District Court Denver Juvenile Court ________________________________ County, Colorado Court Address: In re: The Marriage of: The Civil Union of: Parental Responsibilities concerning: ______________________________________________________ Petitioner: and Co-Petitioner/Respondent: Attorney or Party Without Attorney (Name and Address): COURT USE ONLY Case Number: Phone Number: FAX Number: E-mail: Atty. Reg. #: Division Courtroom MOTION FOR AN EVALUATION AND REPORT PURSUANT TO §14-10-127, C.R.S. The Petitioner, Co-Petitioner/Respondent, Stipulation of the parties requests this Court to order an evaluation and written report concerning the disputed issues relating to the allocation of parental responsibilities of the child(ren) pursuant to §14-10-127, C.R.S. and appoint a mental health professional or approve the appointment of the following evaluator _________________________________________________. I request this evaluation because: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ Date: __________________________ _____________________________________________ Petitioner or Co-Petitioner/Respondent CERTIFICATE OF SERVICE I certify that on __________________________ (Date) the original was filed with the Court; and, a true and accurate copy of the Motion for an Evaluation and Report Pursuant to §14-10-127, C.R.S. 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 JDF 1331 R7/13 MOTION FOR AN EVALUATION AND REPORT PURSUANT TO §14-10-127, C.R.S. © 2013 Colorado Judicial Department for use in the Courts of Colorado American LegalNet, Inc. www.FormsWorkFlow.com