Fill and Sign the Adoption Birth Parent Form

 District Court ___________________________________ County, Colorado Court Address: IN THE MATTER OF THE ADOPTION OF : Birth Name of Adoptee (If known) A ND CONCERNING Current Legal Name of Petitioner COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E-mail: FAX Number: Atty. Reg.#: Case Number: Division Courtroom MOTION AND AFFIDAVIT TO OPEN ADOPTION FILE BY BIRTH PARENT OR BIOLOGICAL GRANDPARENT I, _______________________________________________________________________________, declare under oath that: My current address is: __________________________________________________________________________________. (Street Address, City, State, Zip) My date of birth is: ____________________________________ My current telephone numbers are: (Home) ________________________________ (Work) ____________________________ My birth child or grandchild was born on: _______________ Place of birth of child (City & State ): ________________________ Date of relinquishment: __________________. Relinquishment of the child occurred in ___________________________ County, Colorado. OR  Unknown Agency handling relinquishment/termination: ________________________________________________________________ Birth mother’s name at time of relinquishment: Birth father’s name at time of relinquishment: Birth mother’s maiden name: Alias * used by birth mother at time of relinquishment: * If alias was used, a copy of the birth mother’s own birth certificate should be submitted, together with an Affidavit of a Birth Mother Who Used a Fictitious Name at the Time of Relinquishment of a Child (form JDF 344A). Name of the child at the time of birth: ______________________________________________________________________ I know the following about my birth child or grandchild: _________________________________________________________ I am seeking my birth child or grandchild because: ____________________________________________________________ JDF 344 R2-18 MOTION AND AFFIDAVIT TO OPEN ADOPTION FILE BY BIRTH PARENT Page 1 of 2 OR BIOLOGICAL GRANDPARENT I petition the Court to order the adoption files of the _______________________ Court for ____________________________ County, and any hospital, homes, adoption agencies, state or public agencies or courts that have files concerning this case, be open for review by a confidential intermediary.  By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form.  By checking this box, I am acknowledging that I have made a change to the original content of this form. VERIFICATION I declare under penalty of perjury under the law of Colorado that the foregoing is true and correct. Executed on the ______ day of ________________, _______, at ______________________________________ (date) (month) (year) (city or other location, and state OR country ___________________________________ ______________________________________ (printed name of Petitioner) Signature of Petitioner JDF 344 R2-18 MOTION AND AFFIDAVIT TO OPEN ADOPTION FILE BY BIRTH PARENT Page 2 of 2 OR BIOLOGICAL GRANDPARENT