Free ______________________County, Colorado District Court - Colorado

District Court Juvenile Court ____________________________ County, Colorado Court Address: _________________________________ In re: The Marriage of: _______________________________ Parental Responsibilities concerning: ______________________________________________ Petitioner: ____________________________________ and Co-Petitioner/Respondent: _______________________ and concerning: Grandparent(s) Intervenor(s) ______________________ Attorney or Party Without Attorney (Name and Address): _________________________________________ _________________________________________ Phone Number: _________________ E-mail: _________________ FAX Number: ___________________ Atty. Reg. #:_____________

COURT USE ONLY Case Number: _________________

Division _______ Courtroom_______

VERIFIED MOTION/AFFIDAVIT FOR GRANDPARENT VISITATION PURSUANT TO §19-1-117, C.R.S.
Note to Responding Party: If you disagree with this Motion/Affidavit, the Colorado Civil Rules of Procedure allow you to file a written response with the Court which must be filed within 15 days of the date this Motion was served on you or mailed to you. maternal paternal grandparent(s) of the minor child(ren), states the following for the The intervenor(s), the purpose of establishing visitation between the grandparent(s) and the child(ren), pursuant to §19-1-117, C.R.S. has has not been filed in the last two 1. A Motion/Affidavit seeking an Order for grandparent visitation years. If one has been filed, please identify the date filed _____________________________. If a Motion/Affidavit has been filed in the last two years, state reasons for good cause in section 8. 2. Information about Intervenor (1): Check if in Military

Full Legal Name: __________________________________ Date of Birth: ___________________________ Current Mailing Address: ___________________________________________________________________ City: ____________________ State: _____ Zip Code: _________ Home Phone #: _____________________ Email Address: _______________________________Cell Phone #: ________________________________ Intervenor has the following relationship with the minor child(ren): child(ren)'s grandmother, or child(ren)'s grandfather 3. Information about Intervenor (2): Check if in Military

Full Legal Name: __________________________________ Date of Birth: ___________________________ Current Mailing Address: ___________________________________________________________________ City: ____________________ State: _____ Zip Code: _________ Home Phone #: _____________________ Email Address: _______________________________Cell Phone #: ________________________________ Intervenor has the following relationship with the minor child(ren): child(ren)'s grandmother, or child(ren)'s grandfather 4. Information about the Mother: Petitioner Respondent/Co-Petitioner Check if in Military

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Full Legal Name: ___________________________________ Address: _______________________________________________________________________________ City: ____________________ State: _____ Zip Code: _________ Home Phone #: ____________________ Email Address: _______________________________Work Phone #: ______________________________

5. Information about the Father:

Petitioner

Respondent/Co-Petitioner

Check if in Military

Full Legal Name: ___________________________________ Current Mailing Address: ___________________________________________________________________ City, State & Zip Code: _____________________________________________________________________ Home Phone #: ____________________ Work Phone #: ___________________ Cell #: _________________

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

Yes 7. The parental rights of the parents of the minor child(ren) have been terminated. If Yes, please furnish the case number: __________________________________

No

8. Visitation with the grandparent(s) is in the child(ren)'s best interest for the following reasons: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________

9. The grandparent(s) wish(es) to have visitation with the minor child(ren) at the following times and under the following conditions: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________

10. Transportation of the child(ren) will be as follows: _______________________________________________________________________________________ _______________________________________________________________________________________

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11. Have any Temporary or Permanent Protection/Restraining Orders or any Criminal Mandatory Protection/Restraining Orders (MRO) or Emergency Protection Orders been issued against the grandparent(s) or any of the parties 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? _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ I/We respectfully request that this Court enter an Order for visitation between the intervenor(s)/grandparent(s) and the minor child(ren) as set forth in this motion 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 Motion/Affidavit and that the statements set forth therein are true and correct to the best of my knowledge. _____________________________________ Signature of Grandmother Date Subscribed and affirmed, or sworn to before me in the County of ________________________, State of ____________________, this _______ day of ________________, 20 ____. My Commission Expires: __________________ ______________________________________
Notary Public/Clerk

__________________________________________ Signature of Grandfather Date Subscribed and affirmed, or sworn to before me in the County of _________________________, State of ___________________, this ________ day of ________________, 20 ____. My Commission Expires: __________________ ______________________________________
Notary Public/Clerk

CERTIFICATE OF SERVICE
I certify that on ____________________ (date) the original was filed with the Court; and a true and accurate copy of the MOTION FOR GRANDPARENT VISITION 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)

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