Court of Appeals, State of Colorado th 2 East 14 Ave. Denver, Co 80203 Name of Lower Court(s): _________________________________ Trial Court Judges(s): ___________________________________ Case Number(s): _______________________________________ THE PEOPLE OF THE STATE OF COLORADO In the Interest of : __________________________ [initials pursuant to § 19-1-109(1)] Minor Child(ren), And Concerning: __________________________ [initials pursuant to § 19-1-109(1)] Appellant/Respondent: ___________________________________ Attorney or Party Without Attorney (Name and Address): Case Number: COURT USE ONLY Phone Number: FAX Number: E-mail: Atty. Reg. #: PETITION ON APPEAL Division Courtroom 1. This Petition on Appeal is filed on behalf of _______(initials), the mother father Intervenor other ______________________(initials), with respect to child(ren): Child(ren)'s Initials _____________________________________ _____________________________________ 2. Date(s) of Birth child State __________________________________ __________________________________ Parental rights were terminated by the trial court pursuant to § 19-3-604(1)(___), C.R.S. or The children were adjudicated dependent or neglected pursuant to §19-3-505, C.R.S., and a dispositional decree was entered pursuant to §§19-3-507 and 19-3-508, C.R.S. 3. Appellant's attorney, ____________________________, appellant at trial. is is not the attorney who represented Yes No If Yes, list below: 4. Are there any other pending appeals involving the child (ren)? Case Name and Number: __________________________________________________________________ Type of Appeal: adjudication disposition dissolution 5. Relevant dates regarding this appeal are the following: D & N petition filed: _____________________ Termination hearing: ________________________ Adjudication order: _____________________ Termination order: ________________________ Disposition: ___________________________ Notice of Appeal filed: _______________________ Permanency hearing: ___________________ Other material hearing: _______________________ Motion to terminate filed: _________________ Form 4 JDF 548 R12/12 PETITION ON APPEAL © 2012 Colorado Judicial Department for use in the Courts of Colorado Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com 6. Nature of the case and relief sought: The appellant seeks reversal of the: dispositional decree. order: granting denying termination. 7. State the material facts as they relate to the issues presented on appeal: adjudicatory order. _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 8. State the legal issues presented for appeal, including a statement of how the issues arose: The issues statement should be concise in nature and set forth the specific legal questions. General conclusions, such as "the trial court's ruling is not supported by the law or the facts," are not acceptable. Include supporting legal authority for each issue raised. Issue 1: ________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Supporting legal authority for Issue 1: ________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Issue 2: ________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Form 4 JDF 548 R12/12 PETITION ON APPEAL © 2012 Colorado Judicial Department for use in the Courts of Colorado Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Supporting legal authority for Issue 2: ________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ (Additional issues may be added.) The undersigned requests that the Court of Appeals issue an opinion reversing the order of the trial court in this matter, or, in the alternative, enter an order setting this case for full briefing. _________________________________________ Signature, attorney for appellant Date ATTACHMENTS: ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ CERTIFICATE OF MAILING I certify that on ________________________(date) the original and five copies of this PETITION ON APPEAL were filed with the Court; and a true and accurate copy of this PETITION ON APPEAL was served on the other party(ies) by placing it in the United States mail, postage pre-paid and addressed to the following: _____________________________________ _____________________________________ _____________________________________ _____________________________________ Signature Form 4 JDF 548 R12/12 PETITION ON APPEAL © 2012 Colorado Judicial Department for us