Fill and Sign the Parental Responsibilities 497300320 Form

 District Court ____________________________ County, Colorado Court Address: In re the Parental Responsibilities concerning: _______________________________________________ Petitioner(s): v. Respondent(s): 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 TO GRANDPARENT(S) (PURSUANT TO §14-10-123, C.R.S.) The Petitioner(s), as grandparent(s) of the minor child(ren) named above, seek(s) allocation of parental responsibilities for the minor child(ren), including decision-making and parenting time, and any other orders necessary to effectuate the best interest of the children, pursuant to §14-10-123, C.R.S. 1. Information about Petitioner (1): Check if in Military  Full Legal Name:________________________________________ Date of Birth:______________________ Current Mailing Address: __________________________________________________________________ City & Zip: ______________________________________________________________________________ Home Phone #: ____________________ Work Phone #: ___________________ Cell #: ________________ Email:______________________________________________________________ Petitioner has the following relationship with the minor child(ren):  child(ren)’s grandmother, OR  child(ren)’s grandfather Information about Petitioner (2): Check if in Military  Full Legal Name:________________________________________ Date of Birth: ______________________ Current Mailing Address: ___________________________________________________________________ City & Zip: ______________________________________________________________________________ Home Phone #: ____________________ Work Phone #: ___________________ Cell #: ________________ Email:_____________________________________________________________ Co-Petitioner has the following relationship with the minor child(ren):  child(ren)’s grandmother, OR  child(ren)’s grandfather 2. Information about Respondent (1): JDF 1703 R2-18 PETITION FOR ALLOCATION OF PARENTAL RESPONSIBILITIES TO GRANDPARENT(S) PURSUANT TO §14-10- 124(1.5), C.R.S. Page 1 of 5 Full Legal Name:________________________________________ Date of Birth: ______________________ Current Mailing Address: ___________________________________________________________________ City & Zip: ______________________________________________________________________________ Home Phone #: ____________________ Work Phone #: ___________________ Cell #: _________________ Email:______________________________________________________________ Respondent has the following relationship with the minor child(ren):  child(ren)’s mother, OR  child(ren)’s father, OR  other relationship please identify _____________________________________________________ Information about Respondent (2): Full Legal Name:________________________________________ Date of Birth: ______________________ Current Mailing Address: ___________________________________________________________________ City & Zip: _______________________________________________________________________________ Home Phone #: ____________________ Work Phone #: ___________________ Cell #: ________________ Email:____________________________________________________________ Respondent has the following relationship with the minor child(ren):  child(ren)’s mother, OR  child(ren)’s father, OR  other relationship please identify _____________________________________________________ 3. The minor child(ren) is/are: Name Present Address Sex Date of Birth Soc. Sec. No. 4. Check one:  The child(ren) is/are not in the physical care of the parent(s).  The child(ren) has/have been in the physical care of Petitioner(s) for a least 182 days or more, if such action is commenced within 182 days of the termination of such physical care. 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) JDF 1703 R2-18 PETITION FOR ALLOCATION OF PARENTAL RESPONSIBILITIES TO GRANDPARENT(S) PURSUANT TO §14-10- 124(1.5), C.R.S. Page 2 of 5 6. The Petitioner(s) are requesting allocation of parental responsibility for the following reasons: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 7. 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) (list the Court name, case number, state, date and type of proceeding): Name of Court Case Number State Date of Proceeding Type of Proceeding 8. I/we know of the following proceeding(s) that could affect the current proceeding including, but not limited to proceedings for Dissolution of Marriage/Legal Separation or Dissolution of Civil Union/Legal Separation, enforcement or Court orders, domestic violence or domestic abuse, protection/restraining orders, termination of parental rights, and adoptions (list the Court name, case number, state, type of proceeding): Name of Court Case Number State Type of Proceeding 9. 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. 10. The following people are not parties in this matter but have physical custody of the child(ren) or claim rights of parental responsibilities, legal custody or physical custody, or visitation/parenting time with the child(ren) (names and addresses of those persons): Name of Person Address (City/State & Zip Code) JDF 1703 R2-18 PETITION FOR ALLOCATION OF PARENTAL RESPONSIBILITIES TO GRANDPARENT(S) PURSUANT TO §14-10- 124(1.5), C.R.S. Page 3 of 5 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 PRIOR PROTECTION/RESTRAINING ORDERS. Have any Temporary or Permanent Protection/Restraining Orders to prevent domestic abuse or any Criminal Protection/Restraining Orders or Emergency Protection Orders been issued against any of the parties 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 and issued against _____________________________________________________ in the County of ___________________, State of ________________, in case number _____________. What was the subject matter of the Protection/Restraining Order or Emergency Protection Order? ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ 13. Provide any information on any past or current criminal child abuse cases, if applicable: _______________________________________________________________________________________ _______________________________________________________________________________________ Wherefore, the Petitioner(s) seek(s) an order regarding an allocation of parental responsibilities, including decision-making and parenting time, 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 ___________________________________ ______________________________________ JDF 1703 R2-18 PETITION FOR ALLOCATION OF PARENTAL RESPONSIBILITIES TO GRANDPARENT(S) PURSUANT TO §14-10- 124(1.5), C.R.S. Page 4 of 5 (printed name of Petitioner) (Signature of Petitioner) 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) (Signature of Co-Petitioner) JDF 1703 R2-18 PETITION FOR ALLOCATION OF PARENTAL RESPONSIBILITIES TO GRANDPARENT(S) PURSUANT TO §14-10- 124(1.5), C.R.S. Page 5 of 5