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