JDF 1258 R 2 - 1 8 AFFIDAVIT FOR DECREE WITHOUT APPEARANCE OF PARTIES (CIVIL UNION) Page 1 of 3 District Court County, Colorado Court Address: In re the Civil Union of: Petitioner: a nd Co - Petitioner/Respondent: COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom AFFIDAVIT FOR DECREE WITHOUT APPEARANCE OF PARTIES (CIVIL UNION) Please complete the appropriate information in Numbers 1 7 prior to filing with the Court. The Petitioner and/or Co - Petitioner/Respondent files this Affidavit in support of a request for issuance of a Decree of Dissolution of Civil Union or a Decree of Legal Separation of Civil Union without appearance of th e parties. 1. The Petition for Dissolution of Civil Union /Petition for Legal Separation of Civil Union was filed on (date). On that date, Petitioner and/or Co - Petitioner/Respondent (name) had been domiciled in Colorado for more than 91 days immediately before the Petition for Dissolution of Civil Union /Petition for Legal Separation of Civil Union was filed OR Neither Petitioner nor Co - Petitioner/Respondent reside in the State of Colorado, however, the Civil Union was obtained in the State of Colorado. 2. The Petition and Summons were served by: (check one) A Co - Petitioner filing. (When both parties sign the Petition JDF 1250 ) Personal service (service by Return of Service/Affidavit of Service) on (date). Waiver of service (Respondent signs Waiver to accept service) signed on (date). Publication/Certified Mail ( Note: Service by eit her of these methods is only allowed by Court Order.) The publication occurred on (date) OR the return receipt for Certified Mail was signed by the Respondent on (date). 3. There are no minor child(ren) of the Civil Union and neither party is p regnant. Or There are minor child(ren) of the Civil Union and each party is represented by counsel . The parties have completed a Parenting Plan that provides for the allocation of parental responsibilities (decision - making responsibilities and parenting time) and have reached an agreement with respect to child support, and medical/dental insurance of the child(ren) of the civil union . The Parenting Plan is in the best interests of the child(ren). (The Parenting Plan must be filed with the Cou rt.) 4. Check only one. The parties have signed a written Separation Agreement. The parties have completed a Separation Agreement that provides for the division of all property and debts of the civil union , and addresses partner support/maintenance. The parties agree that the Separation Agreement is fair and not unconscionable. (The Separation Agreement must be signed and notarized by both parties and filed with the Court.) Or American LegalNet, Inc. www.FormsWorkFlow.com JDF 1258 R 2 - 1 8 AFFIDAVIT FOR DECREE WITHOUT APPEARANCE OF PARTIES (CIVIL UNION) Page 2 of 3 There is no property to be divide d and there are no debt of this civil union and neither party requests par tn er support/maintenance. 5. Petitioner Co - Petitioner/Respondent acknowledge (s) that they have reviewed the maintenance guidelines contained in 247 14 - 10 - 114, C.R.S. 6. The parties agree that there are no genuine issues o f material fact and the Civil Union is irretrievably broken. 7. The Petitioner Co - Petitioner/Respondent wishes to have the prior full name of restored. The restoration of the prior name will not defraud any creditors or injure third parties. 8. Other: The Petitioner and/or Co - Petitioner/Respondent request that the attached D ecree of Dissolution of Civil Union /Decree of Legal Separation of Civil Union be entered after the statutory waiting period has elapsed. 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 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 (P rinted name of Petitioner) Signature of Petitioner City State Zip Code Home Phone Cel l Phone Attorney Signature (if any) 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 ( P rinted name of Co - Petitioner /Respondent ) Signature of Co - Petitioner /Respondent City State Zip Code Home Phone Cell Phone Attorney Signature (if any) American LegalNet, Inc. www.FormsWorkFlow.com JDF 1258 R 2 - 1 8 AFFIDAVIT FOR DECREE WITHOUT APPEARANCE OF PARTIES (CIVIL UNION) Page 3 of 3 CERTIFICATE OF SERVICE (If only one party signs this Affidavit, you must complete the Certificate of Service below.) I certify that on (date) a true and accurate copy of the AFFIDAVIT FOR DECREE WITHOUT APPEARANCE OF PARTIES (CIVIL UNION) was served on the other party by: Hand Delivery, E - filed, Faxed to this number , or by placing it in the United States mail, postage pre - paid, and addressed to the following: To: (Your signature) American LegalNet, Inc. www.FormsWorkFlow.com