District Court Denver Juvenile Court _________________________________County, Colorado Court Address:
IN THE MATTER OF THE PETITION OF: ________________________________ (name of person seeking to adopt) FOR THE ADOPTION OF A CHILD Attorney or Party Without Attorney (Name and Address): COURT USE ONLY Case Number:
Phone Number: FAX Number:
E-mail: Atty. Reg. #:
Division
Courtroom
PETITION FOR STEPPARENT ADOPTION
The Petitioner being desirous of adopting a child so as to make said child for all intents and purposes the legal child of Petitioner and to render him/her capable of inheriting Petitioner's estate, states the following facts:
Information about the Petitioner:
Petitioner: _______________________________________________________________________ (Full Name) Date of Birth: ________________ Race: ______________ Place of Birth: _______________________________ Place of Residence: __________________________________________________________________________ City & Zip: _________________________________________________________________________________ Home Phone #: ____________________ Work Phone #: ___________________ Cell #: ___________________ Length of Residence in Colorado: ____________________ Occupation: ________________________________ If applicable, maiden name of adopting mother: ____________________ Date of Marriage: _________________ Petitioner's place of residence at or about the time of the birth of the child: __________________________________________________________________________________________
Street Address City State Zip Code
Venue is proper in this matter because the Petitioner resides in this county. The Petitioner has attached as "Attachment A" a current fingerprint-based criminal history records check as required by §19-5-207(2.5)(a)(I)-(IV), C.R.S. The Petitioner has attached as "Attachment B" the TRAILS background check as required by §19-5-207, C.R.S. If you have been convicted of a felony or misdemeanor in any of the following areas, please check the appropriate box and identify for the Court the date of the conviction and if it was a felony or misdemeanor. child abuse or neglect on ______________________ (date). Felony Misdemeanor spousal abuse on _______________________ (date). Felony Misdemeanor Misdemeanor any crime against a child on ____________________ (date). Felony
any crime, the underlying factual basis of which has been found by the Court to include an act of Felony Misdemeanor domestic violence on _______________________ (date). violation of a Protection/Restraining Order on ____________________ (date). Felony Misdemeanor any crime involving violence, rape, sexual assault, or homicide on _____________________ (date). Felony Misdemeanor
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any felony involving physical assault or battery on __________________________ (date). Felony Misdemeanor any felony drug-related conviction within the past five years, at a minimum on _________________(date). Felony Misdemeanor Identify all children of the Petitioner (both natural and adopted and both living and deceased). Full Name of Child Full Name of Child
Facts concerning the child to be adopted:
(Do not fill in if placement is by an agency or Department of Social Services.)
Full Name: __________________________________________
Date of Birth: _____________________
Place of Birth: __________________________ Relationship of child to Petitioner, if any: ___________________ Place of Residence: __________________________________________________________________________ The child is is not a member or eligible to be a member of an Indian tribe as defined by the Indian Welfare Act. If applicable, name of tribe _______________________________________________________________. Notice of this Petition has been provided to the parent or Indian custodian of the child and to the tribal agent of the tribe, as required by §19-1-126(1)(c), C.R.S. Reasonable efforts have been made to send notice to the identified persons as follows: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Attach the postal receipts to this Petition, indicating that notice was properly sent. If the postal receipts have not been returned at the time of filing, the postal receipts or copies shall be filed with the Court within ten days of the filing of this Petition. If applicable, inquiries have been made by the County Department of Social Services or child placement agency to determine whether the child is an Indian child as follows: _______________________________________________________________________________________ _______________________________________________________________________________________ Full description of the property of said child, if any: _________________________________________________ __________________________________________________________________________________________ Name and address of the Guardian(s) of the child and estate of said child if any have been appointed: __________________________________________________________________________________________ Name of the agency, if any, to which custody of the child has been given by proper order of the Court: __________________________________________________________________________________________
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The child has been in the care and custody of the Petitioner since ________________________________ (date). The legal custody of said child is with _____________________________________________________ (name).
Information about the Birth Parents of the Child:
Full name of birth father: _____________________________________________________________________ __________________________________________________________________________________________
Street Address City State Zip Code
Full name of birth mother: ____________________________________________________________________ __________________________________________________________________________________________
Street Address City State Zip Code
The written consent of the custodial birth parent
is or
is not attached. is not attached.
The written consent of the non-custodial birth parent
is or
The child will not be the subject of a pending dependency and neglect action when the adoption is heard. If parental rights are relinquished, are terminated, or are being terminated in this action pursuant to §§19-5-101 108, C.R.S., as amended, or parent is deceased, state details: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Wherefore, Petitioner pray that a Decree of Adoption be entered herein declaring said child to be the child of Petitioner and that the name of said child be changed to_____________________________________ (full name) and that said child shall be entitled to all of the rights and privileges and be subject to all of the obligations now conferred and imposed by law.
VERIFICATION AND ACKNOWLEDGEMENT
I swear/affirm under oath that I have read the foregoing Petition and that the statements set forth herein are true and correct to the best of my knowledge and belief. _____________________________________ Attorney Signature, if applicable ______________________________________ Petitioner Signature
Subscribed and affirmed, or sworn to before me in the County of ________________________, State of ____________________, this _______, day of ________________, 20 _____.
My Commission Expires: ___________________
__________________________________ Notary Public/Deputy Clerk
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