JDF 1253 R 2 / 1 8 MOTION /STIPULATION TO MODIFY PETITION (CIVIL UNION) Page 1 of 2 District Court County, Colorado Court Address: In re the Civil Union of: Petitioner: and 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 MOTION STIPULATION T O MODIFY PETITION (CIVIL UNION) The Petitioner Co - Petitioner/Respondent Both moves this Court to modify the Petition and states the follow ing : Check one: Convert from a Petition for Dissolution of Civil Union to a Petition fo r Legal Separation of Civil Union Convert from a Petition for Legal Separation of Civil Union to a Petition for Dissolution of Civil Union 1. The Petition was filed on ( date) and final orders have not been issued by this Court . 2. If applicable, n otice has been provided to the other party as set forth in the Certificate of Service (below). 3. If applicable, the Petitioner Co - Petitioner/Respondent requests that the Court restore his/her prior name to . 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. SIGNATURE ( P rinted name of Petitioner) Signature of Petitioner Date Printed name of Co - Petitioner/Respondent Signatu r e of Co - Petitioner/Respondent Date American LegalNet, Inc. www.FormsWorkFlow.com JDF 1253 R 2 / 1 8 MOTION /STIPULATION TO MODIFY PETITION (CIVIL UNION) Page 2 of 2 CERTIFICATE OF SERVICE (If only one party signs this Motion/Stipulation , complete the Certificate of Service below.) I certify that on (date) a true and accurate copy of the Motion /Stipulat ion to Modify Petition (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