Fill and Sign the Agreement Court Form

 District Court __________________________________County, Colorado Court Address: In re:  The Marriage of:  The Civil Union of:  Parental Responsibilities concerning: ___________________________________________________ Petitioner: and Respondent/Co-Petitioner: COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E-mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom  TEMPORARY ORDERS AGREEMENT OR  INFORMATION FOR THE COURT The  Petitioner  Respondent/Co-Petitioner or  both state the following: Petitioner: Date of Birth: ___________________ Social Security Number: _______________________ Mailing Address: _____________________________________________________________________ Residential Address: __________________________________________________________________ Phone Numbers: Home: ___________________ Work: ___________________ Cell: _______________ Respondent/Co-Petitioner: Date of Birth: ___________________ Social Security Number: _______________________ Mailing Address: _____________________________________________________________________ Residential Address: __________________________________________________________________ Phone Numbers: Home: ___________________ Work: ___________________ Cell: _______________ 1. The names(s), address(es), birth date(s) and social security numbers of the minor child(ren) is/are: Name Present Address Sex Date of Birth Soc. Sec. No. 2. Allocation of temporary parental responsibilities (decision-making and parenting time). A. Decision-making should be as follows. Select only one of the 3 following options. 1.  The  Petitioner  Respondent/Co-Petitioner (check one) will make all of the major decisions regarding the child(ren). 2.  Both parties will make ALL major decisions regarding the child(ren) together. 3.  The parties will divide decision-making as set forth in the attached  Parenting Plan or  as identified below: JDF 1109 R2/19 TEMPORARY ORDERS AGREEMENT OR INFORMATION FOR THE COURT Page 1 of 4  Education issues shall be determined by  Petitioner  Respondent/Co-Petitioner  Both  Medical, dental and mental health issues shall be determined by  Petitioner  Respondent/Co- Petitioner  Both  Religious issues shall be determined by  Petitioner  Respondent/Co-Petitioner  Both  Extracurricular and recreational issues shall be determined by  Petitioner  Respondent/Co- Petitioner  Both  Other significant decisions (General Welfare, Driving, Car, Car Insurance, College, etc.) shall be determined by  Petitioner  Respondent/Co-Petitioner  Both _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ B. Parenting time (visitation) should be (check all that apply): 1.  As set forth in the attached Parenting Plan or select either 2, 3, or 4. 2.  Petitioner every ________________ from _____________________ to ____________________ 3.  Respondent/Co-Petitioner every_______________ from _______________ to _______________ 4.  Other (include holidays, birthdays, special occasions): _________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 3. Child Support (A Child Support Obligation Worksheet must be filed.)  Both parties agree on this issue. (If you agree, please indicate the terms of agreement below.) The  Petitioner  Respondent/Co-Petitioner shall pay child support to the  Petitioner  Respondent/Co-Petitioner (check one) in the sum of $ ____________ per month pursuant to the Colorado Child Support Guidelines, beginning on _________________ (date).  Child support payments will be paid to: (check one)  Family Support Registry P. O. Box 2171, Denver, CO 80201-2171.  The Parties request that the Court order the payment to be made directly to the appropriate person.  Child support payments will be paid as follows:  Monthly  Bi-weekly  Weekly  Other _________________________________________  The parties do not agree on this issue. 4. Information on any prior child(ren), spousal/partner abuse allegations or protection/restraining orders: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 5. Temporary maintenance (spousal/partner support) shall be paid by  Petitioner  Respondent/Co-Petitioner in the amount of $_________________ per month, commencing on __________________ (date). 6. A. The following debts shall be temporarily paid by the Petitioner: Creditor/Debt Account Number To by Paid by JDF 1109 R2/19 TEMPORARY ORDERS AGREEMENT OR INFORMATION FOR THE COURT Page 2 of 4 B. The following debts shall be temporary paid by the Co-Petitioner/Respondent: Creditor/Debt Account Number To by Paid by C. Each party shall provide proof to the other party of the above-stated payments made within _____days of payment date. 7. Property you need use of (home, car, business property, tools, etc.):  Both parties agree on this issue. (If you agree, please indicate the terms of agreement below.)  The parties do not agree on this issue. Petitioner: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Respondent/Co-Petitioner: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Property that needs immediate protection: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 8. Other issues: ____________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________  I  We believe this would be a fair and equitable division of our property and debts on a temporary basis and that the temporary allocation of parental responsibilities is in the best interest of the child(ren). (Both parties must sign if this is an agreement.)  I  We have attached the required financial affidavits.  I  We have attached the required child support worksheets (A or B).  By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. JDF 1109 R2/19 TEMPORARY ORDERS AGREEMENT OR INFORMATION FOR THE COURT Page 3 of 4  By checking this box, I am acknowledging that I have made a change to the original content of this form. SIGNATURE _______________________________________ ______________________________________ (printed name Petitioner) (printed name Co-Petitioner/Respondent) Petitioner Signature Date Co-Petitioner/Respondent Signature Date Petitioner’s Attorney Signature, if any Co-Petitioner’s Attorney Signature, if any IF ONLY ONE PARTY SIGNS THE TEMPORARY ORDERS AGREEMENT OR INFORMATION FOR THE COURT, COMPLETE THE CERTIFICATE OF SERVICE BELOW. CERTIFICATE OF SERVICE I certify that on ________________________ (date), a true and accurate copy of the TEMPORARY ORDERS AGREEMENT OR INFORMATION FOR THE COURT 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 1109 R2/19 TEMPORARY ORDERS AGREEMENT OR INFORMATION FOR THE COURT Page 4 of 4