District Court Denver Juvenile Court _________________________________ County, Colorado Court Address: In re the Parental Responsibilities concerning: _________________________________________________ Petitioner(s): and Co-Petitioner/Respondent(s): COURT USE ONLY Case Number: Division Courtroom ORDER FOR ALLOCATION OF PARENTAL RESPONSIBILITIES This matter was heard on _____________________________ (date). Petitioner Appeared in person Did not appear Participated by absentee testimony Was represented by an attorney Attorney Name: Co-Petitioner Respondent Appeared in person Did not appear Participated by absentee testimony Was represented by an attorney Attorney Name: The Court has examined the records and evidence presented and has heard the testimony and statements of the parties and makes the following Findings: 1. The Court has jurisdiction over the Petitioner and the minor children. 2. The Court does does not have jurisdiction over the Co-Petitioner/Respondent. The Respondent was served in _____________________ (name of state) on ________________ (date). The Respondent signed an Acceptance and Waiver of Service on _________________________ (date). The child(ren) was/were conceived in Colorado. The Respondent was served by publication on __________________________________ (date) pursuant to §14-10-107(4)(a), C.R.S. and/or §14-13-108, C.R.S. if the Respondent does not reside in Colorado. Other jurisdiction _____________________________________________________________________. 3. The Petitioner is the biological of the minor children. Mother Father Grandparent Other __________________________ 4. The Co-Petitioner/Respondent is the biological ______________________ of the minor child(ren). Mother Father Grandparent Other 5. The following minor child(ren) is/are: Full Name of Child Present Address Sex Date of Birth JDF 1422 R7/13 ORDER FOR ALLOCATION OF PARENTAL RESPONSIBILITIES © 2013 Colorado Judicial Department for use in the Courts of Colorado Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com The Court based on these Findings, Orders as follows: 1. The Parenting Plan (JDF 1113), Signed Stipulation filed on _______________________ (date), or Mediation Agreement filed on _____________________ (date) is found to be in the best interest of the child(ren) and is incorporated into and made a part of this Order. or 2. The Court finds that it is in the best interest of the child(ren) to allocate decision-making responsibilities as follows: ______________________________ (name of party) shall have sole decision-making responsibilities. The parties shall jointly share decision-making responsibilities. Other as set forth in "Additional Court Orders" - Section 12 below. 3. Parenting time as set forth below is found to be in the best interest of the child(ren) and is ordered as follows: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 4. Child Support shall be per the Support Order (JDF 1117), Parenting Plan, or another Order issued on ______________________________ (date) and is incorporated into and made part of this Order. or 5. Child Support shall be as follows: a. The Petitioner Co-Petitioner/Respondent shall pay child support to the Petitioner CoPetitioner/Respondent Other Party: __________________________ in the amount of $_____________ per month. b. Payments shall be paid weekly bi-weekly twice a month monthly other: ___________________________and shall continue until the children reach the age of 19 or are emancipated at an earlier age, or the Court modifies child support. c. The first payment is due on ____________________________ (date). d. Child support payments shall continue until further Order of the Court. Payments shall be mailed to: Family Support Registry P. O. Box 2171, Denver, CO 80201-2171. or Child Support shall be paid directly to Petitioner Co-Petitioner/Respondent Other Party. The Court Orders the immediate activation of an Income Assignment against the Obligor pursuant to §1414-111.5, C.R.S. The Income Assignment shall be paid per section 5d above. or This Order is not subject to the immediate activation of an Income Assignment because either: Both parties have entered into a written agreement, however if a payment is missed, a wage assignment will be established. The Court finds there is good cause not to require the immediate activation of an Income Assignment because: ________________________________________________________________________________ ________________________________________________________________________________ JDF 1422 R7/13 ORDER FOR ALLOCATION OF PARENTAL RESPONSIBILITIES © 2013 Colorado Judicial Department for use in the Courts of Colorado Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com 6. Medical, Dental, Vision, and Mental Health Insurance and Extraordinary/Out-of Pocket Medical Expenses shall be paid per the Parenting Plan or another Order issued on __________________________ (date) and is incorporated into and made a part of this Order. or 7. The Court orders the Petitioner or Co-Petitioner/Respondent to provide medical dental vision mental health insurance for the child(ren). If not all children, please identify the names of the children that this party will be providing insurance for: _________________________________________. Coverage shall be provided pursuant to Policy Number: ___________________________, Name of Insurer: ___________________________, Address of Insurer: ___________________________________________. 8. The Court finds________________________________ insurance is currently not available to either party at a reasonable cost and does not order either party to provide coverage for the children at this time, but does order the parties to provide coverage when it becomes available at a reasonable cost. 9. The Dependency Exemption shall be per the Parenting Plan and is incorporated into and made a part of this Order. or 10. The Dependency Exemption shall be as follows: 11. A Protection/Restraining Order was issued on _________________________________ (date). The Protection/Restraining Order is: Vacated. Continued to ___