Residential Time Summary Report (****)



Superior Court of Washington

County of

|In re the Marriage of: |No. |

| | |

| |Residential Time Summary Report |

|Petitioner, |(RTSR) |

|and | |

| |Clerks Action Required |

| | |

|Respondent. | |

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 was: [ ] by agreement of the parties |It is: [ ] an original order |

|[ ] after a contested hearing or trial |[ ] a modification of a prior order |

|[ ] by default | |

| |It applies to ____________ [number] of children. |

2. Residential Schedule From Part III of the Parenting Plan

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

|each parent: |

|Oldest Child - Age: ______ |Next Child - Age: _____ |Next Child - Age: _____ |

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

|the time with father |the time with father |the time with father |

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

|99 % of the time with father |– 99 % of the time with father |– 99 % of the time with father |

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

|– 65 % of the time with father |– 65 % of the time with father |– 65 % of the time with father |

|[ ] 50 % of the time with each parent |[ ] 50 % of the time with each parent |[ ] 50 % of the time with each parent |

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

|– 49 % of the time with father |– 49 % of the time with father |– 49 % of the time with father |

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

|34 % of the time with father |– 34 % of the time with father |– 34 % of the time with father |

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

|the time with father |the time with father |the time with father |

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

|spends with each parent: |

|Next Child - Age: _____ |Next Child - Age: _____ |Next Child - Age: _____ |

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

|the time with father |the time with father |the time with father |

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

|99 % of the time with father |99 % of the time with father |99 % of the time with father |

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

|– 65 % of the time with father |– 65 % of the time with father |– 65 % of the time with father |

|[ ] 50 % of the time with each parent |[ ] 50 % of the time with each parent |[ ] 50 % of the time with each parent |

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

|– 49 % of the time with father |– 49 % of the time with father |– 49 % of the time with father |

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

|34 % of the time with father |34 % of the time with father |34 % of the time with father |

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

|the time with father |the time with father |the time with father |

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

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

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

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

|[ ] other:______________________________________________________________. |

4. Dispute Resolution From Part V. of the Parenting Plan

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

Prepared by: ________________________________________ on ____________________ [Date].

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