District Court Denver Juvenile Court ___________________ County, Colorado Court Address: In the Matter of the Petition of: ____________________________________Mother and ____________________________________ Father Adjudicated COURT USE ONLY Alleged Presumed Petitioner Co-Petitioner Case Number: For the Relinquishment of a Child ___________________________________________________________ (child's name) Division Courtroom FINAL ORDER OF RELINQUISHMENT PURSUANT TO §19-5-104, C.R.S. This matter having come on for hearing on _____________________ (date), and the Court having considered the Petition and Affidavit, and the evidence and testimony offered in support thereof; or Upon Court review on the Petition for Expedited Relinquishment, the Court having considered said Petition and Affidavit, and the evidence offered in support thereof; The Court being fully advised in the premises finds: 1. The Court has jurisdiction over the subject matter and persons herein and venue is proper because: Petitioner Co-Petitioner reside(s) in this County Minor child resides in this County ___________________________________________ 2. The child was born on 3. 4. (name of Child Placement Agency), registered with the Department of Human Services, is located in this County. (date). (name) is the biological mother of the child. (name) is the child's father, due to having been: Named as the alleged/presumed father(s) of the child and has/have failed to appear in Court, or has/have failed to file a formal response. OR Named as the presumed father and has consented to the relinquishment. Named as the father on the child's Birth Certificate. Adjudicated as the child's father in 5. (case number). The biological mother was was not married at the time of the conception or birth of the child and the biological mother engaged in sexual intercourse with _____________________ at least 45 days prior to, during time of conception and/or 45 days following conception of the minor child of this action. 6. Petitioner(s) has/have completed relinquishment counseling and guidance as required by §19-5-103(1) and (5), C.R.S. 7. The minor child has completed relinquishment counseling, if deemed appropriate by the Court. JDF 488 R10/10 FINAL ORDER OF RELINQUISHMENT Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 8. The Court is satisfied that the Petitioner(s) has/have been fully advised of the consequences of his/her/their acts and that the decision to relinquish is knowing, voluntary and not the result of any threats, coercion or undue influence or inducements. 9. Other: The Court also finds that the relinquishment is desired because the Petitioner(s) is/are unable to provide for the child adequately to address the child's needs and feel(s) that it is in the best interest of the child to relinquish all rights to the child. The Petitioner(s) understand his/her rights and states that this is a knowing and voluntary decision and not the result of any threats, coercion, or undue influence or inducements. _________________________________ (name) is the presumed father of said child pursuant to §19-4-105(1), C.R.S., and has been identified to the satisfaction of the Court as the biological father of said child. _________________________________ (name) is the biological father and has acknowledged his paternity of said child orally to the Court or in writing filed with the Court. The Court finds that sufficient guidance and counseling have been given to the Petitioner(s) and to the child, if deemed appropriate by the Court, and that it would be in the child's best interests to enter a Final Order of Relinquishment. Wherefore it is Ordered, Adjudged and Decreed by the Court that the Petitioner(s) is/are hereby divested of all legal rights and obligations to the child and that the child is hereby released from any and all legal obligations in respect to the Petitioner(s). It is also ordered that the custody and guardianship of the person of the child is hereby awarded to ______________________________________ (name) with full power and authority to place the child for, and consent to, adoption. This Order shall not modify the child's status as an heir at law, which shall cease only upon a subsequent Final Decree of Adoption. Date: _____________________ _____________________________________ Judge Magistrate CERTIFICATE OF MAILING I certify that on __________________ (date), I mailed, faxed, or hand-delivered a copy of this Order to the following: Attorney for Petitioner(s) or Petitioner(s) pro se Other: ____________________________________ ______________________________________ Clerk JDF 488 R10/10 FINAL ORDER OF RELINQUISHMENT Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com