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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):

COURT USE ONLY Case Number:

Phone Number: FAX Number:

E-mail: Atty. Reg. #:

Division

Courtroom

PETITION

MOTION FOR ABDUCTION PREVENTION MEASURES PURSUANT TO 14-13.5-101, C.R.S.

This Petition/Motion seeks abduction prevention measures and any other orders necessary to effectuate the best interests of the child(ren) pursuant to 14-13.5-101, et seq., C.R.S. The Petitioner Co-Petitioner/Respondent states the following for the purpose of seeking abduction prevention measures:

1. Information about Petitioner: Date of Birth: ______________________

Check if in Military

Current Mailing Address: __________________________________________________________________ City, State & Zip Code: ____________________________________________________________________ Home Phone #: ____________________ Work Phone #: ___________________ Cell #: ________________ Petitioner has the following relationship with the minor child(ren): child(ren)'s mother, or child(ren)'s father, or non-parent, and the child(ren) is/are not in the physical custody of one of the parents, or non-parent, who has had physical custody of the child(ren) for six months or more, and the physical custody did not end more than six months before the filing of this action.

2. Information about Co-Petitioner/Respondent: Date of Birth: _______________________

Check if in Military

Current Mailing Address: ___________________________________________________________________ City, State & Zip Code: _____________________________________________________________________ Home Phone #: ____________________ Work Phone #: ___________________ Cell #: _________________ Co-Petitioner/Respondent has the following relationship with the minor child(ren): child(ren)'s mother, or child(ren)'s father

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3. The minor child(ren) is/are: Full Name of Child Present Address Sex Date of Birth Age

4. Each party has a continuing duty to inform the Court of any proceeding(s) in this or any other state that could affect the current proceeding.

5. I am identifying below the name and address of each person that the child(ren) has/have lived with over the past five years and their relationship to the child(ren). Name of Person Current Address (City/State/Zip Code) Time Period (Month/Year) Type of Relationship

6. I have participated in the following proceeding(s) regarding the child(ren) as a party or a witness, or in any other capacity concerning issues of custody/allocation of decision-making, or visitation/parenting time with the child(ren). I am identifying the name of court, case number, city/state, date and type of proceeding. (If it was not a Colorado proceeding, please attach copies). Name of Court Case Number City/State Date of Proceeding Type of Proceeding

7. I know of the following proceeding(s) filed by a party or other individual or entity having custody of the child to prevent abduction, domestic violence, or domestic abuse. Identify name of court, case number, city/state, type of proceeding and disposition. (If it was not a Colorado proceeding, please attach copies). Name of Court Case Number City/State Type of Proceeding Disposition

8. The following people are not parties in this matter but have physical custody of the child(ren) or claim rights of parental responsibilities or visitation with the child(ren). Identify name and address of those persons. Name of Person Address (City/State & Zip Code)

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9. Has a party to this case ever been arrested for a crime related to domestic violence, stalking, or child abuse or neglect? Yes No If Yes, identify the name of party, date, location and disposition of the case: Name of Party Date Location Disposition

10.

Petitioner or Co-Petitioner/Respondent has engaged in the following activities: (Check any that apply) has previously abducted or attempted to abduct the child; has threatened to abduct the child; has recently engaged in activities that may indicate a planned abduction, including: abandoning employment; selling a primary residence; terminating a lease; closing a bank account or other financial management accounts, liquidating assets, hiding or destroying financial documents, conducting unusual financial activities; applying for a passport, visa or obtaining travel documents for the respondent, a family member or the child; seeking to obtain the child's birth certificate or school or medical records; has engaged in domestic violence, domestic abuse, stalking, or child abuse and neglect; has refused to follow a child-custody/allocation of parental responsibility determination; lacks strong familial, financial, emotional, or cultural ties to the State or the United States; has strong familial, financial, emotional, or cultural ties to another state or country; is likely to take a child to a country that: is not a party to the "Hague Convention on the Civil Aspects of International Child Abduction" and does not provide for the extradition of an abducting parent or for the return of an abducted child; is a party to the "Hague Convention on the Civil Aspects of International Child Abduction" but: The Hague Convention on the Civil Aspects of International Child Abduction" is not in force between the United States and that Country; is noncompliant according to the most recent compliance report issued by the United States Department of State; or lacks legal mechanisms for immediately and effectively enforcing a return order under the "Hague Convention on the Civil Aspects of International Child Abduction"; poses a risk that the child's physical or emotional health or safety would be endangered in the country because of human rights violations committed against children; has laws or practices that would: enable the respondent, without due cause, to prevent the petitioner from contacting the child; restrict the petitioner from freely traveling to or exiting from the country because of the petitioner's gender, nationality, marital status, or religion; or restrict the child's ability legally to leave the country after the child reaches the age of majority because of a child's gender, nationality or religion; is included by the United States department of state on a current list of state sponsors of terrorism; does not have an official Untied States diplomatic presence in the country; is engaged in active military action or war, including a civil war, to which the child may be exposed; is undergoing a change in immigration or citizenship status that would adversely affect the respondent's ability to remain in the United States legally; has had an application for United States citizenship denied; has forged or presented misleading or false evidence on government forms or supporting documents to obtain or attempt to obtain a passport, a visa, travel documents, a social security card, a driver's license, or other government-issued identification card or has made a misrepresentation to the United States government; has used multiple names to attempt to mislead or defraud; or
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has engaged in any other conduct the court considers relevant to the risk of abduction

11. I allege that the minor child(ren) is/are in imminent danger of abduction for the following additional reasons:

12. I request that the Court enter the following abduction prevention measures:

Wherefore, the Petitioner or Co-Petitioner/Respondent seeks an order entering abduction prevention measures and any other orders necessary to effectuate the best interests of the child(ren).

VERIFICATION AND ACKNOWLEDGEMENT
I swear/affirm under oath that I have read the foregoing document and that the information provided set forth therein is true and correct to the best of my knowledge and belief.

Date: __________________________

______________________________________ Petitioner or Co-Petitioner/Respondent

Subscribed and affirmed, or sworn to before me in the County of _________________________, State of ____________________, this ________ day of _________________, 20 _____. My Commission Expires: ____________________ ______________________________________ Notary Public/Clerk

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