JDF 1259 R 5 - 1 8 MOTION TO CONVERT DECREE OF LEGAL SEPARATION OF CIVIL UNION TO DECREE OF DISSOLUTION OF CIVIL UNION 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 TO CONVERT DE CREE OF LEGAL SEPARA TION OF CIVIL UNION TO DECREE OF DISSOLU TION OF CIVIL UNION The Petitioner Co - Petitioner/Respondent (check one) moves this Court to convert the Decree of Legal Separation of Civil Union to a Decree of Dissolution of Civil Union pursuant to Colorado Revised Statutes 24714 - 10 - 120(2) and 24714 - 15 - 107(4 ) . In support of this Motion, I state the following: 1. The Court entered a Decree of Legal Separation of Civil Union in this case on ( date). 2. At least 182 days have passed since the entry of the Decree of Legal Separation of Civil Union . 3. Notice has been provided to the ot her party as set forth in the Certificate of Service (below). Therefore, I request that the Decree of Legal Separation of Civil Union be converted to a Decree of Dissolution of Civil Union . 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 Printed name of Petitioner Co - Petitioner/Respondent Signature of Petitioner Co - Petitioner/Respondent Date Address City St a te Zip Code (Area Code) Telephone Number (home) ( A r e a C ode) Telephone Number (work) CERTIFICATE OF SERVICE I certify that on (date), the original was filed with the Court; and, a true and accurate copy of the MOTION TO CONVERT DECREE OF LEGAL SEPARATION OF CIVIL UNION TO DECREE OF DISSOLUTION OF CIVIL UNION was served on the other party by: Hand Delivery or 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