Fill and Sign the Parental Responsibilities Form

 District Court  Denver Juvenile Court __________________ County, Colorado Court Address: In re the Parental Responsibilities concerning: ______________________________________________________ Petitioner: and Co-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 PETITION FOR ALLOCATION OF PARENTAL RESPONSIBILITIES This Petition seeks allocation of parental responsibilities including decision-making responsibilities and parenting time for the minor child(ren), establishment of a child support order, and any other orders necessary to effectuate the best interests of the children pursuant to §14-10-123, C.R.S. and states: 1. Information about Petitioner: Check if in Military  Full Legal Name: Date of Birth: Current Mailing Address: Apt. #________ City: State: Zip Code: Home Phone #: Email Address: Cell Phone #: Petitioner has the following relationship with the minor child(ren):  child(ren)’s mother  child(ren)’s father  non-parent, and the child(ren) is/are not in the physical custody of one of the parents  non-parent, who has had physical custody of the child(ren) for 182 days or more, and the physical custody did not end more than 182 days before the filing of this action  other (please specify): __________________________ 2. Information about Co-Petitioner/Respondent: Check if in Military  Full Legal Name: Date of Birth: Current Mailing Address: Apt. #________ City: State: Zip Code: Home Phone #: Email Address: Cell Phone #: Co-Petitioner/Respondent has the following relationship with the minor child(ren):  child(ren)’s mother  child(ren)’s father  non-parent, and the child(ren) is/are not in the physical custody of one of the parents  non-parent, who has had physical custody of the child(ren) for 182 days or more, and the physical custody did not end more than 182 days before the filing of this action JDF 1413 R2/18 PETITION FOR ALLOCATION OF PARENTAL RESPONSIBILITIES Page 1 of 4  other (please specify):____________________________ 3. The minor child(ren) is/are: Full Name of Child Present Address Sex Date of Birth 4. The child(ren) listed above have lived in Colorado for a minimum of six months prior to the filing of this Petition or since birth if under six months of age?  No  Yes If No, please state the name of child, name of person child lived with and the month, date and year when each child most recently moved to Colorado. Full Name of Child Name of Person Child Lived with State Moved From Month Day Year 5. Identify below the name and address of each person that the child(ren) has/have lived with over the past five years. Please identify the relationship to the child(ren). Name Address (City/Sate/Zip Code) Time Period (Month/Year) Type of Relationship to Child(ren) 6. I/We understand that a request by either party for genetic testing shall not prejudice the requesting party in the allocation of parental responsibilities. 7. Each party has a continuing duty to inform the Court of any proceeding(s) in this or any other state that could affect the current proceeding. 8. I/We understand that the Court may review any case involving the children, Petitioner, Co-Petitioner/ Respondent and other parties named in this Petition that have been filed in any Court. 9. I/We have participated in the following proceeding(s) regarding the child(ren) as a party or a witness, or in any other capacity concerning issues of custody/allocation of decision-making, or visitation/parenting time with the child(ren). Identify name of court, case number, state, date and type of proceeding. Name of Court Case Number State Date of Proceeding Type of Proceeding 10. I/We know of the following proceeding(s) that could affect the current proceeding including, but not limited to proceedings for Dissolution of Marriage or Civil Union, Legal Separation (Marriage or Civil Union), enforcement of Court orders, domestic violence or domestic abuse, protection/restraining orders, termination of parental rights, and adoptions. Identify name of court, case number, state, date and type of proceeding. JDF 1413 R2/18 PETITION FOR ALLOCATION OF PARENTAL RESPONSIBILITIES Page 2 of 4 Name of Court Case Number State Date of Proceeding Type of Proceeding 10. The following people are not parties in this matter but have physical custody of the child(ren) or claim rights of parental responsibilities with the child(ren). Identify name and address of those persons. Name of Person Address (City/State & Zip Code) 11. The best interests of the child(ren) would be served by allocating parental responsibilities to the Petitioner(s) as follows and for the following reasons: 12. Required Notice of Human Services Involvement. The parents or dependent child(ren) listed on this Petition has/have received within the last five years, or is/are currently receiving benefits or public assistance from the state Department of Human Services or the County Department of Social Services .  No  Yes If your answer was Yes , complete the following: Name of Person Receiving Benefit Name of County and State Case Number Month/Year 13. Required Notice of Prior Protection/Restraining Orders. Have any Temporary or Permanent Protection/Restraining Orders to prevent domestic abuse or any Criminal Mandatory Protection/Restraining (MRO) Orders or Emergency Protection Orders been issued against either party by any Court 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? Notice of Existing Case with Child Support Enforcement (CSE) JDF 1413 R2/18 PETITION FOR ALLOCATION OF PARENTAL RESPONSIBILITIES Page 3 of 4 The parents have filed a case with CSE?  No  Yes If Yes , identify the case number: _____________ Notice: Colorado Revised Statutes §14-10-123, provides that upon the filing of a Petition for Allocation of Parental Responsibilities by the Petitioner and Co-Petitioner, or 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 until the Final Order is entered, or the Petition is dismissed, or until further Order of the Court. Either party may apply to the Court for further temporary orders, an expanded automatic temporary injunction, or modification or revocation under §14-10-125, C.R.S. 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 and Co-Petitioner, if any, acknowledge that he or she has received a copy of, has read, and understands the terms of the automatic temporary injunction set forth in this Petition. I/We seek an order granting the allocation of parental responsibilities, the establishment of child support, and any other orders necessary to effectuate the best interests of the child(ren).  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 Petitioner) (Signature of Petitioner) 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 Co-Petitioner/Respondent) (Signature of Co-Petitioner/Respondent) JDF 1413 R2/18 PETITION FOR ALLOCATION OF PARENTAL RESPONSIBILITIES Page 4 of 4