Fill and Sign the Parenting Time Modification Form

 District Court  Denver Juvenile Court ___________________ County, Colorado Court Address: In re:  The Marriage of:  The Civil Union of:  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 STIPULATION REGARDING PARENTING TIME MODIFICATION The ________________________ (Petitioner) and _________________________ (Co-Petitioner/Respondent) stipulate and agree to the following Stipulation Regarding Parenting Time Modification : 1. The parties have _____ minor child(ren): Full Name of Child Present Address Sex Date of Birth 2. We request the Court to change the current parenting time order to provide for the following new parenting plan schedule: (Attach additional documentation, if necessary.) 3. We believe that the modification/restriction of the current parenting time order is in the best interests of the minor child(ren) for reason(s) which were unknown to the Court, or that have arisen since the last order. They are as follows: 4. Other Information: JDF 1423 R8/17 STIPULATION REGARDING PARENTING TIME MODIFICATION © 2013 Colorado Judicial Department for use in the Courts of Colorado Page 1 of 2 5. We request that this Stipulation Regarding Parenting Time Modification be entered as an Order of this Court.  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) (printed name of Co-Petitioner/Respondent) _______________________________________ _____________________________________________ Petitioner’s Signature Co-Petitioner/Respondent’s Signature _______________________________________ _____________________________________________ Address Address _______________________________________ _____________________________________________ City, State, Zip Code City, State, Zip Code _______________________________________ _____________________________________________ (Area Code) Telephone Number (home) (Area Code) Telephone Number (home) _______________________________________ _____________________________________________ (Area Code) Telephone Number (work) (Area Code) Telephone Number (work) _______________________________________ _____________________________________________ Petitioner’s Attorney Signature, if any Co-Petitioner/Respondent’s Attorney Signature, if any JDF 1423 R8/17 STIPULATION REGARDING PARENTING TIME MODIFICATION © 2013 Colorado Judicial Department for use in the Courts of Colorado Page 2 of 2