Fill and Sign the Responsibilities for the Minor Children Including Decision Making and Parenting Time and Any Other Orders Form

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 District Court ____________________________ County, ColoradoCourt 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, ORchild(ren)’s grandfatherInformation 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, ORchild(ren)’s grandfather 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 2. Information about Respondent (1):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, ORchild(ren)’s father, ORother 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, ORchild(ren)’s father, ORother relationship please identify _____________________________________________________3.The minor child(ren) is/are:NamePresent AddressSexDate of BirthSoc. 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). 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 Name Address (City/Sate/Zip Code) Time Period(Month/Year) Type of Relationship to Child(ren) 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 CourtCase NumberStateDate of ProceedingType 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 CourtCase NumberState Type of Proceeding 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 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) 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). 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  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) 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)