Fill and Sign the Colorado Grandparents Form

JDF 1701 R 8-2017 PLEADING AFFIDAVIT FOR GRANDPARENT /GREAT -GRANDPARENT VISITATION PURSUANT TO §19 -1-117, C.R.S. © 201 7 Colorado Judicial Department for use in the Courts of Colorado Page 1 of 4  District Court  Juvenile Court _______ _____ __________ County, Colorado Court Address: In re:  The Marriage of:  The Civil Union of:  Parental Responsibilities concerning: ______________________________________________ Petitioner: and Co -Petitioner/ Respondent: and concerning:  Grandparent(s)  Great -Grandparent(s) Intervenor(s) : COURT USE ONLY Attorney or Party W ithout Attorney (Name and Address) : Phone Number: E -mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom VERIFIED PLEADING AFFIDAVIT FOR  GRANDPARENT  GREAT -GRANDPARENT VISITATION PURSUANT TO §19 -1-117, C.R.S. AND RULE 24 OF THE COLORADO RULES OF CIVIL PROCEDURE Note to Responding Party: If you disagree with this Pleading Affidavit , the Colorado Civil Rules of Procedure allow you to file a written response with the Court which must be filed within 21 days of the date this Pleading Affidavit was served on you or mailed to you. The intervenor(s), the  maternal  paternal  grandparent (s)  great -grandparent(s) of the minor child(ren), states the following for the purpose of establishing visitation between the  grandparent(s)  great -grandparent(s) and the child(ren), pursuant to §19 -1-117, C.R.S. A Pleading Affidavit seeking an Order for grandparent /great -grandparent visitation  has  has not been filed in the last two years. If one has been filed, please identify the date filed _____________________________ and state in section 8 below, the reasons why you believe you have good cause to now file again for visitation . 1. 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  child(ren)’s grandfather  child(ren)’s great -grandmother  child(ren)’s great -grandfather JDF 1701 R 8-2017 PLEADING AFFIDAVIT FOR GRANDPARENT /GREAT -GRANDPARENT VISITATION PURSUANT TO §19 -1-117, C.R.S. © 201 7 Colorado Judicial Department for use in the Courts of Colorado Page 2 of 4 2. 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  child(ren)’s grandfather  child(ren)’s great -grandmother  child(ren)’s great -grandfather 3. Information about the Mother:  Petitioner  Respondent/Co -Petitioner Check if in Military  Full Legal Name: Current Mailing Address: City: State: _____ Zip Code: _________ Home Phone #: Email Address: Cell Phone #: 4. Information about the Father:  Petitioner  Respondent/Co -Petitioner Check if in Military  Full Legal Name: Current Mailing Address: City: State: _____ Zip Code: _________ Home Phone #: 5. The minor child(ren) is/are : Full Name of Child Present Address Sex Date of Birth 6. The parental rights of the parents of the minor child(ren) have been terminated.  Yes  No If Yes , please furnish the case number: __________________________________ 7. Visitation with the  grandparent(s)  great -grandparent(s) is in the child(ren)’s best interest for the following reasons: JDF 1701 R 8-2017 PLEADING AFFIDAVIT FOR GRANDPARENT /GREAT -GRANDPARENT VISITATION PURSUANT TO §19 -1-117, C.R.S. © 201 7 Colorado Judicial Department for use in the Courts of Colorado Page 3 of 4 8. The  grandparent(s)  great -grandparents(s) wish(es) to have visitation with the minor child(ren) at the following times and under the following conditions: 9. Transportation of the child(ren) will be as follows: 10. 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) /great -grandparent(s) or any of the parties within two years prior to the filing of this Petition?  No  Yes If your answer was Yes , complete the following: The Protection/Restraining Order was  Temporary  Permanent  MRO and issued against _______________ __________________ 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 v isitation between the  intervenor(s)/grandparent(s)  Intervenor(s)/great -grandparent(s) and the minor child(ren) as set forth in this Pleading Affidavit and any other orders necessary to effectuate the best interests of the child(ren).  I/We respectfully request a hearing before the Court before an order is entered. (Optional)    JDF 1701 R 8-2017 PLEADING AFFIDAVIT FOR GRANDPARENT /GREAT -GRANDPARENT VISITATION PURSUANT TO §19 -1-117, C.R.S. © 201 7 Colorado Judicial Department for use in the Courts of Colorado Page 4 of 4  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. (Checking this box requires you to remove JDF number and copyright at the botto m of the form ) VERIFICATION AND ACKNOWLEDGEMENT I _______________________________(name) swear/affirm under oath , and under penalty of perjury, that I have read the foregoing Verified Pleading Affidavit for Grandparent /Great -Grandparent Visitation Pursuant to §19 -1- 117, C.R.S. and Rule 24 of the Colorado Rules of Civil Procedure and that the statements set forth therein are true and correct to the best of my knowledge and belief . ___________________________ __________ __________________________________________ Signature of  Grandmother Date Signature of  Grandfather Date Signature of  Great -Grandmother Signature of  Great -Grandfather ______________________________________ __________________________________________ Attorney Signature, if any Attorney Signature, if any The foregoing instrument was s ubscribed and The foregoing instrument was subscribed and affirmed, or sworn before me in the County of affirmed, or swo rn before me in the County of _____________________, State of Colorado, _____________________, State of Colorado, this _____ day of _________________, 20___ this _____ day of _________________, 20 ___ by __________________________________ by _____________________________________ My Commission Expires: ________________ My Commission Expires: ________________ ______________________________________ ______________________________________ Notary Public/ Deputy Clerk Notary Public/ Deputy Clerk CERTIFICATE OF SERVICE I certify that on ____________________ (date) a true and accurate copy of th is Verified Pleading Affidavit for Grandparent /Great -Grandparent Visitation Pursuant to §19 -1-117, C.R.S. and Rule 24 of the Colorado Rules of Civil Procedure 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: _____ _____________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ ______________________________________ Signature