Fill and Sign the Verification and Acknowledgement Form

JDF 1812 R8-17 STIPULATION FOR IMMEDIATE ACTIVATION OF AN INCOME ASSIGNMENT © 2017 Colorado Judicial Department for use in the Courts of Colorado PAGE 1 OF 1  District Court _________________________________________ County, ColoradoCourt Address:In Re:Petitioner:Respondent/Co-Petitioner: COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E-mail:FAX Number: Atty. Reg.#:Case Number:Division Courtroom STIPULATION FOR IMMEDIATE ACTIVATION OF AN INCOME ASSIGNMENT The parties stipulate and agree to the immediate activation of an income assignment._______________________________ ___________________________________ Date Obligor_______________________________ ___________________________________ Date Obligee__________________________________________________________________________________ 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 Obligor) (printed name of Obligee)________________________________________ __________________________________________ (Obligor’s Signature Obligee’s signature ________________________________________ __________________________________________ (Obligor’s Attorney Signature, if any) (Obligee’s Attorney Signature, if any)