Fill and Sign the Judgment Pursuant to 14 10 122 C Form

JDF 1813 R2/18 VERIFIED ENTRY OF SUPPORT JUDGMENT Page 1 of 2District Court Juvenile Court____________________________ County, ColoradoCourt Address:In re:The Marriage of:The Civil Union of:Parental Responsibilities concerning:______________________________________________________Petitioner:andCo-Petitioner/Respondent: COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E-mail:FAX Number: Atty. Reg. #:Case Number:Division Courtroom VERIFIED ENTRY OF SUPPORT JUDGMENT The Obligee, __________________________________________, submits this Verified Entry of Support Judgment pursuant to §14-10-122, C.R.S.:1.The Obligor, _________________________________________, is currently ordered to pay $ _________ per month, commencing ______________ (date). All previous modifications are as follows:$ _________________ per month, commencing ___________________________$ _________________ per month, commencing ___________________________$ _________________ per month, commencing ___________________________2.During the period of _____________________ (date) through __________________ (date), the Obligor should have paid $ _____________.3. Through ________________ (date), the Obligor paid the sum of $ ___________, leaving an arrearage due and owing to the Obligee in the amount of $ _____________. Pursuant to §5-12-102, C.R.S. and §14-14-106, C.R.S., the Obligor owes accrued interest in the sum of $____________ for this time period, for a total due of $ ____________ to the Obligee.4. Interest shall continue to accrue at the statutory rate.5.As evidence of payment, a copy of the Family Support Registry record is attached, pursuant to §14-14- 111.5(3)(b)(III), C.R.S. JDF 1813 R2/18 VERIFIED ENTRY OF SUPPORT JUDGMENT Page 2 of 2WHEREFORE, the Obligee submits to the Court that the sum of $ _____________ should be entered as a consolidated judgment against the Obligor ________________________________________, and in favor of the Obligee __________________________________________. 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 Obligee) Signature of Obligee __________________________________________________________________________________________City State Zip Code _____________________________________________ ______________________________________ (Area Code) Daytime Phone Number (Area Code) Work Phone Number_____________________________________________Signature of Attorney (if any) CERTIFICATE OF SERVICE I certify that on ____________________ (date) a true and accurate copy of the VERIFIED ENTRY OF SUPPORT JUDGMENT was served on the other party by:Hand Delivery, E-Filed, or Faxed to this number ___________________ or by placing it in the United States mail, postage pre-paid, and addressed to the following:To: ______________________________________ ______________________________________ ______________________________________ ______________________________________ (Your Signature)