SUPERIOR COURT OF WASHINGTON COUNTY OF ______JUVENILE COURT NO: STATE OF WASHINGTON v. MOTION AND DECLARATION FOR ORDER TO CORRECT OR DESTROY IMPROPERLY RETAINED RECORDS (MTAF) Respondent(s). D.O.B.:

I. MOTION

I, ______, request that the court issue an order directing (Name) ______[Juvenile Justice or Care Agency]  to correct  to destroy records pertaining to me. This motion is based upon RCW 13.50.010(6)(7) and GR 15(h).

______Signature

______Title/Relationship

II. DECLARATION

I, ______, hereby declare as follows:

2.1 I am the respondent in the above-captioned case. I make this declaration of personal knowledge and could and would competently testify to its contents.

2.2 Factors pursuant to RCW 13.50.010(6)(7):

I have reasonable cause to believe information concerning me is included in the records of the above-referenced agency because:

MTN/DECL FOR ORD TO CORRECT/DESTROY RECORDS (MTAF) - Page 1 of 2 WPF JU 10.0200 (7/2007) – GR 15(h), RCW 13.50.010(6)(7) The information should:

 no longer be in the possession of the agency and should be destroyed because:

 be corrected, because the following inaccuracies exist therein:

2.3 I have given reasonable notice of this motion to all parties to the original action and to any agency whose records will be affected by this motion including (list persons, agencies, methods of notice):

I declare under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct.

Signed at ______, Washington on ______. [Place] [Date]

______Declarant

______Print Name

MTN/DECL FOR ORD TO CORRECT/DESTROY RECORDS (MTAF) - Page 2 of 2 WPF JU 10.0200 (7/2007) – GR 15(h), RCW 13.50.010(6)(7)