Fill and Sign the Co Income Form

 District Court _________________________________________ County, Colorado Court Address: In Re: Petitioner: 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 OBLIGOR’S REQUEST FOR IMMEDIATE ACTIVATION OF AN INCOME ASSIGNMENT I, , have been determined to be the Obligor and have been ordered to pay child support, maintenance (spousal/partner support), or maintenance when combined with child support. I request the immediate activation of an income assignment. ________________________________ _______________________________________ Date Obligor ____________________________________________________________________________________ VERIFICATION AND ACKNOWLEDGEMENT 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 Obligor) Signature of Obligor JDF 1811 R8-17 OBLIGOR’S REQUEST FOR IMMEDIATE ACTIVATION OF AN INCOME ASSIGNMENT © 2017 Colorado Judicial Department for use in the Courts of Colorado