Wash. R. App. P. Form 4

(Rule 4.2(b))

No. (Supreme Court)

SUPREME COURT OF THE STATE OF WASHINGTON

[Title of the trial court )

proceeding with )

parties designated )

as in rule 3.4] )

STATEMENT OF

GROUNDS FOR DIRECT

REVIEW BY THE

SUPREME COURT

(Name of party ) seeks direct review of the ( describe the

decision or part of the decision t hat the party wants reviewed)

entered by the ( name of court) on ( date of entry.) The issues

presented in the review are: [State issues presented for review.

See Part II of Form 6 for suggestions for framing issues

presented for review.]

The reasons for granting direct review are: (Briefly

indicate and argue grounds for direct review. See rule 4.2.)

[If the petition is prepared using word processing

software, include the following statement: This document

contains words, excluding the parts of the document

exempted from the word count by RAP 18.17.]

[Date]

Respectfully submitted,

_____________________________________

Signature

(Name, personal pronouns (optional), address, telephone

number, and Washington State Bar Association

membership number of attorney)