Free District Court Denver Juvenile Court _________________________________County, Co... - Colorado

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 SECOND PARENT ADOPTION
According to the requirements set forth in §19-5-203, C.R.S. the Petitioner requests that he/she adopt the child identified below. The child has a sole legal parent. 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: _______________________________ 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 written home study prepared by a county Department of Social Services, Designated Qualified Individual, or Child Placement Agency and approved by the Department pursuant to §19-5-207.5(2), C.R.S. is attached. The child was adopted by the sole legal parent less than six months prior to the date of the filing of this action petition and the Petitioner was included in the home study report that was prepared pursuant to §19-5-207, C.R.S. for the adoption of the child by the sole legal parent. The home study prepared for that adoption is attached. The current fingerprint-based criminal history records check as required by §19-5-207(2.5)(a)(I)-(IV), C.R.S. and the TRAILS background check as required by §19-5-207, C.R.S. are included in the written home study.

JDF 504

8/07

PETITION FOR SECOND PARENT ADOPTION

Page 1 of 3

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 any crime against a child on ____________________ (date). Felony Misdemeanor 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 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

Facts concerning the child to be adopted:
Full Name: __________________________________________ Place of Birth: __________________________ Place of Residence: __________________________________________________________________________ The child is under the age of twelve years ; or The child is over the age of twelve years and his/her written consent to the adoption is attached. The child will not be the subject of a pending dependency and neglect action when the adoption is heard. Name and address of the Guardian(s) of the child and estate of said child if any have been appointed: __________________________________________________________________________________________ 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. Date of Birth: _____________________

Information about the Sole Legal Parent:
Full name of Sole Legal Parent: ________________________________________________________________ __________________________________________________________________________________________
Street Address City State Zip Code

The person named above is the Sole Legal Parent because: The other parent relinquished parental rights to the child in _________________________ (county/state) __________________ (case number) on __________________ (date). The other parent's rights are terminated in _________________________ (county/state) _____________________ (case number) on __________________ (date). The person named above adopted the child as a single parent in ____________________________ (county/state) ________________________ (case number) on _____________________ (date). The other parent died on ___________________ (date).
JDF 504 8/07 PETITION FOR SECOND PARENT ADOPTION Page 2 of 3

The child was conceived by assisted reproductive means and no other legal parent exists pursuant to §19-4106, C.R.S. The written consent of the Sole Legal Parent is attached. 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

JDF 504

8/07

PETITION FOR SECOND PARENT ADOPTION

Page 3 of 3