
3.11
Transportation Arrangements
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3
Transportation costs are included in the Child Support Worksheets and/or the
Order of Child Support and should not be included here.
Transportation arrangements for the child, between parents shall be as follows:

The receiving parent shall provide transportation from the home of the
other parent; however, the parent picking up the child shall remain in his
or her vehicle at the curb or parking lot outside the other parents home
and shall not approach or enter the home of the other parent.
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3.12
The child named in this parenting plan are scheduled to reside the majority of the
time with both parents equally. Both parents are designated the custodian of the
child solely for purposes of all other state and federal statutes which require a
designation or determination of custody. This designation shall not affect either
parents rights and responsibilities under this parenting plan.
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Designation of Custodian
3.13
Other
A. The parties shall use the My Family Wizard software for calendaring,
communication, storing information and tracking of financial matters. All non
emergency communication between the parents shall be made using the My
Family Wizard software. No phone calls or text messages shall be made to the
other party except in the event of an emergency and in event of an emergency
shall be strictly limited to discussion of the emergency. All communication
between the parents shall be civil, courteous and respectful.
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B. Neither parent shall discuss the residential schedule with the child except for
plans that have already been agreed to by both parties. Neither parent shall
provide information to the child of the status of child support payments or other
legal matters regarding the parents.
C. Each parent acknowledges that the other parent spends substantially equal
residential time with the child. For purposes of any future relocation of the child,
neither parent may claim the presumption under RCW 26.09.520 favoring
relocation of the child and both parents are required to give the notice of
relocation under RCW 26.09.430 and .440 when relocating. Based upon the
child's long-term involvement in school, athletics and other extra-curricular
activities, the existence of family and social relationships and the connections to
health care professionals all in the Pierce County area the parties agree that the
child should remain in the Pierce County area if one parent decides to relocate
out of the Pierce County area.
WPF DR 01.0400 Mandatory (6/2008) - RCW 26.09.016,
. 181;. 187;. 194
S : \C A S E S 1 W a n D am \D R AFTS\Pleadings\Proposed Parenting Plan.doc
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
253-581-0660
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3.14
Summary of RCW 26.09.430 - .480, Regarding Relocation of a Child
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This is a summary only. For the full text, please see RCW 26.09.430 through
26.09.480.
If the person with whom the child resides a majority of the time plans to move,
that person shall give notice to every person entitled to court ordered time with
the child.
If the move is outside the childs school district, the relocating person must give
notice by personal service or by mail requiring a return receipt. This notice must
be at least 60 days before the intended move. If the relocating person could not
have known about the move in time to give 60 days notice, that person must
give notice within 5 days after learning of the move. The notice must contain the
information required in RCW 26.09.440. See also form DRPSCU 07.0500,
(Notice of Intended Relocation of A Child).
If the move is within the same school district, the relocating person must provide
actual notice by any reasonable means. A person entitled to time with the child
may not object to the move but may ask for modification under RCW 26.09.260.
Notice may be delayed for 21 days if the relocating person is entering a domestic
violence shelter or is moving to avoid a clear, immediate and unreasonable risk
to health and safety.
If information is protected under a court order or the address confidentiality
program, it may be withheld from the notice.
A relocating person may ask the court to waive any notice requirements that may
put the health and safety of a person or a child at risk.
Failure to give the required notice may be grounds for sanctions, including
contempt.
If no objection is filed within 30 days after service of the notice of intended
relocation, the relocation will be permitted and the proposed revised residential
schedule may be confirmed.
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A person entitled to time with a child under a court order can file an objection to
the childs relocation whether or not he or she received proper notice.
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An objection may be filed by using the mandatory pattern form WPF DRPSCU
07.0700, (Objection to Relocation/Petition for Modification of Custody
Decree/Parenting Plan/Residential Schedule). The objection must be served on
all persons entitled to time with the child.
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The relocating person shall not move the child during the time for objection
unless: (a) the delayed notice provisions apply; or (b) a court order allows the
move.
Parenting Plan (PPP, PPT, PP) Page 6 of 10

FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
253-581-0660
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If the objecting person schedules a hearing for a date within 15 days of timely
service of the objection, the relocating person shall not move the child before the
hearing unless there is a clear, immediate and unreasonable risk to the health or
safety of a person or a child.
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IV. Decision Making
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4.1
Day-to-Day Decisions
Each parent shall make decisions regarding the day-to-day care and control of
each child while the child is residing with that parent. Regardless of the allocation
of decision making in this parenting plan, either parent may make emergency
decisions affecting the health or safety of the child.
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4.2
Major Decisions
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Education decisions
Non-emergency medical and mental health care
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joint
joint
joint
Regarding medical decisions, either parent may take the child for regularly
scheduled with their ordinary physicians or medical care providers for
check-ups, vaccinations, routine/recurring doctor or dental appointments
or for treatment of mild or seasonal type illnesses (e.g., cold, flu, allergy,
earaches, anti-biotic, short term prescriptions etc.) without triggering joint
decision-making requirements. The parties shall communicate as much
as possible about even these routine medical and dental decisions to
ensure coordination of care and full advice to the medical professionals
caring for the child.
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Joint decision means that the parent seeking to make a major decision
shall notify the other parent of the proposed major decisions he or she
intends to make and the other parent may object to the decision and/or
propose an alternative within 14 days of notice. If the other parent does
not object or propose an alternative the parents decision shall be final and
he or she may proceed immediately after the expiration of the 14 days.
The parent seeking to make a decision shall not take any irreversible
action in furtherance of a proposed major decision until after 14 days
notice, or, until after an agreement is reached or a court order is issued if
the other parent objects to the decision.
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4.3
Restrictions in Decision Making

Does not apply because there are no limiting factors in paragraphs 2.1 and 2.2.
WPF DR 01.0400 Mandatory (6/2008) - RCW26.09.016, . 181;. 187;. 194

FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
253-581-0660
1
V. Dispute Resolution
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The purpose of this dispute resolution process is to resolve disagreements about

carrying out this parenting plan. This dispute resolution process may, and under some
local court rules or the provisions of this plan must be used before filing a petition to
modify the plan or a motion for contempt for failing to follow the plan.
Disputes between the parties, other than child support disputes, shall be
submitted to (list person or agency):
Mediation by Pierce County Center for Dispute Resolution, if this box is
checked and issues of domestic violence or child abuse are present, then
the court finds that the victim requested mediation, that mediation is
appropriate and that the victim is permitted to have a supporting person
present during the mediation proceedings, or
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50% petitioner 50% respondent.
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The dispute resolution process shall be commenced by notifying the other party
by written request via certified mail:
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(a)
(b)
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(c)
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(d)
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(e)

Unless an emergency exists, the parents shall use the designated process
to resolve disputes relating to implementation of the plan, except those
related to financial support.
A written record shall be prepared of any agreement reached in
counseling or mediation and of each arbitration award and shall be
provided to each party.
If the court finds that a parent has used or frustrated the dispute resolution
process without good reason, the court shall award attorneys fees and
financial sanctions to the other parent.
The parties have the right of review from the dispute resolution process to
the superior court.
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VI. Other Provisions

There are the following other provisions:
Each party shall have the right to equal access to all of the childs medical,
psychological, psychiatric, counseling, criminal, juvenile, and educational records,
and to any other information relevant to the childs best interest or welfare. These

FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
253-581-0660
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may include, but not be limited to, any records being kept or maintained by a
State or Federal government department or agency. Any third party having or
maintaining any such records is hereby authorized to release any and all
information upon presentation of this order. Any person, including, but not limited
to, any physician, psychologist, counselor, officer or educator, may speak candidly
of or concerning the child named herein to either of the above named parents
without court order or subpoena authorizing same, upon presentation of this
order. It shall be the responsibility of the parent requesting the records to do so
directly with the source of the records.
Both parties shall allow the child to freely communicate with the other party,
including allowing the child to call the other party on the telephone. Both parties
shall have telephone access with the child, excluding the childs calls to that
party, of not less than two calls per week at reasonable times and for reasonable
durations.
Neither parent shall make disparaging remarks about the other parent or any
other remarks that might cause diminishment of the childs respect for the other
parent either to the child or in the presence of the child, nor shall they allow the
child to make disparaging remarks about the other parent.
VII. Declaration for Proposed Parenting Plan
(Only sign if this is a proposed parenting plan.) I declare under penalty of perjury
under the laws of the state of Washington that this plan has been proposed in
good faith and that the statements in Part II of this Plan are true and correct.
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l / 1( /
/
Date and Place of Signature
Thomas Van D&rn, Petitioner
a *4 ;
U]
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VIII. Order by the Court
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It is ordered, adjudged and decreed that the parenting plan set forth above is adopted
and approved as an order of this court.
WARNING: Violation of residential provisions of this order with actual knowledge of its
terms is punishable by contempt of court and may be a criminal offense under RCW
9A.40.060(2) or 9A.40.070(2). Violation of this order may subject a violator to arrest.
When mutual decision making is designated but cannot be achieved, the parties shall
make a good faith effort to resolve the issue through the dispute resolution process.
If a parent fails to comply with a provision of this plan, the other parents obligations
P a re n tin g P la n (P P P , P P T , PP ) - P a g e 9 o f 10
WPF DR 01.0400 Mandatory (6/2008) - RCW 26.09.016,. 181;. 187;. 194

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F A U B IO N , R E E D E R ,
F R A L E Y & C O O K , P.S.

Lakewood, WA 98499
253-581-0660
under the plan are not affected.
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Dated:
Judge/Commissioner
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Approved and agreed by:

Notice of presentation waived.
Daniel N. Cook, WSBA #34866

, WSBA#
Attorney for Respondent
Presented by:
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A signature below is actual notlceiof this order.
A signature below is actual notice of this order,
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T h om as V an bm , P e titio n e r"
Date Sara Van Dam, Respondent
Date
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WPF DR 01.0400 Mandatory (6/2008) - RCW 26.09.016, .181; .187; .194

S : \ C A S E S 1\ Van Dam \DRAFTS\Pleadings\Proposed Parenting Plan.doc
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
253-581-0660
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IN A N D FO R THE C O U N T Y OF P IE R C E
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In re:
No. 07-3-02242-1
Petitioner,
and
Respondent.
PROPOSED PARENTING PLAN.
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[email protected] m.
Signed at Lakewood, WA on October 15, 2014
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Sally DufCharme, Legal Assistant
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FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
Phone: (253) 581-0660
E-FILED
PIERCE COUNTY, W ASHING Tt
O ctober 15 2014 3:41 PM
KEVIN STO CK
COUNTY CLERK
NO: 07-3-02242-1
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No. 07-3-02242-1
In re:
THOMAS L. VAN DAM,
Petitioner,
and
Motion and Declaration for

Temporary Order
(MTAF)
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SARA L. VAN DAM,

______________________Respondent.
I. Motion
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Based on the declaration below, the undersigned moves the court for a temporary order
which:
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Establishes adequate cause to modify the parenting plan

Approves the parenting plan which is proposed by THOMAS VAN DAM.
Enters a restraining order prohibiting both parties from going into or being within 50
feet of the residence of the other party.
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DATED this j_
day of October 2014.
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P.S.
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Daniel N. Cook, WSBA 34866

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Mtn/Decl for Temp Ord (MTAF) - Page 1 of 6
WPF DR 04.0100 Mandatory (06/2014) - RCW26.09.060; .110; .120; .194

S : \ C A S E S 1 W a n D a m \D R A F T S\P le a d in gs\M o tio n for Tem porary Order.doc
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
Phone: (253) 581-0660
1
II. Declaration
2
I, TOM VAN DAM, and the Petitioner in this matter. I am over the age of 18 and I
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4
5
am competent to testify. I make this declaration on the basis of my personal knowledge

in support of my request for adequate cause and my request for entry of a temporary
parenting plan.
SARA VAN DAM and I were formerly married. We had one child together, SILAS,
who is now 12 years old. SARA and I dissolved our marriage in 2007 when SILAS was
only 4 years old. In the seven years since we first established the parenting plan, many
10
things have changed, including work schedules for both parties, residences for both
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12
parties and I have remarried.
For these and other reasons, SARA and I are no longer
following the 2007 parenting plan. We have substantially deviated from the parenting
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plan for a long time and I am now asking the court to enter a formal parenting plan
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reflecting the changes we have agreed upon and implemented.
I am also asking the
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court to enter a restraining order. There have been two incidents when SARA has come
to my house and acted very inappropriately. She has been hostile, belligerent, rude and
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frankly a little scary. Certainly it has traumatized the children in my home. SARA and I
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generally get along well and are fairly cooperative but certain topics (mostly financial) are
20
very triggering for SARA and if I do not do what she wants financially she will sometimes
21
erupt in an angry and inappropriate manner. To avoid this happening in my home and
22
upsetting my wife and children I am asking the court to enter a restraining order.
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ADEQUATE CAUSE SHOULD BE FOUND ON BASIS OF INTEGRATION BECAUSE

THERE HAS BEEN A PERMANENT AGREEMENT TO SUBTANTIALLY DEVIATE
FROM THE PARENTING PLAN
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Mtn/Decl fo r Temp Ord (MTAF) - Page 2 o f 6
WPF DR 04.0100 Mandatory (06/2014) - RCW 26.09.060; .110;. 120;. 194

S :\C A S E S 1 W a n D a m \D R A F T S \P le a d in g s \M o tio n for Tem porary O rder.doc
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
Phone: (253) 581-0660
The original parenting plan entered in 2005 provided for both parents to have daily
2
contact with SILAS. It was intended to be an equally shared residential schedule. At the
3
4
5
time, I was working an aftemoon/evening shift and SARA was working days.
The
parenting plan provides for me to have SILAS every weekday morning and SARA would
have SILAS every weekday evening. He was generally in daycare in the afternoons. We
divided the weekend between both parents.
read as follows:
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The designation of custodian paragraph
The child named in this parenting plan are [sic]

scheduled to reside the majority of the time with the
mother and father.
Clearly the original intent was for the parents to enjoy equal residential time with
SILAS and we created a schedule that maximized each parents ability to have a
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meaningful relationship with SILAS.

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I now work three 12 hour day shifts on Thursday, Friday and Saturday. I have
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every Sunday, Monday, Tuesday and Wednesday off.

Sara now works four days each week: Monday through Thursday. Sara has every
Friday, Saturday and Sunday off.
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We have not followed the prior parenting for the last 4-5 years. We have modified
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the residential schedule by mutual agreement and we have intended that change to be
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permanent. We still provide for Silas to reside equally with both parents but we divide it
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up differently because our work schedules and residence locations have changed. For
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the last 4-5 years we have followed an alternating and repeating two week schedule with
SILAS spending overnights as follows:
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WPF DR 04.0100 Mandatory (06/2014) - RCW26.09.060;. 110;. 120;. 194

S : \ C A S E S 1 W a n D a m \D R A F T S\P le a d in gs\M o tio n for Tem porary Order.doc
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
Phone: (253) 581-0660
1
2
3
4
5
Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Mother
Mother Mother
Father
Father
Mother
1 Father
Mother Father
Mother
Father
Father
Mother
2 Father
We developed this schedule to maximize the time SILAS spends with each of us
on days we have off while still alternating some weekend time. We split the weekends
and alternate exchanging SILAS on Saturday at noon. SILAS is old enough to be home
alone for short periods at this point, but when SILAS was younger this minimized the time
SILAS had to spend in before or after-school care. Since I was always working on Friday
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and Saturday and SARA always had these days off it made sense for her to have these
days. It made sense for me to have Sundays through Tuesdays since I was always off
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those days.
13
This also made sense because I have now remarried and have a dynamic blended
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family. In our family attending church on Sunday is a high priority and SILAS enjoys
attending church with my wife and his step-siblings. Linder this schedule SILAS comes
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to my house on Saturday at noon, and he is able to enjoy that dynamic blended family
18
relationship and our various church activities on Sunday.
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NEED FOR RESTRAINING ORDER AND USE OF OUR FAMILY WIZARD

COMMUNICATION TOOL
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SARA and I have been generally cooperative and able to reach agreement on the
major aspects of our parenting plan, for example, the residential schedule. Flowever,
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SARA has also been very unpredictable and explosively angry when discussing other
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issues, primarily financial ones. For example, when she asks for money for a school
25
expense if I suggest that I should pay the school the amount she suggested she gets

S : \ C A S E S 1 W a n D am \D R A F T S\P le a d in gs\M o tio n for Temporary Order.doc
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, W A 98499
Phone: (253) 581-0660
angry, rude, belligerent and even hostile. SARA has cursed me and my current wife out
2
many times. SARA has called me and my spouse foul names. SARA has sent me
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4
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harassing texts when she has not gotten her way.

Sometimes SARAs rage has gotten so completely out of control that she has
invaded my home. In the Fall of 2013, SARA was angry and violent toward me after I
disagreed with her about issues related to SILAS. Sara was late picking up Silas, so we
tried contacting her to find out what time she would be there. She didnt answer the
phone call or call back in response to our voicemail. At 9:30 p.m., past Silass bedtime,
10
we had not heard back, so we put Silas to bed. When Sara showed up at 10:00 p.m. to
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pick Silas up, he was already in bed asleep, as were all the children. I terminated the
conversation and shut the front door. SARA began kicking and pounding on the door in a
13
loud and obnoxious way. SARA took landscaping rocks and began throwing them at the
14
house in a violent and dangerous way. The children in the house woke up and were
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afraid. I was at a loss to know what to do.

In August 2014 SARA asked me for money to pay a school related bill for SILAS a
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few weeks prior to the incident. On the day of the incident she came to my house and
19
again demanded money. I had checked with the school and found that not as much was
20
owed as she had originally said so I told her I had paid or would pay my half to the school
21
directly. SARA got extremely angry I would not give her the money. SARA screamed at
22
me, shouted obscenities and called me disparaging names (e.g., deadbeat). I told SARA
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I would not allow her to talk to me like that and I closed and locked the front door. SARA
then ran around to the garage and forced herself into my house and continued screaming
25

S :\C A S E S 1 \V a n D a m \D R A F T S \P le a d in g s \M o tio n fo rT e m p o r a ry O rd e r .d o c
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
Phone:(253) 581-0660
and yelling at me in front of my family (my current spouse, two children of my current
2
spouse from a prior relationship and SILAS).
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4
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For these reasons I am asking for a restraining order prohibiting SARA from
coming into my house or onto the grounds of my residence. We can exchange SILAS via
a curbside exchange. He is 12 years oid and fuily capable of walking to and from a car at
the end of the driveway.
I also believe our family would be best served by using the Our Family Wizard
communication tool available online. SARA and i generally have a cooperative
10
relationship and have been able to reach agreement on most major issues involving
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12
SILAS. Sometimes our communications break down, particularly when finances are
involved. SARAs text messages have been so harassing I would like a neutral and
13
objective service to record all of our communications. Obviously, exceptions could be
14
made for true emergencies or time sensitive matters (e.g., if child is in hospital or
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unavoidable delay impacts exchange time). But all other routine and non-emergency
communications should be through Our Family Wizard. We can also use the information
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sharing, calendar and financial functions of the website service. This will improve our
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communications and hopefully prevent SARAs foul language and harassment.
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Signed at (city) h p / ) / ) g ^
h jKt
(state)
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M tn/D ecl fo r Tem p Ord (M TAF) - Page 6 o f 6
W P F D R 0 4 .0 1 0 0 M andatory ( 0 6 /2 0 1 4 ) - RCW 2 6 .0 9 .0 6 Q ; . 1 10; .120; . 1 9 4

S:\CASES1Wan Oam\DRAFTS\Ptee(imgs\Motion tor Temporary O n ter.d o c
FAUBIO N, KEEPER,
FRALEY & COOK, P.S.

Lakewood, WA 98499
Phone: (253) 581-0660
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IN A N D F O R THE C O U N T Y OF P IE R C E
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In re:
No. 07-3-02242-1
Petitioner,
and
S A R A L. VAN DAM,
Respondent.
MOTION AND DECLARATION FOR TEMPORARY ORDER.
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[email protected].
Signed at Lakewood, WA on October 15, 2014.
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Sally D^rbharme, Legal Assistant
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Declaration Pursuant to GR 17 - Page 1 of 1
S:\CASES1Wan Dam\DRAFTS\Pleadings\Dec!aration re Emailed Signature.doc
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
Phone: (253) 581-0660
E-FILED
O ctober 15 2014 3:55 PM
KEVIN STO CK
COUNTY CLERK
NO: 07-3-02242-1
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S U P E R IO R C O U R T OF W A SH IN G T O N
C O U N T Y OF P IE R C E
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No. 07-3-02242-1
In re:
Petitioner,
and
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Respondent.
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To the C le rk o f C o u rt a n d to: S ara Van D am
1.
Please note that the court will be asked to determine if adequate cause exists to
modify/adjust the custody decree/parenting plan/residential schedule as requested
in the petition filed in this case.
2.
A hearing has been set for the following date, time and place.
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Date: December 10, 2014

Place:Pierce County Superior Court
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This request is based on the declaration in the Petition for Modification/Adjustment

of Custody Decree/Parenting Plan/Residential Schedule [ ] and on the additional
declarations served on the nonmoving party.
4.
You may serve and file a response and opposing declarations prior to the hearing
date. If the court determines that adequate cause for hearing the petition is
established by the declarations, it will set a date for hearing on an order to show
cause why the petition should not be granted.
5.
If you do not file a response to the petition, opposing declarations, or a notice of

appearance, an order may be entered without further notice to you finding you in
default and granting the relief requested in the petition.
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Time: 9:00 a.m.

Room/Department: T B A
3.
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Petitioners Notice of
Hearing for Adequate C au se
Determination
(Optional Use)
(NTHG)
[X] Clerks Action Required
Petitioners Not of Hrng (Adequate Cause) (NTHG) - Page 1 of 1
WPF DRPSCU 07.0250 (6/2006) - RCW 26.09.260; .270; 26.10.200

S:\CASES1Wan Dam\DRAFTS\Pleadings\Notice o f Hearing re Adequate Cause.doc

& COOK, P.S.
Lakewood, WA 98499
253-581-0660
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Presented by:
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Petitioners Not of Hrng (Adequate Cause) (NTHG) - Page 2 of 1
WPF DRPSCU 07.0250 (6/2006) - RCW 26.09.260; .270; 26.10200

S:\CASES1Wan Dam\DRAFTS\Pleadings\Notice o f Hearing re Adequate Cause doc

& COOK, P.S.
Lakewood, WA 98499
253-581-0660
E-FILED
O ctober 15 2014 3:55 PM
KEVIN STO CK
COUNTY CLERK
NO: 07-3-02242-1

THOMAS L VAN DAM

No. 07-3-02242-1
Petitioner(s),
vs.
SARA L VAN DAM

Respondent(s)

Name: SARA LOUISE VAN DAM
Address: 3310 214TH AVE E BONNEY LAKE, WA 98391
Phone:
Respondent
Adequate Cause - C ustody
Nature of Hearing: Parenting Plans
CALENDAR DATE: Wednesday, December 10, 2014 9:00 AM

DATED:
October 15, 2014.
Signed:
/s/ Daniel N Cook
NAME:
Daniel N Cook
Phone:
(253) 581-0660
WSBA#:
For:
34866
ADDRESS:
5920 100th St SW Ste 25

1 of
II
07-3-02242-1
43615670
LTR8
11-12-14
-------------------------
SUPERIOR COURT
OF THE
STATE OF WASHINGTON
FOR PIERCE COUNTY
(253) 798-3654

Tacoma, Washington 98402-2102
FAX (253) 798-7214
DATED: November 10, 2014

Re:
Cause No. 07-3-02242-1

THOMAS L VAN DAM
vs.
SARA L VAN DAM
Dear Counsel or PRO SE (Self-Represented):

Court records indicate that the attorneys and/or parties listed below have failed to comply with the Case
Schedule or Order Assigning Case to Department in regard to the following item:
Confirmation of Service - Not Filed - Refer to Pierce County Local Rule 3 & 5(b)
Deadline:
11/05/14
Pursuant to Pierce County Local Rules and also pursuant to the Case Scheduling Order or Order Assigning
Case to Department given to you at the time of filing this case, you are out of compliance. Please take the
actions necessary to immediately comply with the Case Schedule or Order Assigning Case to Department.
Please file and deliver a courtesy copy of the document to the Judge.
If the court finds that an attorney or party has failed to comply with the Case Schedule or Order Assigning
Case to Department and has no reasonable excuse, the court may order the attorney or party to pay
monetary sanctions to the court, or terms to any other party who has incurred expense as a result of the
failure to comply, or both; in addition, the court may impose such other sanctions as justice requires. See
PCLR 3(k) or PCLSPR 94.05(g).
Copies mailed to:

Glint P. Johruon----Daniel N Cook
Van Dam, Sara Louise
Sincerely,
l* f
Brian Matson
Department 08
Phone #: 253-798-7565
Judge Brian Tollefson
Superior Court Clerk fo r Filing

(Court File Copy)
\lxcivil.pbf\d_noncom plianceJetter_report
2014
10:26AM
2533012645
PAGE
ANDERSON INVESTIGATI
E-FILEL
IN COUNTY CL
PIERCE COUNTY W
Novem ber 14 2 ) 1
KEVIN S
COUNTY CL
NO: 07-3-02
2
3
4
5
6
8
9
10
In re:
THOMAS L. VAN DAM,
11
Petitioner,
12
and
13
SARA L. VAN DAM,

Respondent.
)
)
)
)
)
)
)
)
)
)
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J
Case No: 07-3-02242-1

DECLARATION OF
SERVICE:
SUMMONS, ORDER
SETTING CASE SCHEDULE,
NOTES FOR
COMMISSIONERS
CALENDAR, NOTICE OF
ADEQUATE CAUSE
HEARING, MOTION FOR
TEMPORARY ORDER,
PROPOSED PARENTING
PLAN, NOTICE re
MILITARY DEPENDANT
AND PETITION FOR
MODIFICATION OF
PARENTING PLAN
The undersigned declares under penalty o f peijury under the laws o f the State of
Washington that the following is true and correct.
The declarant is now and at all tim es herein mentioned was a citizen o f the United
States and a resident of the State o f Washington, over the age o f 18, not a party to nor
interested in the above-entitled action and competent to be a witness therein:
A nderson investigations , l l c
P.CL Box 7770
Tacoma, W A 98417
Telephone: (253) 301-2240
1 0 :26AM
1
2
3
2533012645
ANDERSON INVESTI6ATI
On the 6thDay Of NOVEMBER, 2014 at 12:47 PM I served the above-described

documents on SARA L. VAN DAM, named respondent (s), by then and there:
Personally delivering ONE (1) true and correct copy(ies) thereof to JOSEPH L.
HOWARD, PERSONALLY.
The service address is: 2101 North 34th Street, Suite #160, Seattle, King County, WA
5
98103.
6
Dated this 14thDay Of November, 2014 at Tacoma, Pierce County, WA.
7
Cost: $70.00
10
Private Investigator, WA Tic. #3317

Process Server
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
A nderson Investigations , LLC
P.O.Box 7770
Tacoma, WA 98417
Telephone: (253) 301-2240
E-FILED
Novem ber 14 2014 10:48 AM
KEVIN STO CK
COUNTY CLERK
NO: 07-3-02242-1

P etitioner(s),
vs.
N O . 07-3-02242-1
C O N F IR M A T IO N OF SE R V IC E
__________________ R espondent(s)
CS
CSSRV O
All the named defendants/petitioners/respondents have been served, have

joined or have accepted service in writing.
One or more named defendants have not yet been served.
(If this is checked, an additional confirmation of service must be filed pursuant to subsection (b)
when service is obtained and the following information must be provided.)
D A T E D : N o v em b er 14, 2014
cssup-0002.pdf
/s/ D aniel N C ook

D aniel N Cook, #34866
Faubion, Reeder, Fraley and Cook, PS
5920 100th St SW Ste 25
(253) 581-0660
E-FILED
Case Number:
07-3-02242-1
November 17 2014 8:30 AM

KEVIN STO CK
COUNTY CLERK
NO: 07-3-02242-1
Case Name:
THO M AS L VAN D AM VS. SARA L VAN DAM
Certificate of Attendance
This certifies that
THOMAS L VAN DAM

Has successfully completed
I m p a c t O n C h ild r e n ^
The Changing Family
A four hour seminar at:
HOPESPARKS
On NOV 15,2014
_____ /S/ Signature_______
Pati West
Instructors:
David Kralevich, LMHCA & Morgan Vanderpool, MSW
E-FILED
November 17 2014 3:12 PM
KEVIN STO CK
COUNTY CLERK
NO: 07-3-02242-1

Petitioner(s),
vs.
N O . 07-3-02242-1
N O T IC E OF A P P E A R A N C E
__________________ R espondent(s)
TO: C lerk o f the C ourt
A N D TO: C L IN T P. JO H N SO N , attorney for Petitioner, D aniel N C ook, attorney fo r Petitioner,
T H O M A S L E E V A N D A M , SILA S R V A N D A M
P L E A S E T A K E N O T IC E th at SU E L L E N H O W A R D , appears herein on b e h a lf o f the

R espondent(s) SA R A L O U IS E V A N D A M and requests th at all further pleadings and paper,
except original process, be served upon said attorney at th e address listed below .
D A T E D : N o v em b er 17, 2014
ntaprsup-0001.pdf
/s/ S U E L L E N H O W A R D
SU ELLEN H O W A R D , #20506
A ttorney fo r R espondent(s)
SUELLEN HOWARD
15 S Grady Way Ste 400
WA 98057-3240
(425) 228-8899
t *'
c*
07-3-02242-1
43650528
MAIL
11-18-14
IN T H E S U P E R IO R C O U R T O F W A S H IN G T O N , C O U N T Y O F P IE R C E
.
,,/
(253)798-3654
' ' :
'
' '
SUPERIOR COURT
OF THE
STATE OF WASHINGTON
FOR PIERCE COUNTY
'
- : .334 County-City Building

930 Tacoma A venue South
FAX (253) 798-7214
Tacoma, W ashington 98402-2102
DATED: November 10, 2014

Re:
Cause No. 07-3-02242-1
Docket code: CRRSP
THOMAS L VAN DAM

vs.
SARA L VAN DAM
Confirmation of Service - Not Filed - Refer to Pierce County Local Rule 3 & 5(b)
Deadline:
11/05/14
Case to Department given to you at the time.of.filing this case, you are out of compliance. Please take the
Copies mailed to:
Sincerely,
C lint P. J u I i i i s u i i -------- *
Daniel N Cook
Van Dam, Sara Louise
Brian Matson
Department 08
Phone #: 253-798-7565
To:
VAN DAM, SARA LOUISE

PRO SE (Self-Represented)
3318 214TH AVE E
LAKE TAPPS, WA 98391-
'Jxcivil.pbl\d_noncom pliance_letter_report
1 1
Has 1st
SUPERIOR COURT FOR PIERCE COUNTY
FIKST-CI.ASS MAHauto
930 TACOMA AVE S RM 334

TACOMA WA 98402
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E-FIL ED
IN COUNTY CLE RK'S OFFICE
PIERCE COUNTY W ASHING TO N
Decem ber 02 2 J14 12:58 PM
1
KEVIN S TO C K
COUNTY CLERK
NO: 07-3-0:2242-1
-J>
4
5
6
7
8
9
10

COUNTY OF PIERCE
In re:
Thomas L. Van Dam
Petitioner,
and
11
Sara L. Van Dam

Respondent.
12
13
NO. 07-3-02242-1
RESPONSE TO PETITION FOR
MODIFICATION/ADJUSTMENT OF
CUSTODY DECREE/PARENTING
PLAN/RESIDENTIAL SCHEDULE
(RSP)
TO: Daniel N. Cook, attorney for Petitioner
14
I. RESPONSE
15
16
1.1
ADMISSIONS AND DENIALS.
17
The allegations of the petition in this matter are ADMITTED or DENIED as follows:
18
Paragraph of the
Petition
19
20
1.1
Admitted
1.2
Admitted
1.3
Admitted
24
2.1
Admitted
25
2.2
Admitted for a minor modification
21
22
23
26
27
28
RESPTOPETFORMOD/ADJ(RSP) - Page1of3
WPFDR07.0200(9/2000)- RCW26.09.260; .270; 2610.200
SUELLEN HOWARD
ATTORNEY AT LAW
15 SOUTH GRADY WAY. SUITE 400
RENTON, WASHINGTON 08057
(425) 228-8899 Fax: (425) 277-9279
2.3
Lacks knowledge
2.4
Admitted
2.5
Admitted
2.6
Admitted
2.7
Admitted
2.8
Admitted in part and Denied as to any detriment
2.9
Admitted
2.(0
Admitted
10
2.11
Admitted
11
2.12
Admitted
12
2.13
Admitted
13
2.14
Denied
2.15
Admitted
4
5
6
7
8
14
15
16
17
The allegations of the petition which are denied, are denied for the following reasons:
18
19
There is no detriment to the child and a shared time plan in a different arrangement should be continued.
20
There is not basis for a protection order.
21
1.2
NOTICE OF FURTHER PROCEEDINGS.
22
23
Notice of all further proceedings in this matter should be sent to the nonmoving party care of the
24
address below.
25
26
27
28
WPFDR07.0200(9/2000) - RCW26.09.260; .270; 26.10.200
SUELLEN HOWARD
ATTORNEY AT LAW
15 SOUTH GRADY WAY, SUITE 400
(425)228-8899 Fax: (425) 277-9279
1.3
OTHER.
2
3
4
II. REQUESTS
5
2.1
REQUEST FOR DISMISSAL.
6
Does not apply.
7
8
2.2
REQUEST FOR MODIFICATION OR ADJUSTMENT.

The nonmoving party requests that the court enter an order modifying or adjusting the custody
decree/parenting plan/residential schedule in this matter.
9
10
The nonmoving part)' also requests that the court:
11
Find there is adequate cause for hearing this matter.
12
Find that there is adequate cause to enter a parenting plan based on the mothers relocation to
Florida that does not relocate the child but provides for a long distance parenting plan.
13
14
15
16
Dated:
A jsu u -t-^h .. ,
2.0 V
'
17
18
19
Suellen Howard
WSBA 20506
15 South Grady Way. Suite 400
Renton, WA 98057
20
21
22
23
24
25
26
27
28
WPFDR07.0200(9/2000)- RCW26.09.260;.270; 26.10.200
SUELLEN HOWARD
ATTORNEY AT LAW
RENTON. WASHINGTON 98057
(425) 228-8899 Fax: (425) 277-9279
<7 ^
For Petitioner
r~1
For Respondent
RE:
^J> U~eL_
oû?
December 10, 2014 9:00 AM
k*j
Adequate Cause - Custody

PT COM HILLARY ANN HOLMES
^ f\
>
i
Clerk:
HARROWSCHIESL
DEPUTVCfERK
Courtroom number: 407

Calendar:C3 - SHOW CAUSE/FAMILY LAW
Run date/time 12/10/14 8:05
Ixcrtrpt.pbl dJoum al_entry_show cause_report
E-FILE
IN COUNTY CLEF
PIERCE COUNTY, 1
Decem ber 10 20
1
KEVIN S I
COUNTY C
2
3
4
5
6
IN THE SUPERIOR COURT OF WASHINGTON, COUNTY OF PIERCE
7
8
9
P etitioner(s),
10
Cause No. 07-3-02242-1
Order Granting
Adequate Cause
vs.
11
12
R espondent(s)
Clerks Filing code: ORAGR
13
14
15
16
THIS MATTER having come on regularly for hearing to determine if there is adequate cause to
proceed to trial with regard to a Petition which has been filed.
17
Now, therefore, it is hereby
18
ORDERED the Show Cause hearing determining Adequate Cause is granted.
19
20
21
22
Dated this 10 day o f D ecem ber, 2014
23
24
25
/S /P T C O M H IL L A R Y A N N H O L M E S
PT COM HILLARY ANN HOLMES
Judge/Commissioner

COUNTY OF
PIERCE
:.*** .........
*
No. 07-3-02242-1
In re:
THOMAS L. VAN DAM,

Petitioner,
and
SARA L. VAN DAM,

Respondent.
Order re Adequate Cause

(Modlfication/Adjustment of Custody
Decree/Parenting Plan/Residential Schedule
[ ] Denied (ORRACD)
[X ] Granted(ORRACG)
[ ] Hearing set (ORH)
Clerk's Action Required
I. Basis
1.1
A petition requesting the modification/adjustment of the custody decree/parenting

plan/residential schedule in this matter has been presented to the court.
1.2
A hearing was held on: does not apply because this order is an agreed order.
II. Findings
The Court Finds:
2.1
Jurisdiction
This court has jurisdiction over the proceeding and the parties.
2.2
Service on Nonmoving Party

The nonmoving party was served with a copy of the petition or joined in the
petition for modification/adjustment of custody decree/parenting plan/residential
schedule, summons and a proposed parenting plan on November 6,2014.
O rd re A d e q u a te C au se (O R R A C D , O R RACG , O RH) - P a g e 1 of 2
WPF DRPSCU 07.0300 Mandatory (7/2007) - RCW 26.09260; .270;

26.10.200
S.tC^SBSflVan DBm\DRAFT$\Pieadings\Onier re Adequate Causa.doc
FAUBION, REEDER,
FRALEY & COOK, P.S.
5920 - 100* St. SW#25
Lakewood, WA 98499
253-581-0660
C)
2.3
Time Elapsed Since Service on the Nonmovtng Party
The nonmoving party was served within the state of Washington and fewer than
20 days have elapsed since the date of service.
3
4
(Jl
2.4
The nonmoving party has not responded.
4
&i
2.5
4
9
Q
(M
y
10
tH
11
Adequate Cause Finding
The parties stipulate there is adequate cause for hearing the petition with respect
to fathers petition and mothers relocation that does not relocate the child. There
is not adequate cause based upon detrimental home environment.
Response
2.6
Servicemembers Civil Relief A ct Statement
Does not apply.
H
\
eg
III. Order
12
ft is Ordered.
13
The matter is set for hearing or trial at:
14
Time: 9:00 am
Room/Department: TBD
Date: June 24, 2015
Place: Pierce County Superior Court
15
16
Dated:
{ssioniBIILLARY HOLM ES
Commissioner Pro Tern
17
18
Approved by:
Notice of'Qres^htation waived:
19
20
21
Daniel N. CockrWSBA#34866
Suellen Howard, WSBA #20506

22
23
24
25
O rd re A d e q u a te C au se (O R R A C D , O R R A C G , O R H ) - P ag e 2 o f 2
WPF DRPSCU 07.0300 Mandatory (7/2007) - RCW 26 09.260; .270;

26.10.200
S \CASSHVa/) Dam\DRAFTS\Ptea(&ngs\0 {tie r f& Adequate Cause ooc
FAUBION, REEDER,
FRALEY & COOK, P.S.
5920-1 0 0 th St. SW#25
Lakewood, WA 98499
253-581-0660
\0 1
j
h 2
O
3
4
5
O'1
'.f
iCi 7
8
4 9
î j 10

In re:
THOMAS L. VAN DAM,
No. 07-3-02242-1
Petitioner,
i\j
0 11
H 12
\
N 13
14
15
16
17
18
DECLARATION PURSUANT TO GR 17
'and
(FILING OF E-MAILED SIGNATURE)
SARA L. VAN DAM,
Respondent.
J, Sally DuCharme, declare under penalty of perjury under the laws of the State
ORDER RE ADEQUATE CAUSE.
19
20
21
22
23
[email protected].
Signed at Lakewood, WA on December 9, 2014.
24
'sally DuCfarme, Legal Assistant
25
S : \ C A S E S 1 W a n D am \D R A FTS\Pieadings\D eclaratio n re Em ailed Signature.doc
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
Phone: (253) 581-0660
<
ro
l.Ji
is")
. 4*
si
(J
N

COUNTY OF PIERCE
10
9:~i
THOMAS L. VAN DAM,
12
Petitioner,
13
No. 07-3-02242-1
In re:
11
and
[ ] Clerks Action Required

[ ] Law Enforcement Notification,
14
SARA L. VAN DAM,
15
Temporary Order
(TMO)
3.1
Respondent
16
I. Money Judgment Summary
17
Does not apply.
18
II. Basis
19
A motion for a temporary order was presented to this court and the court finds
reasonable cause to issue the order.
21
22
III. Order
ft is Ordered.
3.1
Restraining Order
The parties shall comply with the Restraining Orders restraining THOMAS VAN
DAM and SARA VAN DAM signed by the court on this date under this cause
number.
Temp O rder (TMO) - Page 1 of 3
WPF DR 04.0250 Mandatory (06/2014) - RCW 26.09.060;. 110; .120; .194, .300(2)

S:\CASES1W an Dam \DRAFTS\Plaadings\Temporary Order.docx
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
253-581-0660
1
2
3.2
Surrender of Weapons
Does not apply: There is no surrender of weapon order in effect under this
cause number and the court is not entering one now,
3
4
5
3.3
Temporary Relief
BOTH PARTIES are restrained and enjoined from removing any of the children
from the state of Washington. This provision does not prohibit day trips (e.g., visits
to Oregon), or overnight vacations so long as the vacation is taken with at least 7
days prior notice to the other parent.
6
7
The mother has indicated an intention to relocate to Florida. If the mother relocates
to Florida the child, SILAS VAN DAM, will reside with the Father.
9
10
Pending the mothers relocation to Florida the residential schedule for the child,
SILAS VAN DAM, shall be as follows until further order:
11
11/28 to 12/10 @ 8:00 pm - Silas will be with the Father Thomas Van Dam.
12
13
12/10 @ 8:00 pm to 12/18 - Silas will be with the Mother Sara Van Dam.
14
12/18 to 12/26 - Silas will be with the Father Thomas Van Dam.
15
12/26 to 1/4 - Silas will be with the Mother Sara Van Dam.
16
After January 4, 2015, the parties the child will reside with each parent on
the following schedule:
17
Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Mother Mother
Mother
Mother
1 Father Father
Father
Mother Father
Mother
Mother
2 Father Father
Father
18
19
Exchanges shall occur on Sunday at 8 p.m., Wednesday at 8 p.m., and

Saturday at 12:00 p.m. Noon.
20
21
All exchanges shall take place curbside. Neither parent shall come onto
the other parents property or enter the other parent's home to exchange
the child.
22
23
24
25
3.4
Bond or Security
Does not apply.
Temp Order (TUO) - Page 2 of 3

WPF DR 04.0250 Mandatory (06/2014) - RCW26.09.060;, 110;. 120;. 194, .300(2)

S:\CASES1Wan Dam\DRAFTS\PleacHngs\Tewporary Order.docx
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
253-581-0660
3.5
Other
2
Does not apply.
3
HILLARY HOLM ES
Commissioner Pro Tem
nt\i
4
5
6
7
Dated:
Judge/âmm issioner
Presented by:
FAUBIONrREEDER. f
COOK, P.S.
Apprc(ved by)
NoticeOf-presentation waived:
DanieTN. Cook'rwSBfr#32ra6

10

A signature below is actual notice of this order.

Tfiomas Van Dam, Petitioner
Sara Van Dam, Respondent
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Temp Order (TMO) - Page 3 of 3

WPFDR 04.0250 Mandatory(06/2014) - RCW26.09.060;. 110;. 120;. 194, .300(2)
S ;\Cfl SESIWan Dam\DftAFTS'lPteadingE\Jemporarv O der, docx
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
253-581-0660
1
3.5
Other
2
Does not apply.
3
4
5
6
7
D a te d :___________________________ _________
______________________________
J u d g e /C o m m is s io n e r
Presented by:
Approved by:
Daniel N. Cook, W SBA #34866

Suellen Howard, W SBA #20506


A signature below is a4?ua! notit

8
9
10
11
12
of this order.
I Q
Thom as Van D^m. Petitioner
13
14
15
16
17
18
19
20
21
22
23
24
25
T e m p O rd e r (T M O ) -
Page 3 o f 3
W P F D R 04.0250 M andatory (06/2014)- R C W 26.09.060; .110;.120;.194, ,300{2)
Van Dam. Thomas and Van Dam, Sara

S.IC/tSESnVan Dam\DRAFTS\Pieadings\Temporary Order.docx:
'
FAUBIO N, REEDER,
. FRALEY & COOK, P.S.
Lakewood, W A 98499
253-581-0660
"
1
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O
3
H
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4
5
(fi
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in
6
7
8

9
4
u
10
In re:
THOMAS L. VAN DAM,
11
and
No. 07-3-02242-1
Petitioner,
\
I
CM
Xs
i;\j
13
14
15
16
17
18
SARA L. VAN DAM,

Respondent.
TEMPORARY ORDER.
19
20
21
22
23
sducharme(5)fir-law.com.
24
/
Sally DuCharme, Legal Assistant
25
S :\C A S E S 1 W a n D am \D R A FT S \P leadin gs\D eclaration re E m ailed Signature.doc
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
Phone: (253).581-0660
u1
H
O
07-3-02242-1
43775453
TMRO
12-11-14
3
4
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in
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7
8
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10
11
12
13
14
15
16

COUNTY OF PIERCE
No. 07-3-02242-1
In re:
THOMAS L. VAN DAM,
Restraining Order
Petitioner,
0 Temporary (TRO)
and
Final (RSTO)
SARA L. VAN DAM,
0
C le r k 's A c tio n R e q u ir e d
Respondent.
3 L a w E n fo r c e m e n t N o tific a tio n
This is S a temporary restraining order the final restraining order signed by the court
pursuant to a decree or final order, on this date.
Name of person restrained: THOMAS VAN DAM.
Name of person(s) protected: SARA VAN DAM.
Names of Protected Children:
First
Middle
Last
Age
N/A
Restrained Party's Distinguishing Features:
17
18
19
20
21
22
23
24
Restrained Partys Identifiers

Hair
Sex
Race
M
Caucasian
Height
Weight
Eyes
Caution: Access to weapons: yes 0 no unknown

The court finds: this order is necessary based on the evidence presented and: the court
has jurisdiction over the parties, the children, and the subject matter; the restrained
party had reasonable notice and an opportunity to be heard. Notice of this hearing was
served on the restrained person by S personal service service by mail pursuant to
court order service by publication pursuant to court order
other_____________________________________________________________ .
This order is issued in accordance with the Full Faith and Credit provisions of VAWA: 18
U.S.C. 2265.________________________________________________________
Violation of this Restraining Order with actual notice of its terms is a criminal
offense under Chapter 26.50 RCW and will subject the violator to arrest. RCW
26.09.060.
25
This restraining order is effective immediately and expires on:

Restraining Order (TRO/RSTO) Page 1 of 4
WPF DR 04.0500 Mandatory (06/2014) - RCW26 09.060

S \CASES 1\Van Dam\DRAFTS\Pieadings\Restrainmg Order TOM.docx
12/31/2020
FAUBION, REEDER,
FRALEY & COOK, P.S.

Lakewood, WA 98499
253-581-0660
H is Ordered, Adjudged and Decreed.
THOMAS VAN DAM is restrained and enjoined from:
disturbing the peace of the protected party or children.

going onto the grounds of or entering the home, work place or school of the
protected party, or the day care or school of the protected children.
knowingly coming within or knowingly remaining within (distance)
______________________ of the home, work place or school of the protected
party, or the day care or school of the protected children.
assaulting, harassing, stalking, or molesting the protected party or children, or
using, attempting to use, or threatening to use physical force against the
protected party or children that would reasonably be expected to cause bodily
injury, or engaging in other conduct that would place a protected party in
reasonable fear of bodily injury to the protected party or children.
If the restrained person had actual notice and the restrained person
represents a credible threat, then the Mandatory Surrender of Weapons and
Restrictions apply.
Other restraints:
T7?eprotected party o r the protected partys attorney must complete a taw

enforcement information sheet and provide it with this order before this order
wiil be entered into the law enforcement computer system.
0
Does not apply.

Warnings to Restrained Person
A violation of any provision of this order with actual notice of its terms is a criminal
offense under chapter 26.50 RCW and will subject vou to arrest. If the violation of
this restraining order involves travel across a state line or the boundary of a tribal
jurisdiction, or involves conduct within the special maritime and territorial jurisdiction
of the United States, which includes tribal lands,you may be subject to criminal
prosecution in federal court under 18 U.S.C. 2261, 2261A or 2262.
A violation of any provision of this order is a gross misdemeanor unless one of the
following conditions apply . Any assault that is a violation of this order and that does
not amount to assault in the first degree or second degree under RCW 9A.36.011 or
9A.36.021 is a class C felony. Any conduct in violation of this order that is reckless
and creates a substantial risk of death or serious physical injury to another person is
a class C felony. Also, a violation of this order is a class C felony if you have at least
two previous convictions for violating a protection order issued under Titles 7, 10, 26
or 74 RCW.
RestrainingOrder(TRO/RSTO)Page 2 of 4
WPF DR 04.0500 Mandatory (06/2014) - RCW26.09.060

S.lC-ASESMVan Dam\DRAFTS\Pieadings\Restraming Order TOM.docx
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
253-581-0860
1
2
3
4
6
7
8
9
10
11
12
13
Federal law: effective Immediately and continuing as long as this restraining order is
in effect, the restrained person may not possess a firearm or ammunition. 18. U.S.C.
922(g)(8). A violation of this federal firearms law carries a maximum possible
penalty of 10 years in prison and a $250,000 fine. An exception exists for law
enforcement officers and military personnel when carrying department/governmentissue firearms. 18 U.S.C. 925(a)(1).
State law: If mandatory firearm surrender and restrictions under state law apply: It
is unlawful for the restrained person to own, possess, or have under his/her control a
firearm while this order is in effect. A violation is a class C felony.
You Can Be Arrested Even if the Person or Persons Who Obtained the Order
invite or Allow You to Violate the Order's Profi/b/tions. You have the sole
responsibility to avoid or refrain from violating the orders provisions. Only the court
can change the order upon written application.
Pursuant to 18 U.S.C. 2265, a court in any of the 50 states, the District of
Columbia, Puerto Rico, any United States territory, and any tribal land within the
United States shall accord full faith and credit to the order._____________________
Previous Order
[X ]
[]
14
15
16
17
18
There are no prior Restraining Orders restraining the same person issued under
this cause number.
This order replaces all prior Restraining Orders nesfra/ning the same person
issued under this cause number.
Clerk's Action/Law Enforcement Action

This order shall be filed forthwith in the clerks office and entered of record. The clerk of
the court shall forward a copy of this order on or before the next judicial day to (name of
appropriate law enforcement agency) SOUTH SOUND 911 law enforcement agency
where the protected party resides which shall forthwith enter this order into any
computer-based criminal intelligence system available in this state used by law
enforcement agencies to list outstanding warrants.
19
20
Service
21
[X ]
22
[]
23
24
The restrained party or attorney appeared in court or signed this order; service of
this order is not required.
The restrained party or attorney did not appear in court; service of this order is
required.
The protected party must arrange for service of this order on the restrained party.
File the original Return of Service with the clerk and provide a copy to the law
enforcement agency listed above.
25
Restraining Order (TRQ/RSTO) Page 3 of 4

WPF DR 04.0500 Mandatory (06/2014) - RCW26.09.060
S.'iCASEStWert Dam\DRAFTS\Pteadtngs'\Ftestraining Order TOM.docx
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
253-581-0660
This order is in effect until the expiration date on page one.
2
3
4
&
Jyd^C oram t^sioner

Presented by:
FAWBIOFTREEDER
Approve'Gy:
& COOK, P.S.
Dated:
Daniel NTcook,' mBAr#348S?>

Notice orpreseKtation waived:

C
1
\
; A __
Suellen Howard, 1/VSBA #20506
10
11
12

A signature below is actual notice of this order. A signature below is actual notice of this order.
_X
____________________________
Thomas Van Dam, Petitioner
13
14
15
16
17
18
19
20
21
22
23
24
25
RestrainingOrder(TRO/RSTO)Page 4of 4
WPF DR 04.0500Mandatory (O&2014)- RCW26.09.060
S:\CASES1Wan Dam'ORAFTS\Pfeadings\Pe$trajn)ng OrtferTOM docx
FAUBION, REEDER,
FRALEY & COOK, P.S.
5920-100th Street SW, Ste 25
Lakewood, WA 98499
253-581-0660
This o rd e r is in e ffe ct u n til the expira tion date on page one,
D a te d :____________________________________
______________________________
J u d g e /C o m m is s io n e r
Presented by:
Approved by:
Daniel N. Cook, W SBA #34866

Suellen Floward, W SBA #20506

Approved and agreed by: /

A signature b e lo w ^ & c tg a l ndfice of this order,
Thom as VaniDam, Petitioner
R e stra in in g O rder(TR O /R S TO ) P a g e 4 o f 4
W P F D R 0 4 .0 5 0 0 M a n d a t o r y ( 0 6 /2 0 1 4 ) - R C W 2 6 .0 9 ,0 6 0

S.AG4SS1tVan Dam\DRAFTS\Pleadings\Reslr3ining Order TOM.docx
A sig n a tu re b e lo w is a ctual n otice o f this order.
FAUBIO N, REEDER,
. FRALEY & COOK, P.S. '
Lakewood, WA 98499
253-581-0660
1
2
3
4
5
6
7
8

9
10
11
In re:
THOMAS L. VAN DAM,
No. 07-3-02242-1
Petitioner,
and
13

SARA L. VAN DAM,
_____________________ Respondent._____ _____________________________________
14
12
15
16
17
18

RESTRAINING ORDER.
19
20
21
22
23
[email protected].
24
^Sally DuCfiarme, Legal Assistant
25
S : \ C A S E S 1 W a n D am \D R AFTS\Pteadings\D eclaration re Em ailed Signature.doc
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
Phone: (253) 581-0660
*'
CO
in
o
iTi
to
,4-
6
7
SUPERIOR COURT OF W ASHINGTON

COUNTY OF PIERCE
No. 07-3-02242-1
In re:
THOMAS L. VAN DAM,

8
vt
H
(\j
H
H
l\j
Petitioner,
and
SARA L. VAN DAM,

Respondent.
10
11
12
Restraining Order
Temporary (TRO)
Final (RSTO)
El
E3 Clerks Action Required

IS Law Enforcement Notification
This is E3 a tem porary restraining order the final restraining order signed by the court
pursuant to a decree or final order, on this date.
13
Name o f person restrained: SARA VAN DAM .

Name o f person(s) protected: THOMAS VAN DAM .
14
Nam es o f P ro te cte d C h ild re n :
15
16
First
Age
N/A
Middle
F
Height
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Eyes
C a u tio n : A cce ss to w e a po n s: yes ^ no u nknow n

The court finds: this order is necessary based on the evidence presented and: the court
has jurisdiction over the parties, the children, and the subject matter; the restrained
party had reasonable notice and an opportunity to be heard. Notice of this hearing was
served on the restrained person by
personal service service by mail pursuant to
court order service by publication pursuant to court order
other______________________________________________________________________
.
This order is issued in accordance with the Full Faith and Credit provisions of VAWA: 18
U.S.C. 2265.____________________________
Violation o f this Restraining Order with actual notice of its terms is a criminal
offense under Chapter 26.50 RCW and will subject the violator to arrest RCW
26.09.060.
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W eight
Restrained Party's Distinguishing Features:
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R estrained P a rtys id e n tifie rs

Hair
Sex
Race
Last
_________________ _______________________________________________
T h is re s tra in in g o rd e r is e ffe c tiv e im m e d ia te ly and e xp ire s on:
RestrainingOrder(TRO/RSTO)Page 1 o f 4
WPF DR 04.0500 Mandatory (0&2014) - RCW26.09.060

S.lCMSfSJWan Dam \DRAFTS\Plgedtngs\fiestrB(ning Order SfiRA.docx
12/31/2020
FAUBION, REEDER,
FRALEY & COOK, P.S.
5920-100 Street SW. Ste 25
Lakewood, WA 98499
253-581-0660
c--"f
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It is Ordered, Adjudged and Decreed.
2
SARA VAN DAM is restrained and enjoined from:
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UT
disturbing the peace of the protected party or children.

going onto the grounds o f or entering the home, work place or school of the
protected party, or the day care or school of the protected children.
knowingly coming within or knowingly remaining within (distance)
____________________________ o f the home, work place or school of the protected
party, or the day care or school o f the protected children.
assaulting, harassing, stalking, or molesting the protected party or children, or
using, attempting to use, or threatening to use physical force against the
protected party or children that would reasonably be expected to cause bodily
injury, or engaging in other conduct that would place a protected party in
reasonable fear o f bodily injury to the protected party or children.
If the restrained person had actual notice and the restrained person
represents a credible threat, then the Mandatory Surrender o f W eapons and
Restrictions apply.
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j.
v
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i\]
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H
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Other restraints:
The protected party o r the protected partys attorney must complete a law
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enforcement information sheet and provide it with this order before this order
will be entered into the law enforcement computer system .
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Does not apply.
Warnings to Restrained Person

A violation o f any provision o f this order with actual notice o f its terms is a criminal
offense under chapter 26.50 RCW and will subject you to arrest. If the violation of
this restraining order involves travel across a state line or the boundary of a tribal
jurisdiction, or involves conduct within the special maritime and territorial jurisdiction
of the United States, which includes tribal lands,you may be subject to criminal
prosecution in federal court under 18 U.S.C. 2261, 2261 A, or 2262.
A violation o f any provision of this order is a gross misdemeanor unless one o f the
following conditions apply: Any assault that is a violation of this order and that does
not am ount to assault in the first degree or second degree under RCW 9A.36.011 or
9A.36.021 is a class C felony. Any conduct in violation of this order that is reckless
and creates a substantial risk of death or serious physical injury to another person is
a class C felony. Also, a violation o f this order is a class C felony if you have at least
two previous convictions for violating a protection order issued under Titles 7 , 1 0 , 2 6
or 74 RCW.
RestrainingOrder(TRO/RSTO)Page 2 of 4
WPF DR 04 0500 Mandatory (06&014) - RCW 26.09.060

S \CASES1\Van Dam\DRAFTS\Ptsadings\Restrsining Order SARA.docx
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
253-581-0860
1
Federal taw: effective immediately and continuing as long as this restraining order is
in effect, the restrained person may not possess a firearm or ammunition. 18. U.S.C.
922(g)(8) A violation o f this federal firearms law carries a maximum possible
penalty of 10 years in prison and a $250,000 fine. An exception exists for law
enforcem ent officers and military personnel when carrying department/governmentissue firearms. 18 U.S.C. 925(a)(1).
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State law: If mandatory firearm surrender and restrictions under state law apply: It
is unlawful for the restrained person to own, possess, or have under his/her control a
firearm while this order is in effect. A violation is a class C felony.
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You Can Be Arrested Even if the Person or Persons Who Obtained the Order
Invite or Allow You to Violate the Order's Prohibitions. You have the sole
responsibility to avoid or refrain from violating the orders provisions. Only the court
can change the order upon written application.
Pursuant to 18 U.S.C. 2265, a court in any of the 50 states, the District of

Columbia, Puerto Rico, any United States territory, and any tribal land within the
United States shall accord full faith and credit to the order.___________________________
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Previous Order
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[X ]
There are no prior Restraining Orders re s tra in in g the s a m e person issued under
this cause number.
13
[]
This order replaces all prior Restraining Orders re s tra in in g th e s a m e p e rs o n

issued under this cause number.
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Clerks Action/Law Enforcement Action

This order shall be filed forthwith in the clerks office and entered o f record. The clerk of
the court shall forward a copy of this order on or before the next judicial day to (name of
appropriate law enforcement agency) SOUTH SOUND 911 law enforcement agency
where the protected party resides which shall forthwith enter this order into any
computer-based criminal intelligence system available in this state used by law
enforcement agencies to list outstanding warrants.
Service
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[X ]
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[]
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The restrained party or attorney appeared in court or signed this order; service o f
this order is not required.
The restrained party or attorney did not appear in court; service of this order is
required.
The protected party m ust arrange for service o f this order on the restrained party.
File the original Return of Service with the clerk and provide a copy to the law
enforcement agency listed above.
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RestrainingOrder(TRO/RSTO) Page 3 of 4
WPF OR 04.0500 Mandatory (06/2014) - RCW26.09.060

S:\CASESWan Dam\DfWFTS\Pfeacfings\Resfrarrw>)g Order SARA.door
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
253-581-0660
1
This order is in effect until the expiration date on page one.
2
3
4
Dated:
luU M
*;La r y h o l m e s
commissioner Pro Xem
mmissioner
Presented by:
EEDER-ERALEY & COOK, P.S.
Nptroe of presentation waived:
Daniel N. Cook, WSBA #34866



Thomas Van Dam, Petitioner
roved by:
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Restraining Order (TRO/RS TO) Page 4 of 4
WPF DR 04.0500 Mandatory (064014) - RCW26.09.060

S:\CASES1Wan Dam\DRAFTS\P1eadings\RestrBinmg Order SARA docx
FAUBION, REEDER,
FRALEY & COOK, P.S.
5920-100 Street SW. Ste 25
Lakewood, WA 98499
253-581-0660
1
This o rd e r is in effect u n tii the expiration date on page one.
2
3
4
D a te d :____________________________________
Judge/Commissioner
______________________________
Presented by:
Approved by:
Daniel N. Cook, W S B A #34866

Suellen Howard, W SBA #20506


A signature below is/aotualmobce of this order.
Thom as Van Dam, Petitioned
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A sig n a tu re b e lo w is actual n o tice o f th is order.
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R e s t r a in in g O r d e r ( T R O /R S T O ) P a g e 4 o f 4
W P F D R 0 4 .0 5 0 0 M a n d a t o r y ( 0 6 /2 0 1 4 )
- R C W 2 6 .0 9 .0 6 0

S:\CA$S1\Van Dam\DRAFTS\Pleadings\Restraining Order SARA.docx
FAUBIO N, REEDER,
FRALEY & COOK, P.S.
5920-1 00 th Street SW, Ste 25
Lakew ood, WA 98499
253-581-0660
1
2
3
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5
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7
8

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10
In re:
THOMAS L. VAN DAM,
11
and
12

SARA L. VAN DAM,
______________________Respondent._____ _____________________________________
13
14
15
16
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18
No. 07-3-02242-1
Petitioner,
RESTRAINING ORDER.
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[email protected].
24
^ S a lly DtfCharme, Legal Assistant
25
S : \ C A S E S 1 W a n Dam \D R AFTS\Pleadings\D ectaration re Em ailed Signature.doc
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
Phone: (253) 581-0660
07-3-02242-1
43814596
LTR8
12-16-14
SUPERIOR COURT
OF THE
STATE OF WASHINGTON
FOR PIERCE COUNTY
(253) 798-3654

Tacoma, Washington 98402-2102
FAX (253) 798-7214
DATED: December 17, 2014

Re:
Cause No. 07-3-02242-1
Docket code:
THOMAS L VAN DAM

vs.
SARA L VAN DAM
Schedule or Order Assigning Case to Department in regard to the following items:
Certificate of Parenting Class - Respondent's - Not Filed
Settlement Conference not confirmed by deadline - (See PCLR 16 & PCLSPR
94.04)
Deadline:
Deadline:
12/17/14
12/17/14
Copies mailed to:

Clint P. Johnson
Sincerely,
Daniel N Cook
Suellen Howard
Department 08
Phone#: 253-798-7565
To:
Superior Court Clerk for Filing
(Court File Copy)
\lxcivit.pbl\d_noncom pliance_letter_report
07-3-02242-1
43840512
LTRSTC
12 -23-14
e r io r
o urt
O F TH E
S
tate o f
for
a s h in g t o n
ie r c e
o unty
VICKI L. HOGAN, JU D G E
AND REW SHANSTRO M , Judicial A ssistant
Departm ent 5, Courtroom 2-E
(253) 798-7566
334 CO UNTY-CITY BUILDING

930 TA C O M A AVENUE SOUTH
TACO M A, W A 98402-2108
n L tiu
December 22, 2014
^
Daniel N Cook
ATTORNEY AT LAW
5920 100th St SW Ste 25
n o p I m court
SUELLEN HOWARD
,
ATTORNEY AT LAW
RENTON, WA 98057-3240
Dear Counsel/Litigant:
This is to confirm the following settlement conference:
Case:
Cause No.:
Before:
THOMAS L VAN DAM VS. SARA L VAN DAM

07-3-02242-1
Judge VICKI HOGAN, County-City Bldg, Courtroom 2-E
Date & Time:
Wednesday. Mav2fh. 2015 at 8:30 AM
The court requires all parties to:

1.
Be personally present unless excused by the Judge;
2.
Deliver required settlement conference materials (proposed

documents/statements/any other pretrial or supplemental information) to
Department 5 BY 4:30 PM ON FRIDAY. MAY 22N, 2015: and
3.
Be fully prepared, with all discovery matters completed.
Please remember that failure to supply the settlement judge with appropriate forms in a timely
manner may result in the imposition of sanctions. For complete information regarding settlement
conferences, please refer to the Pierce County Local Rules.
Sincerely,
ANDREW J. SHANSTROM
Judicial Assistant
CC: Pierce County Clerk for Filing
2 2
2014
07-3*02242-1
43849065
LTR8
12-24-14
SUPERIOR COURT
OF THE
STATE OF WASHINGTON
FOR PIERCE COUNTY
(253) 798-3654

FAX (253) 798-7214
DATED: December 22, 2014

Re:
Cause No. 07-3-02242-1
.
DEPT. 8
IN OPEN COURT
Docket code: CRRSP
THOMAS L VAN DAM

vs.
SARA L VAN DAM
DEC 2 3 2014
ti
deputy.
Certificate of Parenting Class - Respondent's - Not Filed
Deadline:
12/17/14
Copies mailed to:
Daniel N Cook
Suellen Howard
Phone #: 253-798-7565
Superior Court Clerk fo r Filing

(Court File Copy)
\lxcivit.pbl\d_noncompliancejetter_report
E-FILED
PIERCE COUNTY, W ASHII
February 03 2015 3:35
KEVIN STO CK
COUNTY CLERF
NO: 07-3-02242-
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4
5
6
7
8
9

10
11
12
13
14
No. 07-3-02242-1
In re:
THOMAS L. VAN DAM,
Petitioner,
and
(MTAF)
SARA L. VAN DAM,

Respondent.
I. Motion
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16
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Motion and Declaration for

Temporary Order
Based on the declaration below, the undersigned moves the court for a temporary order
which:
Orders child support pursuant to the Washington State Support Schedule.
Requires the parents to use Our Family Wizard for all future communications
21
Requires all future travel for visitation between Silas with the mother be scheduled
to not cause Silas to miss any school.
22
Except as added to by this motion, confirms and maintains the Temporary Order
23
and mutual Restraining Orders entered on December 10, 2014. This motion is based
24
upon the following declaration and the records pleadings and file herein.
25
WPF DR 04.0100 M andatory (06/2014) - R CW 26.09.060;. 110;. 120;. 194

S:\CASES1\VanDam \DRAFTS\Pleadings\M otionforTem poraryOrcier2.doc
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
Phone: (253) 581-0660
1
2
DATED this
~> day of February 2015.
^ r Tfradey & COOK, P.S.
4
Daniel N. Cook, \A
5
6
II. Declaration
7
I, TOM VAN DAM, and the Petitioner in this matter. I am over the age of 18 and I
8
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am competent to testify. I make this declaration on the basis of my personal knowledge

in support of my request for a temporary order.
11
SARA VAN DAM and I were formerly married. We had one child together, SILAS,
12
who is now 12 years old. SARA and I dissolved our marriage in 2007 when SILAS was
13
only 4 years old. In the seven years since we first established the parenting plan, many
14
things have changed, including work schedules for both parties, residences for both
15
parties and I have remarried.
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For these and other reasons, SARA and I are no longer following the 2007
parenting plan. We have substantially deviated from the parenting plan for a long time
and I am now asking the court to enter a formal parenting plan reflecting the changes we
19
have agreed upon and implemented.
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Since asking the court to modify the parenting plan SARA indicated she would be
relocating to Florida but leaving SILAS here with me.
On December 10, 2014, we
23
entered an Agreed Temporary Order outlining a schedule for the holidays and before her
24
relocation to Florida and confirming SILAS would remain here after her departure.
25

S :\C A S E S 1 W a n Dam \DRAFTS\Pleadings\Motion for Temporary 0rder2.doc
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
Phone:(253) 581-0660
1
I also asked the court to enter a restraining order and mutual restraining orders
2
preventing both parties from entering the home of the other party were entered on
3
4
5
December 10, 2014. There have been two incidents when SARA has come to my house
and acted very inappropriately. She has been hostile, belligerent, rude and frankly a little
scary. Certainly it has traumatized the children in my home. SARA and I generally get
along well and are fairly cooperative but certain topics (mostly financial) are very
triggering for SARA and if I do not do what she wants financially she will sometimes erupt
in an angry and inappropriate manner.
10
upsetting my wife and children I asked the court to enter a restraining order as well as
11
12
To avoid this happening in my home and
modify the parenting plan.

ALL FUTURE TRAVEL NEEDS TO NOT RESULT IN SILAS MISSING SCHOOL
13
SARA and I have been generally cooperative and able to reach agreement on the
14
major aspects of our parenting plan, for example, the residential schedule. However,
15
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SARA has also been very unpredictable and explosively angry when discussing other
issues, primarily financial ones. For example, when she asks for money for a school
18
expense if I suggest that I should pay the school the amount she suggested she gets
19
angry, rude, belligerent and even hostile. SARA has cursed me and my current wife out
20
many times. SARA has called me and my spouse foul names. SARA has sent me
21
harassing texts when she has not gotten her way. I incorporate herein by reference my
22
motion and declaration dated October 15, 2014.
23
24
In addition to the harassment and hostile communications described in my prior

declaration, we recently problematic communication situation arise. SARA and I
25

S :\C A S E S 1 W a n Dam \DRAFTS\Pleadings\Motion for Temporary Order2.doc
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
Phone: (253) 581-0660
1
mediated prior to her relocation to Florida. We agreed she would go to Florida and leave
2
SILAS with me and generally outlined the visits SILAS would have with her. Drafting the
3
4
paperwork would be left up to the attorneys. But the one issue I was very emphatic about
was that SILAS not miss school for visits to Florida. We talked about a visit during mid
winter break and I wholeheartedly agreed SILAS could come with a strong caveat that he
not miss any school for the visit. In mediation and in subsequent telephone calls SARA
agreed he would not miss school.
10
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12
Then after SARA went to Florida and started scheduling the mid-winter vacation
visit she asked me if he could miss a day of school for the visit. I said no because I had
already indicated this was a priority issue for me and she agreed to it.
SILAS already has five absences this year all on times he was scheduled to be
13
with SARA. The simple fact is SARA does not believe school attendance is a priority.
14
SARA takes the position that SILAS can always just make up a day and that missing
15
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school is not a big deal. Perhaps in isolation it is not, but when SARA repeatedly does it
many times during the course of the school year it has a negative impact on him.
In addition, SARA does not check schedules or plans with the school in advance,
19
to see what SILAS is doing that day or if there is something important he would miss.
20
She just keeps it out of school when it suits her needs without really considering the
21
impact on SILAS. That is one reason I was so insistent that SILAS not miss school to
22
visit Florida.
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I appreciate that SARA is not trying to uproot SILAS and move him across the
country because she wishes to move to Florida. SARA should also consider the
25
WPF DR 04.0100 Mandatory (06/2014) - RCW 26.09.060;. 110;. 120;. 194

S:\CA SES1W anD am \DRAFTS\Pleadings\M otionforTem poraryO rder2.doc
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
Phone: (253) 581-0660
1
ramifications of keeping SILAS out of school just because it is better for her (apparently
2
3
4
5
the flight was significantly cheaper if he missed school than if she sent him back as we
originally agreed).
Since SARA did not abide by our agreement to not have SILAS miss school for
visitation in Florida I am asking the court to enter an order to that effect at this time. I
never refused to send SILAS to Florida - I only insisted that SARA ensure he had a ticket
to return prior to school starting. Then SARAs attorney threatened to go to court for an
emergency order because I was not complying with our agreement to send SILAS.
10
Nothing could be further from the truth. I fail to see how SARAs lack of planning and
11
12
then dealing with it at the last minute creates an emergency. Furthermore, it was SARA
who did not comply with our agreement not me. But in any event, what is done is done
13
for now but I do not want to set a precedent that SARA can just unilaterally schedule visits
14
whenever she wants without regard to SILAS school schedule or our agreements and
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16
17
18
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then expect SILAS and my family and me to all accommodate what is best for her. The
court needs to make it clear that conduct such a this will not be tolerated in the future.
IN ADDITION TO THE RESTRAINTS PREVENTING EITHER PARTY FROM COMING
TO THE HOME OF THE OTHER THE PARENTS SHOULD BE REQUIRED TO USE
OUR FAMILY WIZARD FOR ALL COMMUNICATIONS REGARDING SILAS
20
All future communication should be using Our Family Wizard as I originally
21
requested. As noted above, SARA agreed to not have SILAS miss school then failed to
22
follow through. I want future agreements in writing so would like to use Our Family
23
24
Wizard to confirm. In addition, during this process SARA claims I am refusing to let
SILAS go. That is not the case, I never refused to let SILAS go - 1always just insisted
25
WPF DR 04.0100 Mandatory (06/2014) - RCW 26.09.060;. 110;. 120;. 194

S:\C A S E S 1 W a n Dam \DRAFTS\Pleadings\Motion for Temporary Order2.doc
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
Phone:(253)581-0660
1
her return before school started again like we agreed. At one point we were talking on
2
the phone when I insisted that SILAS come home before school resumed instead of
3
4
5
missing school as she insisted SARA hung up on me. Later she tried to call and I
declined to answer because I did not want to have a pointless conversation. Then she
texted me and asked me to call her and I texted her back and said I would prefer to
communicate in writing and did not want to be hung up on. She refused to communicate
substantively about the issue (only texting to ask me to call).
9
10
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12
In addition, SARA frequently tries to engage my wife in conversation about SILAS

when SARA does not get the answer she wants. Often the communications with my wife
are harassing and hostile as they are with me. This is inappropriate.
For all of these reasons I ask the court to order that all future non-emergency
13
communications regarding SILAS be made using Our Family Wizard.

14
CHILD SUPPORT SHOULD BE SET PURSUANT TO THE SCHEDULE

15
16
17
18
My gross income in 2014 was $114,093.84. My paystub for 12/31/2014 confirms

this and confirms that I deducted almost $10,000 for a 401 (k) so I am eligible for
maximum 401 (k) deductions.
19
Before her relocation to Florida SARA was a dental assistant in Seattle. On
20
information and belief I believe she was making about $60,000 per year. I have imputed
21
income to her at this level in my proposed child support worksheets.
22
23
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I am proposing a transfer payment of $489 per month with a 65/35 percent split of
income. I am asking for the effective date to be February 2015 because SARA paid
100% of the round trip airline ticket in January 2014 for SILAS to visit her this winter.
25

S:\C A S E S 1 W a n Dam \DRAFTS\Pleadings\Motion for Temporary Order2.doc
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
Phone: (253) 581-0660
CONCLUSION
2
3
4
Based upon ali of the forgoing, I am asking the court to order all future visits be
scheduled so as to avoid SILAS missing any school, for SARA and I to only communicate
through Our Family Wizard unless there is an emergency and for the court to set child
support based upon the Washington State Support Schedule.

j (state) iA/P
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WPFDR 04.0100 Mandatory (06/2014) - RCW26.09.060;. 110;. 120;. 194

S:\C A SES1W an Dam\DRAFTS\Pleadings\Motion for Temporary Order2.doc
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
Phone: (253) 581-0660
1
2
3
4
5
6
7

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In re:
THOMAS L. VAN DAM,
No. 07-3-02242-1
Petitioner,
and
SARA L. VAN DAM,
Respondent.
MOTION AND DECLARTION FOR TEMPORARY ORDER.
19
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21
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[email protected].
Signed at Lakewood, WA on February 3, 2015.
24
' Sally DiOiarme, Legal Assistant
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S :\C A S E S 1 W a n D am \D R A F T S \P lead in g s\D eclaratio n re E m ailed Signature.doc
FAUBION, REEDER,
FRALEY & COOK, P.S.
Lakewood, WA 98499
Phone: (253) 581-0660
E-FILED
February 03 2015 3:35 PM
KEVIN STO CK
COUNTY CLERK
NO: 07-3-02242-1
Part II: Basic Child Support Obligation (see Instructions, page 7)

7. Each Parent's Basic Child Support Obligation without consideration
of low income limitations (Each parent's Line 6 times Line 5.)
8. Calculating low income limitations: Fill in only those that applySelf-Support Reserve: (125% of the Federal Poverty Guideline.)
a. Is combined Net Income Less Than $1.000? If yes. for each
parent enter the presumptive $50 per child.
b. Is Monthly Net Income Less Than Self-Support Reserve? If ves.
for that parent enter the presumptive $50 per child.
c. Is Monthly Net Income equal to or more than Self-Support
Reserve? If ves. for each parent subtract the self-support
reserve from line 3. If that amount is less than line 7, enter that
amount or the presumptive $50 per child, whichever is greater.
9. Each parent's basic child support obligation after calculating
applicable limitations. For each parent, enter the lowest amount
from line 7, 8a - 8c, but not less than the presumptive $50 per
child.
$488.90
$924.10
I $1,197.00
$924.10
$488.90
Part III: Health Care, Day Care, and Special Child Rearing Expenses (see Instructions, page 8)
Mother
Father

a. Monthly Health Insurance Paid for Chiid(ren)
(line 10c amounts combined)
11. Day Care and Special Expenses
c. Lonq Distance Transportation Expenses
d.Other Special Expenses (describe)
e.Total Day Care and Special Expenses

(Add lines 11a through 11d)
(line 11e amounts Combined!
13. Total Health Care, Day Care, and Special Expenses (line 10d
plus line 12)
14. Each Parent's Obligation for Health Care, Day Care, and Special
Expenses (multiply each number on line 6 bv line 13)
_
_
Part IV: Gross Child Support Obligation

$924.10 |
$488.90
PartV: Child Support Credits (see Instructions, page 9)

b.Day Care and Special Expenses Credit
'
d.Total Support Credits (add lines 16a through 16c)
Part VI: Standard Calculation/Presumptive Transfer Payment (see Instructions, page 9)

17. Standard Calculation (line 15 minus line 16d or $50 per child
whichever is greater)
$924.10
$488.90
$3,266.41
$1,728.95
$231.03
$122.23
Part VII: Additional Informational Calculations

18. 45% of each parent's net income from line 3 (.45 x amount from
line 3 for each parent)
19. 25% of each parent's basic support obligation from line 9 (.25 x
amount from line 9 for each parent)
Part VIII: Additional Factors for Consideration (see Instructions, page 9)

(List the estimated value of all major household assets.)
a. Real Estate
b. Investments
c. Vehicles and Boats
d.Bank Accounts and Cash
e. Retirement Accounts
f. Other: (describe)
21. Household Debt

a.
b
c.
d.
e.
f.
22. Other Household Income
Name
Name
b. Income Of Other Adults in Household
Name
Name
c. Gross Income from overtime or from second jobs the party
is asking the court to exclude per Instructions, page 8
d. Income Of Child(ren) (if considered extraordinary)
Name
Name
Father's
Household
Mother's
Household
"
e. Income From Child Support

Name
Name
f. Income From Assistance Programs

Program
Program
g. Other Income (describe)
Name/age:
Paid [ ] Yes [ ] No
Name/age:
Paid [ ] Yes [ ] No
Name/aqe:
Paid f l Yes [ l No
25. Other Child(ren) Living In Each Household
(First name(s) and age(s))
26.
Mother's
Household
-
Father's
Household
24. Child Support Owed, Monthly, for Biological or Legal Child(ren)
Other Factors For Consideration
Basis for Wages and Salaries for Father: $9,507.82

$114,093.84 Annually

$60,000.00 Annually
Judidal/Reviewing Officer
Date
W orksheet certified by the State of W ashington Adm inistrative Office of the Courts.
WSCSS-Worksheets - M andatory (CSW/CSWP) 07/2013 Page 5 o f S
SupportCafc 2014
c:\program Hes\lega)plus\state lemp/stesWawcrtaheetdtf m:\scdiaWandam\vandsm.sop 02/02/2015 <M:20 pm
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8

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In re:
THOMAS L. VAN DAM,
No. 07-3-02242-1
Petitioner,
and
SARA L. VAN DAM,
______________________R e s p o n d e n t . _______________________________________
I am the person responsible for filing of the e-mailed signature page of the CHILD
SUPPORT WORKSHEETS.
19
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[email protected].
24
Sally DuUharme, Legal Assistant
25
S :\C A S E S 1 W a n D am \D R A F T S \P lead in g s\D eclaratio n re E m a iled Signature.doc
FAUBION, REEDER,
FRALEY & COOK, P.S.

Lakewood, WA 98499
Phone: (253)581-0660
E-FILED
February 03 2015 3:35 PM
KEVIN STO CK
COUNTY CLERK
NO: 07-3-02242-1

THOMAS L VAN DAM

No. 07-3-02242-1
Petitioner(s),
vs.
SARA L VAN DAM

Respondent(s)

Name: SUELLEN HOWARD
Address: 15 S Grady Way Ste 400 RENTON, WA 98057-3240
Phone: (425) 228-8899


CALENDAR DATE: Tuesday, February 24, 2015 9:00 AM

DATED:
February 3, 2015.
Signed:
/s/ Daniel N Cook
NAME:
Daniel N Cook
Phone:
(253) 581-0660
ADDRESS: 5920 100th St SW Ste 25

WSBA#: 34866
For:
1 of
E-FILED
PIERCE COUNTY, WASHING!
February 10 2015 9:57 AM
KEVIN STO CK
COUNTY CLERK
NO: 07-3-02242-1
3
4
5
6
7
8
10
In re:
No. 07-3-02242-1
11
THOMAS L. VAN DAM,
COVERPAGE FOR CORRESPONDENCE

FROM ATTORNEY FOR PETITIONER TO
ATTORNEY FOR RESPONDENT DATED
FEBRUARY 2, 2015
12
13
14
Petitioner,
and
SARA L. VAN DAM,
Respondent.
15
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21
22
23
24
25
Cover Page - Page 1 o f 1
Van Dam, Tom and Van Dam, Sara
S :\C A S E S 1 W a n D a m \D R A F T S \P le a d in g s \C o v e r P ag e.do c
FAUBION, REEDER,
FRALEY & COOK P.S.
Lakewood, WA 98499
Phone: (253) 581-0660
Faubion , Reeder, Fraley & Cook , P.S.

T homas K. F aubion
R ebecca K. R eeder
N elson C. F raley II
D aniel N. C ook
P hone : (253)581-0660
A ttorneys
at
L aw
Lakewood Professional Village

Lakewood, Washington 98499
www.fjr-law.com
E-Mail: [email protected]
N icole C. B, H ancock
P eter D, H aroldson
FAX: (25 3)581-0894
February 2, 2015
Suellen Howard
Renton, WA 98057-3240
RE:
Via e-mail and legal messenger
In re Van Dam, Thomas and Van Dam, Sara

Pierce County Superior Court Cause No.07-3-02242-1
Dear Ms. Howard:

This letter responds to your email of January 29, 2015. Tom Van Dam never
refused to send Silas to visit Sara. Tom insisted both parties comply with their agreement.
The sticking point was Saras desire to hold Silas out of school to save money. In
December Toms condition to agree on the visit was that Silas not miss school. Sara
agreed in December but in January wanted Silas to miss a day of school for the visit.
Tom reiterated this concern when discussing the details in January. Tom found
the alleged cost increase was not as significant as Sara claims and, further, could have
been prevented by planning ahead and purchasing tickets farther in advance.
Tom did not refuse to communicate with Sara. He tried talking with her on the
phone and she hung up on him. He was not willing to repeat the same unproductive,
conversation or be hung up on again. Tom asked Sara to communicate in writing and
she refused. Sara then purchased a ticket which violates their agreement.
Saras lack of planning does not create an emergency but Sara has unilaterally
created a mess. Tom believes Sara should change the ticket and send Silas back on a
day that does not result in him missing school. In this case he will not insist on proof of a
return ticket on a non-school day before sending Silas. But this letter is notice in the
future he does not agree to Silas missing school due to travel to and from Sara's home.
Thank you.
Sincerely,
Daniel N. Cook
Cc:
T o m Van D am , client
P ierce C o u n ty C a u s e N o .0 7 -3 -0 2 2 4 2 -1 C ourt file
E-FILE
PIERCE COUNTY WASHINGTON
KEVIN S O C K
COUNTY CLERK
NO: 07-3-102242-1
SUPERIOR COURT OF W ASHINGTON

COUNTY OF PIERCE
In re the matter of:

NO. 07-3-02242-1
Thomas L. Van Dam
Petitioner
and.
DECLARATION OF SARA VAN

DAM
Sara L. Van Dam

Respondent.
Sara Van Dam declares the following:
The petitioner brought a motion for temporary relief asking, among other things, for temporary
child support. However, he has not provided a financial declaration, tax returns or more than one
pay check. 1 am asking the court to continue the hearing for temporary child support so that the
petitioner can supply all of the required documents and to award attorneys fees to me since there
will be an unnecessary second hearing.
I agreed to a temporary order that included restraints back in December and I no not understand
why the petitioner is asking the court to order another one.
I agree to use Our Family Wizard for communications. I find that the petitioner either fails to
return calls or is abusive to me when he is on the phone and I welcome some other form of
SUELLEN HOW ARD

Declaration
1
ATTORNEY AT LAW
(425)228-8899 Fax: (425) 277-9279
communication. As he knows I only speak to his wife when 1 am desperate to communicate
something about Silas that is time sensitive.
3
4
Although we already have a temporary restraining order, the petitioner wants to put before the
court the on gong problems that we have had. Since the separation and then divorce from the
petitioner, I have been scared of the petitioner and his controlling ways. He uses intimidation and
passive aggression to get what he wants . I have been a single mon and working hard to support
myself and our son Silas.
9
10
Our 2007 parenting plan provided for shared time and the petitioner only paid $150 in support
11
although there is a big disparity between our incomes. The petitioner decided if expenses should
12
come our of the $150. I only asked him to pay for things for Silas when I had no other recourse
13
because I was frightened of him.
14
15
Last year there were two incidents that increased my anxiety and fear. I was physically hurt by the
16
petitioner in front of our son. I was once again trying to ask the petitioner for money that was due
17
but which he was refusing to pay. After he slammed the door in my face in front of Silas I went
18
to the side door to check that Silas was all right. The petitioner threw me into a comer and
19
knocked the wind out of me and I was unable to breathe. He then continued to throw me at the
20
door and my sunglasses, rings and earrings all were thrown off during this. I was crawling on the
21
garage floor grasping for air. When I caught my breath I asked to see Silas because I could hear
22
him crying. The petitioner refused and demanded that 1 leave. I went to a friends house shaking
23
and crying uncontrollably. I continue to have anxiety over this incident.
24
25
26
SUELLEN HOWARD
27
Declaration
28
ATTORNEY AT LAW
RENTON. WASHINGTON 98057
(425) 228-8899 Fax: (425) 277-9279
On another occasion the petitioner tried to physically stop my car when I was trying to drop off
Silas. I agreed to a restraining order and I avoid confrontations.
My choice to relocate to Florida was a hard one. I would love to have Silas with me full time and
come with me to Florida. 1 have chosen to have him stay in school in Washington. My decision
to move to Florida has a lot to do with the harassment and passive aggressive, controlling
behavior of the petitioner than I have had to deal with for over 8 years now.
8
9
We reached a written agreement on some aspects of my move to Florida. The agreement was not
10
final because our attorneys had to agree also. 1have attached the agreement to show that I agreed
11
not to interfere with Silas school if 1 visit him in Washington, but that provision does not appear
12
with the visitation in Florida. 1 do not intend to have Silas miss school to visit me, but sometimes
13
the travel arrangements are easier as to the times or far less expensive if Silas travels on a school
14
day. The times that this would even be considered are a few times a year. I am asking the court
15
not to impose that restriction on the travel times. Silas is a very good student and I have always
16
worked closely with his teachers. Silas can easily make up any work that he might miss or do it in
17
advance.
18
19
Silas has been through a lot of changes the past three years. Several important family members
20
have died, his father has remarried and he has step sisters, and now I have moved. I want to spend
21
as much time with him as I can and I want him to see me happy and not anxious and fearful. I am
22
asking the court not to put monetary restraints on the visitation that could make it happen less
23
frequently if the times are restrictive.
24
25
26
SUELLEN HOWARD
27
Declaration
28
ATTORNEY AT LAW
(425) 228-8899 Fax: (425) 277-9279
Child Support
1am a dental assistant. When I worked in Washington I made $30 an hour. Dental office are not
open 40 hours a week and I averaged 32 or 33 hours a week which is standard in the industry.
This is consistent with my 2014 income.
5
6
At present, I am unemployed and living with my boyfriend. To meet my expenses, I used money
form my tax refund and my mother has helped me. I am looking for work in my field. Here in
Escambia County dental assistants earn between $10 and $15 an hour. I have applied for many
positions and have had two working interviews. The pay for each of those two jobs was $10. The
10
office hours are the same as in Washington, full time is considered $32-36 hours a week.
11
12
I have prepared a worksheet based on 34 hours a week and $12.50 an hour which is the average
13
of the going rate and available hours. Since this is a temporary order, it can be adjusted when I am
14
employed. For the petitioner, I used the one pay check that he provided.
15
16
The petitioner did not pay his child support to me in November and December last year and owes
17
$300. I am asking for an equitable offset of $300 against my child support payment for the first
18
moths.
19
20
21
22
23
24
25
26
SUELLEN HOWARD
27
Declaration
28
ATTORNEY AT LAW
! 5 SOUTH GRADY WAY, SUITE 400
(425) 228-8899 Fax: (425) 277-9279
I declare under penalty of peij ury under the Jaws c f die State of Washington that the foregoing is
true and correct
Signed at
_on _ Z A / _
SUELLEN HOWARD
ATTORNfcYA.TLAW
15SOUTHCRADYWAY. SUITEAOO
(42Jj 22 3-S899 Fa*: I42SY277-927S
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Washington State Child Support Schedule Worksheets

[ ] Proposed by [ ]
[ ] State of WA [ ] Other
Or, [ ] Signed by the Judicial/Reviewing Officer. (CSW)
Mother:
Sara
Father: Thomas
County:
PIERCE
Case No.:
(CSWP)
07-02242-1
Child Support Order Summary Report
This section must be completed for all Worksheets signed by the

____________________judicial/reviewing officer.___________________
A. The order [ ] does [ ] does not replace a prior court or administrative order
B. The Standard Calculation listed on line 17 of the Worksheet for the paying parent is:
$259.66.
C. The Transfer Amount ordered by the Court from the Order of Child Support is:
- to be paid by [X] mother [ ] father.
D. The Court deviated (changed) from the Standard Calculation for the following reasons:
[ ] Does not apply
{ ) Nonrecurring income
[ j Split custody
[ ] Residential schedule (including shared custody)
I j Child(ren) from other relationships for whom the parent owes support
[ j High debt not voluntarily incurred and high expenses for the child(ren)
[ j Other (please describe):
E. Income for the Father is [ ] imputed [X] actual income.

Income for the Mother is [ ] imputed [X] actual income.
Income was imputed for the following reasons:
F. If applicable: [ ] All health care, day care and special child rearing expenses are included in the
Worksheets in Part 111.___________________________________________________________________
WSCSS-Workshoets - Mandatory (CSW/CSWP) 10/2009 Page 1 o f 5
Worksheets
Child(ren) and Age(s): Silas, 12
P arti: Income (see Instructions, page 6)
a. Wages and Salaries
b. Interest and Dividend Income
c. Business Income
d. Maintenance Received
e. Other Income
f. Imputed Income
g.Total Gross Monthly Income (add lines 1a through 1f)
Father
$9,507.00
Mother
$1,841.00
$9,507.00
$1,841.00
a. Income Taxes (Federal and State) Tax Year: M anual

b. FICA (Soc.Sec.+Medicare)/Self-Employment Taxes
d Mandatory Union/Professional Dues
e. Mandatory Pension Plan Payments
f. Voluntary Retirement Contributions
g. Maintenance Paid
h.Normal Business Expenses
i. Total Deductions from Gross Income
(add lines 2a through 2h)
3. Monthly Net Income (line 1g minus 2i)
4. Combined Monthly Net Income
(line 3 amounts combined)
5. Basic Child Support Obligation (Combined amounts ->)
Silas
$1467.00
$1,098.80
$724.34
$6.30
$136.67
$140.84
$416.67
$277.51
$2,246.11
$1,563.49
$7,260.89
$8,824.38
$1,467.00

(each parent's net income from line 3 divided by line 4)
.823
.177
$1,207.34
$259.66
Part II: Basic Child Support Obligation (see Instructions, page 8)

8. Calculating low income limitations: (Complete those that apply.)
Self-Support Reserve: (125% of the Federal Poverty Guideline.)
a Combined Net Income Less Than $1.000: if line 4 is less than
$1000, then for each parent enter the presumptive $50 per child.
b. Monthlv Net Income Less Than Self-SuDDort Reserve: If a
parents monthly net Income on line 3 is less than the self-support
reserve, then for that parent enter the presumptive $50 per child.
c. Monthlv Net Income Greater Than Self-SuDport Reserve: For
each parent subtract the self-support reserve from line 3. If that
amount is less than line 7, then enter that amount or the
presumptive $50 per child, whichever is greater.
from line 7, 8a, 8b or 8c.
I $1,128.00
$1,207.34
$259.66
Part III: Health Care, Day Care, and Special Child Rearing Expenses (see Instructions, page 8)
Mother
Father
10 Health Care Expenses

a. Monthly Health Insurance Paid for Child(ren)
b Uninsured Monthly Health Care Expenses Paid for Child(ren)
d.Combined Monthly Health Care Expenses
c Long Distance Transportation Expenses
e Total Day Care and Special Expenses

(Add lines 11a through 11d)
(line 11e amounts Combined)
13. Total Health Care, DayCare, and Special Expenses (line 10d
plus line 12)
14. Each Parents Obligation for Health Care, Day Care, and Special
Expenses (multiply each number on line 6 by line 13)
Part IV: Gross Child Support Obligation

$1,207.34 [
$259.66
Part V: Child Support Credits (see Instructions, page 9)


$1,207.34
$259.66
$3,267.40
$703.57
$301.83
$64.92

19. 25% of each parents basic support obligation from line 9 (.25 x
WSCSS- Worksheets - Mandatory (CSW/CSWP) 10/2009 Page 3 o f 5

(List the estimated va ue of all major household assets.)
a. Real Estate
b. Investments
e Retirement Accounts
21 Household Debt
a.
b.
c.
d.
e.
f.
Name
Name
Name
Name
d.Income Of Child(ren) (if considered extraordinary)

Name
Name
Father's
Household
Mother's
Household

Name
Name
e. Income From Assistance Programs

Program
Program

-
24 Child Support Owed, Monthly, for Biological or Legal Children}

__
Name/age:
_ ........................
Paid [ ] Yes U No
Name/age:
Paid 1j Yes 1] No
Name/aqe:
Paid [JYes n No
(First name(S) and age(s))
Father's
Household
....... __
7
Mothers
Household
- .....
26. Other Factors For Consideration (attach additional'pages as necessary}
Signature and Dates_______________________________________________________

I declare upder penalty of perjury under the laws of the State of Washington, the information
containe(j/in thege-Wodtsheets is complete, true, and correct
Mothers Signaturp-"'^
Date
Father's Signature
City
Judicial/reviewing Officer
Date
City
Date

WSCSS-Worksheets - Mandatory fCSW/CSWP} 1 0/2009 Page S of 5
SupportCaic* 2 Dio
c \slate ter-aa:esW3ôrnsrieeti' c ip'09-am flesvegalpuf.an dan, sar,ri flam sara .sco Q2/16/2D151214 pm
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E-FILED
PIERCE CO UNTY W ASHING TO N
February 17 20 15 8:30 AM
1
KEVIN S TO C K
COUNTY LERK
NO: 07-3-102242-1
3
4
5
6
7 SUPERIOR COURT OF WASHINGTON
COUNTY OF PIERCE
8
In re:
9
Thomas L. Van Dam
NO. 07-3-02242-1
Petitioner,
10
and
FINANCIAL DECLARATION
PETITTONER/RESPONDENT
(FNDCLR)
11
Sara L. Van Dam
12
Respondent.
13
14 Name: Sara Van Dam
15
16
I. SUMMARY OF BASIC INFORMATION
17
18
Declarants Total Monthly Net Income (from 3.3 below)
$-0-
Declarants Total Monthly Household Expenses (from 5.9 below)
S 1227
19 Declarants Total Monthly Debt Expenses (from 5.11 below)
20 Declarants Total Monthly Expenses (from 5.12 below)
21
S9500.
Estimate of the other partys gross monthly income (from 3.1 f below)
22
23
24
25
26
27
28
WPF DR 01.0550 (2/97)
RCW 26.18.220(1)
Page 1
Suellen Howard
Attorney at Law
15 South Grady Way, Suite 400
Renton, WA 98057
425-228-8899 phone *425-277-9279 fax
II. PERSONAL INFORMATION
2 2.1
3 2.2
4
2.3
Occupation: Dental Assistant

The highest year of education completed:
Are you presently employed? No
5
a. If yes:
(l)
(2)
Where do you work ?

When did you start work there?
7
8
III. INCOME INFORMATION
If child support is at issue, complete the Washington State Child Support Worksheet(s), skip Paragraphs
10 3.1 and 3.2. If maintenance, fees, costs or debts are at issue and child support is NOT an issue this entire
section should be completed. (Estimate of other partys income information is optional.)
11
3.1
GROSS MONTHLY INCOME.
12
If you are paid on a weekly basis, multiply your weekly gross pay by 4.3 to determine your
monthly wages and salaries. If you are paid every two weeks, multiply your gross pay by 2.15.
13
If you are paid twice monthly, multiply your gross pay by 2. If you are paid once a month, list
14
that amount below.
Petitioner
15
a.
Wages and Salaries
$
16
b.
c.
Business Income
d.
Spousal Maintenance From Other Relationships
19
e.
Other Income
20
f.
Total Gross Monthly Income (add lines3.1a through 3.1 e)
21
g.
Actual Gross Income (Year to date)
17
18
(L&I)
$
$
22
23
24
25
26
27
WPF DR 01.0550 (2/97)
28
RCW 26.18.220(1)
Page 2
Suellen Howard
Attorney at Law
Renton, WA 98057
425-228-8899 phone *425-277-9279 fax
I 3.2
MONTHLY DEDUCTIONS FROM GROSS INCOME.
a.
Income Taxes
b.
c.
d.
MANDATORY Union/Professional Dues
e.
f.
g.
h.
5
6
7
8
9
10 3.3
II
12
3.4
13
14
MONTHLY NET INCOME. (Line 3.1 f minus line 3.2h or

line 3 from the Child Support Worksheet!s).)
MISCELLANEOUS INCOME.
a.
Child support received from other relationships
b.
Other miscellaneous income (list source and amounts):
c.
Total Miscellaneous Income (add lines 3.4a through 3.4c)
15
16 3.5
17 3.6
If the income of either party is disputed, state monthly income you believe is correct and explain
below:
18
Sunknown
IV. AVAILABLE ASSETS
19
4.1
Cash on hand
4.2
On deposit in banks
4.3
Stocks and Bonds, cash value of life insurance
4.4
20
21
22
23
24
25
26
27
28
WPF DR 01.0550 (2/97)
RCW 26.18.220(1)
Page 3
Suellen Howard
Attorney at Law
Renton, WA 98057
425-228-8899 phone *425-277-9279 fax
V, MONTHLY EXPENSE INFORMATION
2 Monthly expenses for myself and__ dependents are: (Expenses should be calculated for the future,
3
4 '5.1
i;
5
:!
6I
Rent, 1st mortgage or contract payments

Installment payments for other mortgages or encumbrances
$
$
Taxes & insurance (if not inmonthly payment)
Total Housing
8 5.2
UTILITIES.
Heat (gas & oil)
10
Electricity
11
Telephone
Cable
$150
Other: House maintenance
$140
Total Utilities
$290
12
13
HOUSING.
14
15
i
i,5.3
16
'I
17
18
19
20
21 5.4
22
23
24
25
FOOD AND SUPPLIES.

Food for 1 persons
Meals eaten out
$300
$
$
Other
Total Food Supplies
$
$
CHILDREN.
Clothing
Tuition (if any)
Other child related expenses will be contribution to activities and
and air travel
26
27
28
WPF DR 01.0550 (2/97)
RCW 26.18.220(1)
Page 4
$
$
$
$
Suellen Howard
Attorney at Law
Renton, WA 98057
425-228-8899 phone *425-277-9279 fax
TRANSPORTATION.
Vehicle payments or leases

$397
$240
Parking
Other transportation expenses: AAA
$
$
$637
HEALTH CARE. (Omit if fully covered)
Uninsured dental, orthodontic, medical, eye care expenses
4
5
6
10
Insurance: Premium
Total Health Care
11
12
13 5.7
$
$
$
$
PERSONAL EXPENSES (Not including children).

Clothing
Education
S
S
$
$
19
Books, newspapers, magazines, photos

Gifts
Other:
$
$
$
$
20 5.8
MISCELLANEOUS EXPENSES.
21

Other___________________________
Other___________________________
$
$
$
$
TOTAL HOUSEHOLD EXPENSES

(The total of Paragraphs 5.1 through 5.8)
14
15
16
17
18
22
23
24
5.9
25
26
27
WPF DR 01.0550(2/97)
28
Page 5
RCW 26.18.220(1)
Suellen Howard
Attorney at Law
Renton, WA 98057
425-228-8899 phone *425-277-9279 fax
1
2 5.10
INSTALLMENT DEBTS INCLUDED IN PARAGRAPHS 5.1 THROUGH 5.8.
3
4
Creditor
Description
of Debt
Balance
Month of
Last Payment
5
6
5.11
THROUGH 5.8.
7
8
9
OTHER DEBTS AND MONTHLY EXPENSES NOT INCLUDED IN PARAGRAPHS 5.1

Amount of
Creditor
Description
of Debt
Balance
LastPayment
U.W. Medici Ctr
medical bills
3,800
$200.
10
11
12
Total Monthly Payments for Other Debts and Monthly Expenses
TOTAL EXPENSES (Add Paragraphs 5.9 and 5.11)
13
14
5.12
15
VI. ATTORNEY FEES
16
17
18
19
20
6.1
6.2
6.3
6.4
6.5

The source of this money was: earnings
$1000.00
Arrangements for attorney fees and costs are:

Other:
$2000.00
21
22
23
24
25
26
27
28
WPF DR 01.0550(2/97)
RCW 26.18.220(1)
Page 6
Suellen Howard
Attorney at Law
Renton, WA 98057
425-228-8899 phone *425-277-9279 fax
I declare under penalty of perjury under the laws of the State of Washington that the foregoing is
true and correct
Signed at
C*~s on. ' / fa / ~

r fr )z j t3 _
SUELLEN HOWARD
Y i n U<asaX
Declaration
fd
fr68516P OS8
ATTORNEY AT LAW
15 SOUTH GRADY WAY. SUfTEAOO
RENTON. WASHINGTON' 9S057
(425) EW S59 F : 1425) 277-W27y
e}n|osey ||0w\puQ
d22:eOS19iqed
E-FILED
KEVIN STO CK
COUNTY CLERK
NO: 07-3-02242-1
Part It: Basic C hild Support Obligation (see Instructions, paqe 7)

8. Calculatina low income limitations: Fill in only those that apply.
Self-Support Reserve: (125% of the Federal Poverty Guideline.)
a. Is combined Net Income Less Than $1.000? If ves. for each
parent enter the presumptive $50 per child.
b. Is Monthly Net Income Less Than Self-Support Reserve? If ves.
for that parent enter the presumptive $50 per child.
c. Is Monthly Net Income eaual to or more than Self-SuDDort
Reserve? If ves. for each Darent subtract the self-suDDort
reserve from line 3. If that amount is less than line 7, enter that
amount or the presumptive $50 per child, whichever is greater.
from line 7, 8a - 8c, but not less than the presumptive $50 per
child.
$597.47
$1,149.53
I $1,226.00
.
.
$1,149.53
$597.47
Part III: Health Care, Day Care, and Special C hild Rearing Expenses (see Instructions, page 8)
M other
Father

a. Monthly Health Insurance Paid for Child(ren)
.
_
11. Day Care and Special Expenses

e. Total Day Care and Special Expenses

(Add lines 11a throuqh 11 d)

(line 11e amounts Combined)
13. Total Health Care, Day Care, and Special Expenses (line 10d
plus line 12)
14. Each Parent's Obligation for Health Care, Day Care, and Special
ExDenses (multiply each number on line 6 by line 13)
Part IV: Gross C hild S upport O bligation
$1,149.53 I
$597.47
Part V: C hild S upport C redits (see Instructions, page 9)

a. Monthlv Health Care Expenses Credit

d.Total Support Credits (add lines 16a through 16c)

$1,149.53
$597.47
$3,274.81
$1,699.23
$287.38
$149.37

19. 25% of each parent's basic support obligation from line 9 (.25 x

(List the estimated value of all major household assets.)
Mother's
Household
Father's
Household
a. Real Estate
b. Investments
e. Retirement Accounts
21. Household Debt

a.
b.
c.
d.
e.
f
Name Stephanie VanDam
Name
Name
Name
d. Income Of Child(ren) (if considered extraordinary)

Name
Name
$3,500.00

Name Stephanie VanDam
Name
$280.00
f. Income From Assistance Programs

Program
Program
q.Other Income (describe)
24. Child Support Owed, Monthly, for Biological or Legal

Child(ren)
Name/age:
Paid [ l Yes [ ] No
Name/age:
Paid [ ] Yes [ ] No
Name/aqe:
Paid f l Yes f l No
(First name(s) and age(s))
26.
Father's
Household
Mother's
Household
Other Factors For Consideration
Basis for Wages and Salaries for Father: $9,507.82

$114,093.84 Annually

$60,000.00 Annually

$52,790.00 Annually
Judiciat/Reviewing Officer
Date

WSCSS-Worksheets - Mandatory (CSW/CSWP) 07/2013 Page 5 of 5
S u p p o rt Ca/c 2015
c:\program files (x86)\legalpius\state templates^waworksheet.dtf m:\scdataWandamWandam.scp 02/17/2015 04:50 pm
1
2
3
4
5
6
7
8

9
10
11
12
13
14
15
16
17
18
In re:
THOMAS L. VAN DAM,
No. 07-3-02242-1
Petitioner,
and
SARA L. VAN DAM,
Respondent.
I am the person responsible for filing of the e-mailed signature page of the CHILD
SUPPORT WORKSHEETS.
19
20
21
22
23
[email protected].
yJ_____
""Sally DuCnarme, Legal Assistant
24
25
FAUBION, REEDER,
FRALEY & COOK, P.S.

Lakewood, WA 98499
Phone: (253) 581-0660
E-FILED
February 18 2015 9:59 A
KEVIN STO CK
COUNTY CLERK
NO: 07-3-02242' 1
2
3
4
5
6
7
8
9

COUNTY OF PIERCE
In re:
No. 07-3-02242-1
THOMAS VAN DAM
Petitioner,
Financial Declaration
[X] Petitioner
[ Respondent
(FNDCLR)
And
10
SARA VAN DAM VAN DAM
Respondent.
11
12
Name: Thomas Van Dam
Date of Birth:
I. Summary of Basic Information
13
14
15
10/21/1969
Declarant's Total Monthly Net Income (from 3.3 below)

Declarant's Total Monthly Household Expenses (from 5.9 below)
Declarant's Total Monthly Debt Expenses (from 5.11 below)
Declarant's Total Monthly Expenses (from 5.12 below)
Estimate of the other party's gross monthly income (from 3.1 g below)
[X]
[ ]
16
$7,277.36
$8,950.00
$820.00
$9,770.00
$4,399.20
Unknown
II. Personal Information
17
2.1
Occupation: Engineer
18
2.2
The highest year of education completed:
2.3
Are you presently employed?

[X] Yes
[ ] No
a. If yes:
(1) Where do you work. Employer's name and address must be listed on the
19
3 years of college
Confidential Information Form.

(2) When did you start work there? (month/year) 02/2008
20
21
b.
If no:
(1) When did you last work? (month/year)

(2) What were your gross monthly earnings?
22
(3) Why are you presently unemployed?
23
24
25

WPF DRPSCU 01.1550 (6/2006) - RCW 26.18.220 (1)
FAUBION, REEDER,
FRALEY & COOK, PS
Lakewood, WA 98499
(253) 581-0660
SupportCa/c/FD 2015
1
III.
2
3
4
Income Information
If child support is at issue, complete the Washington State Child Support Worksheet(s), skip
Paragraphs 3.1 and 3.2. If maintenance, fees, costs or debts are at issue and child support is Not an
issue this entire section should be completed. (Estimate of other party's income information is
optional.)
5
3.1
6
7
8
9
10
11
12
13
14
Gross Monthly Income

If you are paid on a weekly basis, multiply your weekly gross pay by 4.3 to determine your
monthly wages and salaries. If you are paid every two weeks, multiply your gross pay by 2.15.
If you are paid twice monthly, multiply your gross pay by 2. If you are paid once a month, list
that amount below.
Sara Van Dam
Thomas Dam
Van Dam
a.
Imputed Income
$4,399.20
$9,507.80
b.
Wages and Salaries
c.
d.
Business Income
Spousal Maintenance Received
"
e.
From
f.
Other Income
$4,399.20
Total
Gross
Monthly
Income
$9,507.80
g(add lines 3.1a through 3.1e)
$11,000.00
h.
Actual Gross Income (Year-to-date)
Monthly Deductions From Gross Income
Thomas Dam
15
16
17
18
19
a.
b.
c.
d.
e.
f.
9h.
Sara Van Dam

Van Dam
$286.60
$336.54
Income Taxes
Mandatory Union/Professional Dues
$1,080.13
$727.34
$6.30
$2,230.44
$623.14
$7,277.36
$3,776.06
$416.67
20
21
Monthly Net Income (Line 3.1f minus line 3.2h

orjine 3 from the Child Support Worksheet(s).)
22
23
24
25
WPF DRPSCU 01.1550 (6/2006) - RCW 26.18.220 (1)
FAUBION, REEDER,
FRALEY & COOK, PS
Lakewood, WA 98499
(253) 581-0660
SupportCa/c/FD 201S
1
2
3
4
3.4
Thomas Dam
Miscellaneous Income
a.
Child support received
relationships
Name: Stephanie VanDam
Name:
b.
Other miscellaneous income
from
Sara Van Dam

Van Dam
other
$280.00
(list source and amounts)
Income of current spouse

Name: Stephanie VanDam
Name:
Income of children
Name:
Name:
Income from assistance programs
Name:
Name:
Non-recurring income
Name:
Name:
Other Income:
6
7
8
9
10
11
$3,500.00
12
c.
13
14
$3,780.00
(add lines 3.4a through 3.4b)
3.5
15
16
Total Miscellaneous Income

Name:
Name:
3.6
If the income of either party is disputed, state monthly income you believe is correct and
explain below:
4.1
4.2
4.3
Cash on hand
On deposit in banks
Stocks and bonds
Cash value of life insurance
17
IV. Available Assets
18
19
20
21
22
4.4
V. Monthly Expense Information

Monthly expenses for myself and 3 dependents are: (Expenses should be calculated for the future,
5.1
23
24
25
Housing
Rent, 1st mortgage or contract payments
Installment payments for other mortgages or
encumbrances
Taxes & insurance (if not in monthly payment)
Total Housing

WPF DRPSCU 01.1550 (6/2006) - RCW 26.18.220 (1)
SupportCa/c/FD 2015
$1,250.00
$1,250.00
FAUBION, REEDER,
FRALEY & COOK, PS
Lakewood, WA 98499
(253) 581-0660
1
5.2
2
3
4
Utilities
Heat (gas & oil)
Electricity
Telephone (includes several lines plus insurance)
Cable (includes cable and high-speed internet)
Other: ADT (home security system)
$125.00
$125.00
$200.00
$300.00
$ 112.00
$49.00
Total Utilities
$911.00
5
6
5.3
7
8
9
5.4
5.5
14
15
Transportation
Vehicle payments or leases (two vehicles)
Parking
Other transportation expenses
5.6
17
18
Health care (Omit if fully covered)

Insurance
Uninsured dental, orthodontic, medical, eye
care expenses
Total Health Care
20
21
22
23
$1,675.00
Children
Clothing
Tuition (if any) (post-secondary assistance for older child of Stephanie VanDam)
Other child-related expenses (sports and extra-curricular for Silas and younger child
13
19
$75.00
$400.00
$250.00
$400.00
$135.00
of Stephanie VanDam)
12
16
$1,200.00
Total Food Supplies
10
11
Food and Supplies

Food for 4 persons
Meals eaten out
Other:
5.7
Personal Expenses (Not including children)

Clothing
Education Travel/vacation
Books, newspapers, magazines, photos (Netflix)
Gifts
Other: Additional 401 (k) investment
$785.00
$830.00
$246.00
$500.00
$30.00
$1,606.00
$30.00
$40.00
$70.00
$300.00
$150.00
$280.00
$300.00
$9.00
$300.00
$417.00
$1,756.00
24
25
WPF DRPSCU 01.1550 (6/2006) - RCW 26.18.220 (1)
FAUBION, REEDER,
FRALEY & COOK, PS
Lakewood, WA 98499
(253) 581-0660
SupportCa/c/FD 2015
1
2
5.8
3
4
5
6
7
5.9
Miscellaneous Expenses
Other: World Vision (support 3 children in 3rd world countries)
Other: Redemption Bible Church (tithe)
$72.00
$105.00
$720.00
$897.00
$8,950.00
Total Household Expenses

(The total of Paragraphs 5.1 through 5.8)
5.10
Installment Debts Included in Paragraphs 5.1 Through 5.8
Creditor/Description of Debt
Balance
Wells Fargo (home
$195,000.00
mortgage)
Toyota Finance
$12,000.00
Honda Financial
$7,000.00
Month of Last Payment

February
February
February
10
11
12
13
14
15
5.11
Other Debts and Monthly Expenses not Included in Paragraphs 5.1 - 5.8
Amount of
Month of
Last Pavment
Monthlv Pavm
Creditor/Description of Debt
Balance
$50.00
January
$1,200.00
Wells Fargo (credit card)
$300.00
January
$5,800.00
USAA (credit card)
$35.00
January
$200.00
JCPenny (credit card)
$75.00
February
$2,000.00
Chase (credit card)
$360.00
February
$12,000.00
Key Bank (consolidation
loan)
16
17
18
19
20
21
22
23
24
25
WPF DRPSCU 01.1550 (6/2006) - RCW 26.18.220 (1)
SupportCa/c/FD 2015
FAUBION, REEDER,
FRALEY & COOK, PS
Lakewood, WA 98499
(253) 581-0660
1
2
Total Monthly Payments for Other Debts and Monthly

Expenses
5.12
$820.00
Total Expenses (Add Paragraphs 5.9 and 5.11)
VI. Attorney Fees
4
5
6.1
6.2
The source of this money was: Wages/salary
6.3
6.4
Arrangements for attorney fees and costs are: Paid monthly.
6.5
Other:
$9,770.00
$2 ,9 5 0,00
$5,515.00
9
10
I declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and
correct.
11
12
Signed at
K u -V rg y
13
/>
14
Thomas Van Dat'd

Signature of Declarant
[City] ( / - / f t '
[State]
[Date].
*"
15
The following financial records are being provided to the other party and filed separately with the court.
16
17
18
19
Financial records pertaining to myself:

[ ] Individual [ ] Partnership or Corporate Income Tax returns for
the years:
including ail W-2s and schedules;
[ ] Pay stubs for the dates of
[ ] Other:
20
21
22
Do not attach these financial records to the financial declaration. These financial records should
be served on the other party and filed with the court separately using the sealed financial source
documents cover sheet (WPF DRPSCU 09.0220). If filed separately using the cover sheet, the
records will be sealed to protect your privacy (although they will be available to all parties In the
case, their attorneys, court personnel and certain state agencies and boards.) See GR 22 (c)(2).
23
24
25
WPF DRPSCU 01.1550 (6/2006) - RCW 26.18.220 (1)
FAUBION, REEDER,
FRALEY & COOK, PS
Lakewood, WA 98499
(253) 581-0660
SupportCatoTO2015
1
2
3
4
5
6
7

10
11
12
In re:
THOMAS L. VAN DAM,
No. 07-3-02242-1
Petitioner,
and
13
SARA L. VAN DAM,

______________________Respondent.___________________________________________
14
15
16
17
18

FINANCIAL DECLARATION.
19
20
21
22
23
[email protected].
Signed at Lakewood, WAon February 18, 2015.
24
--''Sally DuCharme, Legal Assistant
25
D e c la r a t io n P u r s u a n t t o G R 1 7 - P a g e 1 o f 1
S : \ C A S E S 1 W a n D a m \D R A F T S\Plea d ings\D ecla ra tion re Em ailed Signature.doc
F A U B IO N , R E E D E R ,
F R A L E Y & C O O K , P .S .

Lakewood, WA 98499
Phone: (253) 581-0660
E-FILED
PIERCE COUNTY, W ASHING TO N
KEVIN STO CK
COUNTY CLERK
NO: 07-3-02242-1

THOMAS L VAN DAM

No. 07-3-02242-1
Petitioner(s),
vs.
SARA L VAN DAM

Respondent(s)

Name: SUELLEN HOWARD
Address: 15 S Grady Way Ste 400 RENTON, WA 98057-3240
Phone: (425) 228-8899


CALENDAR DATE: Thursday, March 19, 2015 9:00 AM

DATED:
February 19, 2015.
Signed:
/s/ Daniel N Cook
NAME:
Daniel N Cook
Phone:
(253) 581-0660
ADDRESS: 5920 100th St SW Ste 25

WSBA#: 34866
For:
1 of

Thomas L Van Dam vs. Sara L Van Dam Case Number 07-3-02242-1

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E-FILED

IN COUNTY CLERK'S OFFICE

IN THE SUPERIOR COURT OF THE STATE OF WASHINGTON

Assignment to Set Trial Date

Friday, November 09, 2007 9:00 AM

DATED: July 6, 2007

PIERCE COUNTY SUPERIOR COURT/CASE INFORMATION COVER SHEET

FIERCE COUNTY, WASHIN IP 1

IN THE SUPERIOR COURT OF THE STATE OF WASHINGTON

IN AND FOR THE COUNTY OF PIERCE

In re the Marriage of:

SARA L. VAN DAM,

TO THE RESPONDENT: SARA L. VAN DAM

The Petitioner has started an action in the above court requesting:

before an order of default or a decree may be entered.

One method of serving a copy of your response on the Petitioner is to send it by

Moving Party's Lawyer:

Clerk of the Court

IN C O U N T? C LER K'S OFI

(M. 1JUL 0 6 2007

>|BKCE COUNTY, WASHINOIr

IN THE SUPERIOR COURT OF THE STATE OF WASHINGTON

IN AND FOR THE COUNTY OF PIERCE

In re the Marriage of:

PETITION FOR DISSOLUTION

THOMAS L. VAN DAM,

SARA L. VAN DAM,

Thomas L. Van Dam

Sara L. Van Dam

CHILDREN OF THE MARRIAGE DEPENDENT UPON EITHER OR BOTH

FAUBION, JOHNSON & REEDER, P.S.

DATE AND PLACE OF MARRIAGE.

ALLEGATION REGARDING MARRIAGE.

This court has jurisdiction over the marriage.

This court has jurisdiction over the respondent because:

the petitioner and respondent lived in Washington during their marriage

FAUBION, JOHNSON & REEDER, P.S.

The petitioner should be awarded the parties interest in the following

2005 Ford Focus, subject to the obligation owing thereon;

1997 Toyota 4 Runner.

DEBTS AND LIABILITIES.

The petitioner should be ordered to pay the following debts and

1. Any and all expenses associated with the vehicle in his

PETITION FOR DISSOLUTION OF

& REEDER, P.S.

The respondent should be ordered to pay the following debts and

Each party should pay their debts incurred since separation.

CONTINUING RESTRAINING ORDER.

Does not apply.

JURISDICTION OVER THE CHILDREN.

CHILD SUPPORT AND PARENTING PLAN FOR DEPENDENT

Silas R, Van Dam

Sara L. Van Dam

Thomas Van Dam

& REEDER, P.S.

5920 100th S treet S.W., S uite 25

is attached and is incorporated by reference as part of this

During the last five years, the child has lived:

in no place other than the state of Washington and with no

Involvement in any other proceeding concerning the child;

The petitioner has not been involved in any other proceeding

Other legal proceedings concerning the child.

The petitioner does not know of any other legal proceedings

_________________ MINUTES OF PROCEEDING_