Fill and Sign the Pursuant to 19 5 101 Et Seq Form

JDF 520 R5-18 PETITION TO TERMINATE THE PARENT-CHILD LEGAL RELATIONSHIP Page 1 of 2District Court Denver Juvenile Court___________________County, ColoradoCourt Address:In the Matter of the Petition of:_____________________________ (name of person seeking to adopt)For the Adoption of a Child COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E-mail:FAX Number: Atty. Reg. #: Case Number:Division Courtroom PETITION TO TERMINATE THE PARENT-CHILD LEGAL RELATIONSHIP PURSUANT TO §§19-5-101, et seq. C.R.S. Com es now _____________ _____________ ____________________ _____________, th e agency/th e pers o n(s ), ha vin g c u sto dy o f th e c h ild , a n d h ere by p etit io ns th e C ourt fo r a n O rd er te rm in atin g th e p are nt- c h ild le gal r e la tio nsh ip , if a ny, w hic h e xis ts b etw een th e R esp ondent( s ) _ _________ ______________ ______________________ _____ a nd the c h ild n am ed in t h is a ctio n a nd a s g ro unds t h ere fo re , s ta te s t h e f o llo w in g:1 . That _ ____ _____________ __________________ ( n am e o f c h ild ) w as b orn o n _ ________________ ____ ( d ate ).2 . The m oth er o f th e c h ild  was  was n ot m arrie d a t th e tim e o f c o nce ptio n o f th e c h ild o r a t a ny tim e th ere afte r to _ __________________ _______________________ _________________________________ ___. 3 . The moth er of th e ch ild was was not co habit in g wit h a man or men, to -w it : __ ________ ___________ _____________ ____ _____________ a t t h e t im e o f t h e c o nce ptio n o r b ir th o f t h e c h ild .4 . The m oth er o f th e c h ild  has  has n ot re ce iv e d s u pport p aym ents o r p ro m is e s o f s u pport w it h re sp ect to th e ch ild o r in c o nnectio n w it h h er p re gnancy f r o m _ __________________________________________ ______.5 . That _ ________________ ________________________ _________ h as fo rm ally o r in fo rm ally a ckn ow le dged o r de cla re d h is p ossib le p ate rn it y o f t h e c h ild .6 . That _ ____ _____________ _________________________ ____ is n am ed a s f a th er o n t h e c h ild 's b ir th c e rtif ic a te .7 . That _ ____ ____________ _____________________________ h as b een n am ed a s a p ossib le f a th er o f t h e c h ild .8 . That ___ _____________ __________ ____________________ is pre su m ed to be th e fa th er of th e ch ild , pu rs u ant t o § 19-4 -1 05, C .R .S ., a s a m ended.9 . Term in atio n o f th e p are nt- c h ild le gal re la tio nsh ip , if a ny, b etw een th e R esp ondent( s ) a nd th e c h ild is in th e b est in te re sts o f t h e c h il d . JDF 520 R5-18 PETITION TO TERMINATE THE PARENT-CHILD LEGAL RELATIONSHIP Page 2 of 2W here fo re , th e P etit io ner(s ) re sp ectfu lly re quest( s ) th at th e C ourt u pon p ro per n otic e a nd o pportu nit y fo r h earin g, en te r a n O rd er T erm in atin g th e P are nt- C hild le gal R ela tio nsh ip b etw een th e R esp ondent( s ) n am ed a bove a nd th e ch ild a nd t r a nsfe r g uard ia nsh ip o f t h e p ers o n a nd le gal c u sto dy o f t h e c h ild t o a p ro per p ers o n o r a gency. 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 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) ___________________________________ ______________________________________Petitioner Signature Date Co-Petitioner Signature Date