District Court Denver Juvenile Court ____________________County, Colorado Court Address: In the Matter of the Petition of: ______________________________________________________ And _______________________________________________Petitioner(s) For the Relinquishment of a Child, ___________________________________________________________ (child's name) COURT USE ONLY Case Number: Attorney or Party Without Attorney (Name and Address): Phone Number:__________ E-mail: __________________________ FAX Number:___________ Atty. Reg. #: _______________ Division ______ Courtroom ______ NOTICE OF EXPEDITED RELINQUISHMENT PURSUANT TO §19-5-103.5(2)(b), C.R.S. You are hereby served with a copy of the attached Petition for Relinquishment as the presumed or alleged parent of the named child. Your failure to file an answer or to appear within 20 days after service of the Petition upon you, at the Court address shown above, and, in the case of an alleged father, failure to file a claim of paternity within 20 days, may likely result in termination of parental rights concerning the child. You may waive your right to appear and contest the Petition. Failure to appear and contest may likely result in termination of the parental rights. Date: ________________________________ ____________________________________ Petitioner AFFIDAVIT OF SERVICE I declare under oath that I am over the age of 18 years and not a party to this case and that I served this Notice of Expected Relinquishment and Petition for Expedited Relinquishment in ________________ (County) ________________ (State) on (date) at the following location: Check one: By handing it to a person identified to me as the Respondent or by leaving it with the Respondent who refused service. By leaving it with ___________________________________ designated to receive service for the Respondent. I attempted to serve the Respondent ______ occasions but have not been able to locate the Respondent. Private process server Sheriff, _________________________County Fee $ ____________ Mileage $ ________ _______________________________________ Signature of Process Server _______________________________________ Name (Print or type) My Commission Expires: ________________________ JDF 486 R11/10 NOTICE OF EXPEDITED RELINQUISHMENT ___________________________________________ Notary Public /Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com