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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