JDF 525 R 1 /1 8 AFFIDAVIT OF ABANDONMENT District Court Denver Juvenile Court County, Colorado Court Address: IN THE MATTER OF THE PETITION OF: (name of person(s) seeking to adopt) FOR THE ADOPTION OF A CHILD COURT USE ONLY Attorn ey or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom AFFIDAVIT OF ABANDONMENT I/We (name of custodial birth parent in stepparent adoption or adoptive relative(s), legal custodian(s) in kinship and custodial adoptions ) , state the following : The birth parent (s) , of the subject child, , has failed without cause to provide reasonable support for the child for a period of one year or more. and/or has abandoned the child for a period of one year or more. For kinship and custodial adoptions, t he Petitioner(s) has/ have had phys ical custody of the child for a period of one year or more. The child is not the subject of a pending dependency and neglect proceeding. By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. B y checking this box, I am acknowledging that I have made a change to the original content of this form. VERIFICATION I declare under p enalty 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 /Custodial birth parent ) Signa ture of Petitioner/Custodial birth parent 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 American LegalNet, Inc. www.FormsWorkFlow.com