JDF 1104 R 5 /18 CERTIFICATE OF COMPLIANCE WITH MANDATORY FINANCIAL DISCLOSURES District Court Denver Juvenile Court County, Colorado Court Address: In re: The Marriage of: The Civil Union of: Parental Responsibilities concerning: Petitioner: and Co - Peti tioner/ Respondent : COURT USE ONLY Attorney or Party Without Attorney (Name and Address) : Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom CERTIFICATE OF COMPLIANCE WITH MANDATORY FINANCIAL DISCLOSURES ***** EA C H PARTY MUST COMPLETE AND FILE THIS FORM WITH THE COURT***** I, the Petitioner Co - Petiti oner /Respondent (check one) hereby certify that I have sent the other party the following Mandatory Disclosures as required by Rule 16.2(e)(7) of the Colorado Rules of Civil Procedure. See JDF 1125 : Mandatory Disclosure Form 35. 1 for explanation on what is required by the disclosures being listed. C heck those that you have furnished to the other party. (N ote : Only the Sworn Financial Statement and Child S upport Worksheet should be filed with the Court. ) Sworn F inancial Statement Retirement Plans Income Tax Return s ( m ost r ecent 3 years) Bank/Financial Institution Accounts Personal Financial Statements ( l ast 3 years) Income Documentation ( P ay S tubs, etc.) Business Financial Statements ( l ast 3 years ) Employment an d Education Related child Real Estate Documents (Appraisal, Title, etc.) Care Documentation Personal Debt (Loans, Title, C redit C ard S tatements, etc.) Insurance Documentation Investments Employment Benef its Documentation If I have not provided information, it is because: I hereby certify that, to the best of my knowledge, the disclosures I have made are complete and correct as of this date. 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. American LegalNet, Inc. www.FormsWorkFlow.com JDF 1104 R 5/18 CERTIFICATE OF COMPLIANCE WITH C.R.C.P. 26.2 Page 2 of 2 VERIFICAT ION AND ACKNOWLEDGEMEN T 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) (mont h) (year) (city or other location, and state OR country ( P rinted name of Petitioner /Co - Petitioner Respondent ) Signatu re of Petitioner/Co - Petitioner/Respondent ) Attorney Signature, if any CERTIFICATE OF SERVICE I certify that on (date) a true and accurate copy of the CERTIFICATE OF COMPLIANCE WITH MANDATORY FINANCIAL DISCLOSURES was served on the other party by : Hand Delivery , E - filed, Faxed to this number , or by placing it i n the United States mail, postage pre - paid, and addressed to the following: T o : (Your signature) Date American LegalNet, Inc. www.FormsWorkFlow.com