JDF 1514 R 3 - 1 8 PETITION TO DISCLAIM PATERNITY Page 1 of 2 District Court Denver Juvenile Court County, Colorado Court Address: In the Interest of: Petitioner: v. Respondent: 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 DISCLAIM PATERNITY I, Petitioner, ask this Court to find that (Name of Party) is not the biological father of the children and states: 1. Information about the Petitioner Father Mother: Check if in Military Date of Birth: Length of Residence in Colorado: Current Mailing Address: City & Zip: Home Phone #: Work Phone #: Cell #: 2. Information about the Respondent Father Mother: Check if in Military Date of Birth: Length of Residence in Colorado: Current Mailing Address: City & Zip: Home Phone #: Work Phone #: Cell #: 3. Information about the Children: Full Name of C hild Present Address Sex Date of Birth 4. The Court has jurisdiction over the Respondent. 5. The minor children live in this County. 6. Each party has a continuing duty to inform the Court of any proceeding in this or any other state that c ould affect the current proceeding. American LegalNet, Inc. www.FormsWorkFlow.com JDF 1514 R 3 - 1 8 PETITION TO DISCLAIM PATERNITY Page 2 of 2 7. Identify below the name and address of each person that the children have lived with over the past five years. Please identify the relationship to the children. Name Address (City/Sate/Zip Code) Time Period (Month/Yea r) Type of Relationship to Children 8. I seek the following: Determination that (name of party) is not the biological father of the children. Amendment of or issuance of new Birth Certificate(s) to show that the (name of party) is not the biological father. Determination of costs, if appropriate. Other: Notice: Colorado Revised Statutes 24719 - 4 - 105.5, provides that upon personal service of the Petition and Summons on the Respondent, or upon waiver and acceptance of service by the Respondent, an automatic temporary injunction shall be in effect against both parties for 120 days after its effective date, unless all parties consent to a modification of the temporary injunction. Either party may apply to the Court to modify the length of time the temporary injunction is in effect. 1. Both parties are enjoined from molesting or disturbing the peace of the other party; and 2. Both parties are restrained from removing the minor child(ren) from the sta te without the consent of all parties or an Order of the Court modifying the injunction; and 3. Both parties are restrained, without at least 14 days advance notification and the written consent of all other parties or an Order of the Court, from cancelling, modifying, terminating, or allowing to lapse for nonpayment of premiums, any policy of health insurance or life insurance that provides coverage to the minor child(ren) as a beneficiary of a policy. Petitioner acknowledges that he or she has read, and understands the terms of the automatic temporary injunction set forth in this Petition. 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. SIGNATURE ( P rinted name of Petitioner) Signature of Petitioner Date American LegalNet, Inc. www.FormsWorkFlow.com