JDF 1338 Mandatory Disclosure Pursuant to C.R.S. 24714 - 10 - 116, 24714 - 10 - 116.5, 24714 - 10 - 127, 24714 - 10 - 128.1, 24714 - 10 - 128.3. R 7 - 1 3 Page 1 of 2 District Court Denver Juvenile Court County, Colorado Court Address: In re: The Marriage of: The Civil Union of: Parental Responsibilities concerning: Petitioner: a nd Co - Petitioner/Respondent: COURT USE ONLY Case Number: Division Courtroom MAND A TORY DISCLOSURE RE: APPOINTMENT OF LEGAL REPRESENTATIVE OF THE CHILD PURSUANT TO 24714 - 10 - 116, C.R.S. or APPOINTMENT OF A CHILD AND FAMILY INVESTI GATOR PURSUANT TO 24714 - 10 - 116.5, C.R.S. or APPOINTMENT OF A MENTAL HEALTH PROFESSIONAL TO PERFORM AN EVALUATION AND REPORT PURSUANT TO 24714 - 10 - 127, C.R.S. or APPOINTMENT OF PARENTING COORDINATOR PURSUANT TO 24714 - 10 - 128.1, C.R.S. or APPOINTMENT OF DECISION - MAKER PURSUANT TO 24714 - 10 - 128.3, C.R.S. You are required within seven days of your appointment, to disclose to each party, attorneys of record, and the court any familial, financial, or social relationship that the appointed person has or has had with the child, either party, the attorneys of record, or the judicial Officer and, if a relationship exists, the nature of the relationship. Based on the disclosure required, the court may, in its discretion, terminate the appointment and appoint a different person in the proceedings. A party has 7 days from the date of the disclosure to object to the appointment based upon information contained in the disclosure. If a party objects to the appointment, the court shall appoint a different person or co nfirm the appointment within 7 days after the date of the party's Objection. If no party timely objects to the appointment, then the appointment is deemed confirmed. 1 . Do you have or have you had a familial, financial, or social relationship with the child, either party, the attorneys of record, or the J udicial Officer? Yes No 2. If yes, p lease explain the nature of the relationship? 3. Does the relationship that is explained above represent a conflict of interest or appearance of impropriety in your opinion ? Yes American LegalNet, Inc. www.FormsWorkFlow.com JDF 1338 Mandatory Disclosure Pursuant to C.R.S. 24714 - 10 - 116, 24714 - 10 - 116.5, 24714 - 10 - 127, 24714 - 10 - 128.1, 24714 - 10 - 128.3. R 7 - 1 3 Page 2 of 2 N o - Please Explain answer : (Answering Yes to Question 3 requires that you decline appointment in this case. If you h ave answered NO, please complete the form and disclose to each party, attorneys of record, and the court.) Appointments and Objections s hall: CFI appointment: Wait for the court to determine if the appointment should continue. If the court finds a conflict to seek or a ccept appointments were a conflict of interest or appearance of impropriety exists. Decision Maker appointment: Immediately decline the appointment when parties object. Statute and Chief Justice Directive prohibit appointment of Decision Maker without th e agreement of the parties. PC, PRE and CLR: Wait for the court to determine if the appointment should continue when a party objects. Statute and Chief Justice Directive do not prohibit appointment without agreement of the parties; however , the Court mu st confirm your appointment after an objection is filed in order to serve. 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 chan ge to the original content of this form. SIGNATURE ( Printed name of Signee ) Signature of Signee Date CERTIFICATE OF SERVICE I certify that on (Date), I mailed, faxed, e - filed, or hand - delivered a copy of this Order to the following: Attorney for Petitioner or Petitioner pro se Attorney for Co - Petitioner/R espondent or Co - Petitioner/Respondent pro se Professional Evaluator Other: Clerk American LegalNet, Inc. www.FormsWorkFlow.com