JDF 452 R 3 /1 8 PETITION FOR RELINQUISHMENT / EXPEDITED RELINQUISHMENT Page 1 of 3 District Court Denver Juvenile Court County, Colorado Court Address: I n the Matter of the Petition of : And Petitioner(s) F or the Re linquishment of a Child , COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom PETITION FOR RELINQUISHMENT OR EXPEDITED RELINQUISHMENT PURSUANT TO 24719 - 5 - 103.5, C.R.S. The Petitioner(s) respectfully represent(s) to the Court: 1. (name of child), was born on (date), in (city/state), and is the child of the Petitioner(s). 2. The names, dates of birth, and addresses of the parents of the child are: Information about the Mother : Petitioner Co - Petitioner/Respondent Name: Date of Birth: Street Address : Mailing Address, if different: City: State: Zip Code: Main Phone #: Email Address: Secondary Phone #: Information about the Father : Petitioner Co - Petitioner/Respondent Presumed Al leg ed Name: Date of Birth: Street Address : Mailing Address, if different: City: State: Zip Code: Main Phone #: Email Address: Secondary Phone #: Information about the Father : Petitioner Co - Petitioner/Respondent Presumed Alleg ed Name: Date of Birth: Street Address : Mailing Address, if different: City: State: Zip Code: Main Phone #: Email Address: Secondary Phone #: American LegalNet, Inc. www.FormsWorkFlow.com JDF 452 R 3 /1 8 PETITION FOR RELINQUISHMENT / EXPEDITED RELINQUISHMENT Page 2 of 3 3. Venue is proper in this county because: (a) The Petitioner(s) reside(s) in this county at OR (b) The child resides in this county at OR (c) A Child Placement Agency, is involved and is located in this county with an office registered with th e Colorado Department of Human Services at : 4. The Petitioner(s) wish(es) to relinquish the child because: 5. The Petitioner(s) believes that this relinquishment is in th e best interest of the child named above . 6. The Petitioner(s) understand(s) that : After the Order of Relinquishment is entered, the Petitioner(s) will be unable to change his/her/their mind(s) about relinquishment. OR If this is an Expedited Relinqui shment, the Petitioner(s) understand(s) that after the Petition is filed with the Court that the Petitioner(s) will be unable to withdraw the attached affidavit in support of the relinquishment. 7. The Petitioner(s) understand(s) that this is a permanent te rmination of parental rights with respect to the child named above. 8. The decision to relinquish the child named above is knowing and voluntary and without undue pressure or influence from anyone else. 9. The Petitioner(s) has/have has/have not received counseling from regarding this proposed relinquishment, as described in the attached Affidavit of Relinquishment Counseling. 10. The Petitioner(s) has/have has/have not received, been promised or offered any payments, gifts, assistants, goods, or services and the source of such payments. American LegalNet, Inc. www.FormsWorkFlow.com JDF 452 R 3 /1 8 PETITION FOR RELINQUISHMENT / EXPEDITED RELINQUISHMENT Page 3 of 3 11. The child is is not a member or eligible to be a member of an Indian tribe as defined by the Indian Child Welfare Act. If applicable, name of tribe . (Attached is assessm ent form JDF 567 or JDF 568, to comply with the Indian Child Welfare Act (ICWA). Notice of this Petition has been provided to the parent or Indian custodian of the child and to the tribal agent of the tribe, as required by 24719 - 1 - 126(1)(c), C.R.S. Rea sonable efforts have been made to send notice to the identified persons as follows: Attach the postal receipts to this petition, indicating that notice was properly sent. If the postal receipts have not been re turned at the time of filing, the postal receipts or copies shall be filed with the Court within ten days of the filing of this petition. 12. The child is is not twelve years of age or older. 13. The child is is not one year of age at the time of filing th is Petition. 14. The child has has not received counseling in connection with this proposed relinquishment. W herefore , the Petitioner(s) respectfully request(s) that the Court enter a Final Order of Relinquishment and transfer guardianship of the person and legal custody of the child to a proper person or agency. By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. By checking this box, I am acknowledging that I have made a change to the or iginal content of this form. SIGNATURE Printed name of Pe titioner Signature of Petitioner Date Printed name of Co - Petitioner Signature of Co - Petitioner Date American LegalNet, Inc. www.FormsWorkFlow.com