District Court Denver Juvenile Court ___________________________________ County, Colorado Court Address: IN THE MATTER OF THE PETITION OF: COURT USE ONLY Case Number: ___________________ FOR THE ADOPTION OF A CHILD Division: ________ Courtroom:______ _____________________________ (name of person(s) seeking to adopt) FINDING OF FACT AND DECREE PURSUANT TO §19-5-203, C.R.S. This matter comes before the Court and having jurisdiction of the subject and in the best interests of the child, the Court finds: That personal service and/or service by publication, as provided by law, has been properly executed upon _____________________________________________________ (name of Respondent(s)), who is/are the birth/presumed/purported parent(s) of said child; and That the submitted written consent by the person, persons, or agency having authority to execute the same appears to be genuine and valid; and That the Respondents(s) has/have not established a substantial, positive relationship with the child pursuant to §19-5-105(3.1)(c), C.R.S. That the Respondent(s) has/have not promptly taken substantial parental responsibility for the child. §195-105(3.1)(b), C.R.S. That said Respondent(s) has/have abandoned said child for a period of one year or more and/or has/have failed without cause to provide reasonable support for said child for a period of one year or more. It is therefore ordered that the parental rights of ___________________________________________ (name of Respondent(s)), is/are hereby terminated and the child is available for adoption. Date: ______________________________ ____________________________________________ Judge Magistrate CERTIFICATE OF MAILING I certify that on __________________ (date), I mailed, faxed, e-filed, or hand-delivered a copy of this Order to the following: Petitioner/Attorney Respondent/Attorney ______________________________________ Clerk JDF 521 R9/08 FINDING OF FACT AND DECREE American LegalNet, Inc. www.FormsWorkFlow.com