Fill and Sign the Colorado Paternity 497300311 Form

 District Court  Denver Juvenile Court ___________________ County, Colorado Court Address: In the Interest of: Petitioner: v. Respondent: COURT USE ONLY Attorney or Party Without Attorney (Name and Address) : Phone Number: E-mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom PETITION TO DISCLAIM PATERNITY I, Petitioner, ask this Court to find that (Name of Party) is not the biological father of the children and states: 1. Information about the Petitioner  Father  Mother: Check if in Military  Date of Birth: Length of Residence in Colorado: Current Mailing Address: City & Zip: Home Phone #: Work Phone #: Cell #: 2. Information about the Respondent  Father  Mother: Check if in Military  Date of Birth: Length of Residence in Colorado: Current Mailing Address: City & Zip: Home Phone #: Work Phone #: Cell #: 3. Information about the Children: Full Name of Child Present Address Sex Date of Birth 4. The Court has jurisdiction over the Respondent. 5. The minor children live in this County. 6. Each party has a continuing duty to inform the Court of any proceeding in this or any other state that could affect the current proceeding. 7. Identify below the name and address of each person that the children have lived with over the past five years. Please identify the relationship to the children. JDF 1514 R8-17 PETITION TO DISCLAIM PATERNITY © 2017 Colorado Judicial Department for use in the Courts of Colorado Page 1 of 2 Name Address (City/Sate/Zip Code) Time Period (Month/Year) Type of Relationship to Children 8. I seek the following:  Determination that (name of party) is not the biological father of the children.  Amendment of or issuance of new Birth Certificate(s) to show that the (name of party) is not the biological father.  Determination of costs, if appropriate.  Other: Notice: Colorado Revised Statutes §19-4-105.5, provides that upon personal service of the Petition and Summons on the Respondent, or upon waiver and acceptance of service by the Respondent, an automatic temporary injunction shall be in effect against both parties for 120 days after its effective date, unless all parties consent to a modification of the temporary injunction. Either party may apply to the Court to modify the length of time the temporary injunction is in effect. 1. Both parties are enjoined from molesting or disturbing the peace of the other party; and 2. Both parties are restrained from removing the minor child(ren) from the state without the consent of all parties or an Order of the Court modifying the injunction; and 3. Both parties are restrained, without at least 14 days advance notification and the written consent of all other parties or an Order of the Court, from cancelling, modifying, terminating, or allowing to lapse for nonpayment of premiums, any policy of health insurance or life insurance that provides coverage to the minor child(ren) as a beneficiary of a policy. Petitioner acknowledges that he or she has read, and understands the terms of the automatic temporary injunction set forth in this Petition.  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 bottom of the form.) 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 Petitioner) Signature of Petitioner JDF 1514 R8-17 PETITION TO DISCLAIM PATERNITY © 2017 Colorado Judicial Department for use in the Courts of Colorado Page 2 of 2