JDF 504 R 1 /1 8 PETITION FOR SECOND PARENT ADOPTION Page 1 of 3 District Court Denver Juvenile Court County, Colorado Court Address: I n the Matter of the Petition of : ( name of person seeking to adopt) F or the Adoption of a Child COURT USE ONLY Attorn ey or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: A tty. Reg. #: Case Number: Division Courtroom PETITION FOR SECOND PARENT ADOPTION According to the requ irements set forth in 247 19 - 5 - 203, C.R.S. the Petitioner requests that he/she adopt the child identified below . The child has a sole legal parent. The Petitioner desires to adopt the child so as to make said child for all intents and purposes the legal ch estate , states the following facts: Information about the Petitioner: Petitioner: (Full Name) Date of Birth: Race: Place of Birth: Current Mailing Addres s: City, State & Zip: Home Phone #: Work Phone #: Cell #: Length of Residence in Colorado: Occupation: P or about the time of the b irth of the child: Street A ddress City State Zip Code Venue is proper in this matter because the Petitioner resides in this county. The written home study prepared by a county Department of Social Services, Designated Qualified Individual, or Child Placement Agency a nd a pproved by the Department pursuant to 247 19 - 5 - 207.5(2) , C.R.S. is attached. The child was adopted by the sole legal parent less than six months prior to the date of the filing of this action petition and the Petitioner was included in the home study r eport that was prepared pursuant to 247 19 - 5 - 207 , C.R.S. for the adoption of the child by the sole legal parent. The home study prepared for that adoption is attached. The current fingerprint - based criminal history record s check as required by 24719 - 5 - 207 (2.5 ) (a)(I) - (IV), C.R.S. and the TRAILS background check as required by 24719 - 5 - 207, C.R.S. are included in the written home study . American LegalNet, Inc. www.FormsWorkFlow.com JDF 504 R 1 /1 8 PETITION FOR SECOND PARENT ADOPTION Page 2 of 3 If you have been convicted of a felony or misdemeanor in any of the following areas, please check the appropriate box and i dentify for the Court the date of the conviction and if it was a felony or misdemeanor. child abuse or neglect on (date). Felony Misdemeanor spousal abuse on (date). Felony Misdemeanor any crime against a child on (date). Felony Misdemeanor any crime, the underl ying factual basis of which has been found by the Court to include an act of domestic violence on (date). Felony Misdemeanor violation of a Protection/Restraining Order on (date). Felony Misdemeanor any crime involving violence, rape, sexual assault, or homicide on (date). Felony Misdemeanor any felony involving physical assault or battery on (date). Felony Misdemeanor any felony drug - related convictio n within the past five years, at a minimum on (date). Felony Misdemeanor Facts concerning the child to be adopted : Full Name: Date of Birth: P lace of Birth: P lace of Residence: The child is under the age of twelve years or The child is over the age of twelve years and his/her written consent to the adoption is attached. The child will not be the subject of a pending dependency and neglect action when the adoption is heard. If applicable, n ame and address of the Guardian(s) of the child and estate of said child if any have been appointed: T he child is is not a member or eligible to be a member of an Indian tribe as defined by the Indian Welfare Act. If applicable, name of tribe . 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. Information about the So le Legal Parent : Full N ame : Current Mailing Address: City, State & Zip: The person named above is the Sole Legal Parent because: T he other parent relinquished parental rights t o the child in (c ounty/state) ( case number ) on (date). American LegalNet, Inc. www.FormsWorkFlow.com JDF 504 R 1 /1 8 PETITION FOR SECOND PARENT ADOPTION Page 3 of 3 The other in (county/state) (case number) on (date). The person named above adopted the child as a single parent in (county/state) (case number) on (date). The other parent died on (date). The child was conceived by assisted reproductive means and no other legal parent exists pursuant to 247 19 - 4 - 106 , C.R.S . The written consent of the Sole Legal Parent (JDF 508) is attached . W herefore , Petitioner pray s that a Decree of Adoption be entered herein declaring said child to be the child of Petitioner and that the name of said child be changed to (full name) and that said child shall be entitled to all of the rights and privileges and be subject to all of the obligations now conferred and imposed by law. 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 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 Attorney Signature, if applicable American LegalNet, Inc. www.FormsWorkFlow.com