Free _______________________________County, Colorado District Court Juvenile Court - Colorado

District Court Denver Juvenile Court __________________________________________County, Colorado Court Address:

IN THE MATTER OF THE PETITION OF: ______________________________ (name of person(s) 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 KINSHIP ADOPTION
The Petitioner(s) being desirous of adopting a child so as to make said child for all intents and purposes the legal child of Petitioner(s) and to render him/her capable of inheriting their estate, state(s) the following facts: The Petitioner(s) is/are the child's aunt uncle sister brother I am a married person, my spouse joins in this Petition for Adoption. half-sibling
1st cousin or

grandparent. If

Information about the Petitioner(s):
Petitioner #1: ____________________________________________________________________ (Full Name) Date of Birth: ________________ Race: ______________ Place of Birth: ____________________________ Current Mailing Address: ___________________________________________________________________ City & Zip: _______________________________________________________________________________ Home Phone #: ____________________ Work Phone #: ___________________ Cell #: _________________ Length of Residence in Colorado: ____________________ Occupation: ______________________________ Place of residence at the time of birth of the child. _______________________________________________________________________________________
Street Address City State Zip Code

Petitioner #2: ____________________________________________________________________ (Full Name) Date of Birth: ________________ Race: ______________ Place of Birth: ____________________________ Current Mailing Address: ___________________________________________________________________ City & Zip: _______________________________________________________________________________ Home Phone #: ____________________ Work Phone #: ___________________ Cell #: _________________ Length of Residence in Colorado: ____________________ Occupation: _____________________________ Place of residence at the time of birth of the child. _______________________________________________________________________________________
Street Address City State Zip Code

JDF 505 R1/09 PETITION FOR KINSHIP ADOPTION

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If applicable, maiden name of adopting mother: _____________________ Date of Marriage: _____________ Venue is proper in this matter because the Petitioner(s) reside(s) in this county The Petitioner(s) has/have consulted with the appropriate local County Department of Social Services concerning the possible eligibility of the Petitioner(s) and the child for temporary assistance for needy families (TANF), Medicaid, subsidized adoption and other services or public assistance administered by the County Department of Social Services on ___________________. The Petitioner(s) has/have 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(s) has/have attached as "Attachment B" the TRAILS background check as required by §19-5207, C.R.S. If the Petitioners has/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 domestic violence on _______________________ (date). Felony Misdemeanor 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

Identify all children of the Petitioner(s) (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(s), 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.

JDF 505 R1/09 PETITION FOR KINSHIP ADOPTION

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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: _______________________________________________________________________________________ _______________________________________________________________________________________ The child has been in the care and custody of Petitioner(s) since _________________________________ (date). The legal custody of the child is with ______________________________________________________ (name). Full description of the property of the child, if any: _________________________________________________ __________________________________________________________________________________________ Name and address of the Guardian(s) of the child and estate of the child, if any, have been appointed: __________________________________________________________________________________________ __________________________________________________________________________________________ legal guardianship or allocation of parental responsibilities A certified copy of the Court orders granting (decision-making and parenting time) is attached hereto and incorporated herein by reference.

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(s) of the parent(s)

is/are attached or

is/are not attached.

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 §§19-5-101108, C.R.S., as amended, or parent is deceased, state details: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ Wherefore, the Petitioner(s) pray(s) that a Decree of Adoption be entered herein declaring said child to be the child of Petitioner(s) 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.
JDF 505 R1/09 PETITION FOR KINSHIP ADOPTION Page 3 of 4

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. ______________________________________
Petitioner Signature Date

______________________________________
Petitioner Signature Date

______________________________________
Petitioner's Attorney Signature, if any

______________________________________
Petitioner's Attorney Signature, if any

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

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 505 R1/09 PETITION FOR KINSHIP ADOPTION

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