Free ______________________County, Colorado District Court - Colorado

District Court Denver Juvenile Court __________________________________ County, Colorado Court Address: __________________________________ In re the Parental Responsibilities concerning: ______________________________________________________ Petitioner: ______________________________________ and Co-Petitioner/Respondent: _________________________ Attorney or Party Without Attorney (Name and Address):
_____________________________________________________ _____________________________________________________

COURT USE ONLY Case Number: __________________

Phone Number: ___________________ E-mail: _________________ FAX Number: ____________________ Atty. Reg. #:______________

Division ______ Courtroom _______

PETITION FOR ALLOCATION OF PARENTAL RESPONSIBILITIES PURSUANT TO §14-10-123, C.R.S.
This Petition seeks allocation of parental responsibilities including decision-making responsibilities and parenting time for the minor child(ren), establishment of a child support order, and any other orders necessary to effectuate the best interests of the children pursuant to §14-10-123, C.R.S. and states:

1. Information about Petitioner:

Check if in Military

Full Legal Name: ___________________________________________ Date of Birth: __________________ Current Mailing Address: ___________________________________________________________________ City: ____________________ State: _____ Zip Code: _________ Home Phone #: _____________________ Email Address: _______________________________Cell Phone #: ________________________________ 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:

Check if in Military

Full Legal Name: ___________________________________________ Date of Birth: ___________________ Current Mailing Address: ___________________________________________________________________ City: ____________________ State: _____ Zip Code: _________ Home Phone #: _____________________ Email Address: _______________________________Cell Phone #: ________________________________ Co-Petitioner/Respondent has the following relationship with the minor child(ren): child(ren)'s mother, or child(ren)'s father

3. The minor child(ren) is/are:

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Full Name of Child

Present Address

Sex

Date of Birth

Yes No If No, please state the name 4. The child(ren) listed above have lived in Colorado since birth? of child, name of person child lived with and the month, date and year when each child most recently moved to Colorado. Full Name of Child Name of Person Child Lived with State Moved From Month Day Year

5. I/We understand that a request by either party for genetic testing shall not prejudice the requesting party in the allocation of parental responsibilities.

6. 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.

7. I/We understand that the Court may review any case involving the children, Petitioner, Co-Petitioner/ Respondent and other parties named in this Petition that have been filed in any Court.

8. I/We 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). Identify name of court, case number, state, date and type of proceeding. Name of Court Case Number State Date of Proceeding Type of Proceeding

9. I/We know of the following proceeding(s) that could affect the current proceeding including, but not limited to proceedings for Dissolution of Marriage/Legal Separation, enforcement of Court orders, domestic violence or domestic abuse, protection/restraining orders, termination of parental rights, and adoptions. Identify name of court, case number, state, date and type of proceeding. Name of Court Case Number State Date of Proceeding Type of Proceeding

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

10. The best interests of the child(ren) would be served by allocating parental responsibilities to the Petitioner(s) as follows and for the following reasons: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________

11. Required Notice of Human Services Involvement. The parents or dependent child(ren) listed on this Petition has/have received within the last five years, or is/are currently receiving benefits or public assistance from the state Department of Human Services or the County Department of Social Services. No Yes If your answer was Yes, complete the following: Name of Person Receiving Benefit Name of County and State Case Number Month/Year

12. Required Notice of Prior Protection/Restraining Orders. Have any Temporary or Permanent Protection/Restraining Orders to prevent domestic abuse or any Criminal Mandatory Protection/Restraining (MRO) Orders or Emergency Protection Orders been issued against either party by any Court within two years prior to the filing of this Petition? No The Yes If your answer was Yes, complete the following: Order was Temporary Permanent MRO and issued against

Protection/Restraining

_________________________________ in a

Municipal Court

County Court

District Court in the

County of ____________________, State of _______________, in case number ________________ on ________________________ (date). What was the subject matter of the Protection/Restraining Order or Emergency Protection Order? _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________

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13. Notice of Existing Case with Child Support Enforcement (CSE) The parents have filed a case with CSE? No Yes If Yes, identify the case number: _________________

I/We seek an order granting the allocation of parental responsibilities, the establishment of child support, 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.

_______________________________________ Petitioner Signature Date

______________________________________ Co-Petitioner Signature Date

______________________________________ 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: __________________

____________________________________ Co-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/Clerk

______________________________________
Notary Public/Clerk

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