Fill and Sign the Co Custodial Form

 District Court  Denver Juvenile Court ____________________County, Colorado Court Address: In the Matter of the Petition of: ________________________________ ( name of person seeking to adopt) For the Adoption of a Child COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E-mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom PETITION FOR SECOND PARENT ADOPTION According to the requirements set forth in §19-5-203, C.R.S. the Petitioner requests that he/she adopt the child identified below. The child has a sole legal parent. The Petitioner desires to adopt the child so as to make said child for all intents and purposes the legal child of Petitioner and to render him/her capable of inheriting Petitioner’s estate, states the following facts: Information about the Petitioner: Petitioner: (Full Name) Date of Birth: Race: Place of Birth: Current Mailing Address: City, State & Zip: Home Phone #: Work Phone #: Cell #: Length of Residence in Colorado: Occupation: Petitioner’s place of residence at or about the time of the birth of the child: Street Address City State Zip Code  Venue is proper in this matter because the Petitioner resides in this county.  The written home study prepared by a county Department of Social Services, Designated Qualified Individual, or Child Placement Agency and approved by the Department pursuant to §19-5-207.5(2), C.R.S. is attached.  The child was adopted by the sole legal parent less than six months prior to the date of the filing of this action petition and the Petitioner was included in the home study report that was prepared pursuant to §19-5-207, C.R.S. for the adoption of the child by the sole legal parent. The home study prepared for that adoption is attached.  The current fingerprint-based criminal history records check as required by §19-5-207(2.5)(a)(I)-(IV), C.R.S. and the TRAILS background check as required by §19-5-207, C.R.S. are included in the written home study. JDF 504 R1/18 PETITION FOR SECOND PARENT ADOPTION Page 1 of 3 If you have been convicted of a felony or misdemeanor in any of the following areas, please check the appropriate box and identify for the Court the date of the conviction and if it was a felony or misdemeanor.  child abuse or neglect on ______________________ (date).  Felony  Misdemeanor  spousal abuse on _______________________ (date).  Felony  Misdemeanor  any crime against a child on ____________________ (date).  Felony  Misdemeanor  any crime, the underlying factual basis of which has been found by the Court to include an act of domestic violence on _______________________ (date).  Felony  Misdemeanor  violation of a Protection/Restraining Order on ____________________ (date).  Felony  Misdemeanor  any crime involving violence, rape, sexual assault, or homicide on ____________________ (date).  Felony  Misdemeanor  any felony involving physical assault or battery on _______________________ (date).  Felony  Misdemeanor  any felony drug-related conviction within the past five years, at a minimum on ________________ (date).  Felony  Misdemeanor Facts concerning the child to be adopted: Full Name: Date of Birth: Place of Birth: Place of Residence:  The child is under the age of twelve years or  The child is over the age of twelve years and his/her written consent to the adoption is attached. The child will not be the subject of a pending dependency and neglect action when the adoption is heard.  If applicable, name and address of the Guardian(s) of the child and estate of said child if any have been appointed: The child  is  is not a member or eligible to be a member of an Indian tribe as defined by the Indian Welfare Act.  If applicable, name of tribe _______________________________________________________________.  Notice of this Petition has been provided to the parent or Indian custodian of the child and to the tribal agent of the tribe, as required by §19-1-126(1)(c), C.R.S. Information about the Sole Legal Parent: Full Name: Current Mailing Address: City, State & Zip: The person named above is the Sole Legal Parent because:  The other parent relinquished parental rights to the child in _________________________ (county/state) __________________ (case number) on (date).  The other parent’s rights are terminated in (county/state) _______________ (case number) on (date). JDF 504 R1/18 PETITION FOR SECOND PARENT ADOPTION Page 2 of 3  The person named above adopted the child as a single parent in (county/state) __________________ (case number) on (date).  The other parent died on (date).  The child was conceived by assisted reproductive means and no other legal parent exists pursuant to §19- 4-106, C.R.S.  The written consent of the Sole Legal Parent (JDF 508) is attached. Wherefore, Petitioner prays that a Decree of Adoption be entered herein declaring said child to be the child of Petitioner and that the name of said child be changed to_____________________________________ (full name) and that said child shall be entitled to all of the rights and privileges and be subject to all of the obligations now conferred and imposed by law.  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 ____________________________________________ Attorney Signature, if applicable JDF 504 R1/18 PETITION FOR SECOND PARENT ADOPTION Page 3 of 3