District Court Denver Juvenile Court __________________ County, Colorado Court Address: In re: The Marriage of: Parental Responsibilities concerning: ______________________________________________________ Petitioner: and Co-Petitioner/Respondent: Attorney or Party Without Attorney (Name and Address): Phone Number: FAX Number: E-mail: Atty. Reg. #:
COURT USE ONLY Case Number:
Division
Courtroom
CERTIFICATE OF COMPLIANCE WITH MANDATORY FINANCIAL DISCLOSURES *****EATH PARTY MUST COMPLETE AND FILE THIS FORM WITH THE COURT*****
I, the Petitioner Co-Petitioner/Respondent (check one) hereby certify that I have sent the other party the following Mandatory Disclosures as required by Rule 16.2(e)(7) of the Colorado Rules of Civil Procedure. See JDF 1125: Mandatory Disclosure Form 35.1 for explanation on what is required by the disclosures being listed. Check those that you have furnished to the other party. (Note: Only the Sworn Financial Statement and Child
Support Worksheet should be filed with the Court.)
Sworn Financial Statement Income Tax Returns (most recent 3 years) Personal Financial Statements (last 3 years) Business Financial Statements (last 3 years) Real Estate Documents (Appraisal, Title, etc.) Personal Debt (Loans, Title, Credit Card Statements, etc.) Investments Employment Benefits If I have not provided information, it is because: Retirement Plans Bank/Financial Institution Accounts Income Documentation (Pay Stubs, etc.) Employment and Education Related child Care Documentation Insurance Documentation Extraordinary Children's Expense
Documentation
I hereby certify that, to the best of my knowledge, information, and belief, the disclosures I have made are complete and correct as of this date.
________________________________________________ Petitioner/Co-Petitioner/Respondent Signature Date ________________________________________________ Attorney Signature, if any Date
CERTIFICATE OF SERVICE
I certify that on _______________________ (date) a true and accurate copy of the CERTIFICATE OF COMPLIANCE WITH MANDATORY FINANCIAL DISCLOSURES was served on the other party by: Hand Delivery, E-filed, Faxed to this number ____________________, or by placing it in the United States mail, postage pre-paid, and addressed to the following: To: ___________________________________ ___________________________________ ___________________________________
(Your signature) JDF 1104 R7/09 CERTIFICATE OF COMPLIANCE WITH MANDATORY FINANCIAL DISCLOSURES