Fill and Sign the In Matter of the Adoption Tkj 931 P2d 488casetext Form

JDF 452 R3/18 PETITION FOR RELINQUISHMENT/EXPEDITED RELINQUISHMENT Page 1 of 3District Court Denver Juvenile Court____________________County, ColoradoCourt Address:In the Matter of the Petition of:_________________________________________________ And_____________________________________________Petitioner(s)For the Relinquishment of a Child,___________________________________________________________ (child’s name) 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 RELINQUISHMENT OR EXPEDITED RELINQUISHMENT PURSUANT TO §19-5-103.5, C.R.S. The Petitioner(s) respectfully represent(s) to the Court:1. _____________________________________ (name of child), was born on _________________ (date), in _______________________________ (city/state), and is the child of the Petitioner(s). 2. The names, dates of birth, and addresses of the parents of the child are:Information about the Mother: Petitioner Co-Petitioner/Respondent Mother’s Name: Date of Birth:Street Address: Mailing Address, if different: City: State: Zip Code: Main Phone #: Email Address: Secondary Phone #: Information about the Father: Petitioner Co-Petitioner/Respondent Presumed Alleged Name: Date of Birth:Street Address: Mailing Address, if different: City: State: Zip Code: Main Phone #: Email Address: Secondary Phone #: Information about the Father: Petitioner Co-Petitioner/Respondent Presumed Alleged Name: Date of Birth:Street Address: Mailing Address, if different: City: State: Zip Code: Main Phone #: Email Address: Secondary Phone #: JDF 452 R3/18 PETITION FOR RELINQUISHMENT/EXPEDITED RELINQUISHMENT Page 2 of 33. Venue is proper in this county because:(a)The Petitioner(s) reside(s) in this county at OR(b)The child resides in this county at OR(c) A Child Placement Agency, is involved and is located in this county with an office registered with the Colorado Department of Human Services at: 4.The Petitioner(s) wish(es) to relinquish the child because:5.The Petitioner(s) believes that this relinquishment is in the best interest of the child named above.6.The Petitioner(s) understand(s) that:After the Order of Relinquishment is entered, the Petitioner(s) will be unable to change his/her/their mind(s) about relinquishment. ORIf this is an Expedited Relinquishment, the Petitioner(s) understand(s) that after the Petition is filed with the Court that the Petitioner(s) will be unable to withdraw the attached affidavit in support of the relinquishment.7. The Petitioner(s) understand(s) that this is a permanent termination of parental rights with respect to the child named above.8. The Petitioner’s decision to relinquish the child named above is knowing and voluntary and without undue pressure or influence from anyone else.9.The Petitioner(s) has/have has/have not received counseling from regarding this proposed relinquishment, as described in the attached Affidavit of Relinquishment Counseling. 10.The Petitioner(s) has/have has/have not received, been promised or offered any payments, gifts, assistants, goods, or services and the source of such payments. JDF 452 R3/18 PETITION FOR RELINQUISHMENT/EXPEDITED RELINQUISHMENT Page 3 of 311. The child is is not a member or eligible to be a member of an Indian tribe as defined by the Indian Child Welfare Act. If applicable, name of tribe . (Attached is assessment form JDF 567 or JDF 568, to comply with the Indian Child Welfare Act (ICWA). 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.Reasonable efforts have been made to send notice to the identified persons as follows: Attach the postal receipts to this petition, indicating that notice was properly sent. If the postal receipts have not been returned at the time of filing, the postal receipts or copies shall be filed with the Court within ten days of the filing of this petition.12.The child is is not twelve years of age or older.13. The child is is not one year of age at the time of filing this Petition.14.The child has has not received counseling in connection with this proposed relinquishment.Wherefore, the Petitioner(s) respectfully request(s) that the Court enter a Final Order of Relinquishment and transfer guardianship of the person and legal custody of the child to a proper person or agency. 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. SIGNATURE _______________________________________ _______________________________________Printed name of Petitioner Signature of Petitioner Date_______________________________________ _______________________________________Printed name of Co-Petitioner Signature of Co-Petitioner Date