Free District Court Denver Juvenile Court __________________________________________C... - Colorado

District Court Denver Juvenile Court __________________________________________County, Colorado Court Address:

IN THE MATTER OF THE PETITION OF: _______________________________
(name of person(s) seeking to adopt)

COURT USE ONLY Case Number:

FOR THE ADOPTION OF A CHILD Attorney or Party Without Attorney (Name and Address):

Phone Number: FAX Number:

E-mail: Atty. Reg. #:

Division

Courtroom

AFFIDAVIT OF ABANDONMENT I/We____________________________________________ (name of Petitioner(s)), state the following: The parent, _________________________ of the subject child, ______________________________, has failed without cause to provide reasonable support for the child for a period of one year or more. and/or has abandoned the child for a period of one year or more. The Petitioner(s) has/have had physical custody of the child for a period of one year or more. The child is not the subject of a pending dependency and neglect proceeding. I swear/affirm under oath, that I have read the foregoing Affidavit and that the statements set forth herein are true to the best of my knowledge and belief.

________________________________
Petitioner Date

_________________________________
Petitioner Date

Subscribed and affirmed, or sworn to before me in the County of ________________________, State of ____________________, this _______ day of ________________. 20 ____. My Commission Expires:

Subscribed and affirmed, or sworn to before me in the County of _________________________, State of ____________________, this ________ day of ________________. 20 ____. My Commission Expires:

JDF 525 R7/06 AFFIDAVIT OF ABANDONMENT

Clerk/Notary Public

Clerk/Notary Public

JDF 525 R7/06 AFFIDAVIT OF ABANDONMENT