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: COURT USE ONLY Case Number: Division Courtroom ORDER FOR AN EVALUATION AND REPORT PURSUANT TO §14-10-127, C.R.S. This matter is before the Court on the Court's motion, Petitioner's motion, Co-Petitioner/Respondent's motion or Stipulation of the parties for the appointment of a licensed mental health professional to perform an evaluation and file a written report concerning the disputed issues relating to the allocation of parental responsibilities. Pursuant to §14-10-127, C.R.S., the Court hereby appoints the following licensed mental health professional to complete an evaluation: Name of Evaluator: __________________________________________________________________________ Mailing Address: _____________________________________________________________________________ Telephone #: ___________________ Fax #: ____________________ Email: _____________________________ The appointed evaluator is required within 7 days of appointment, to disclose to each party, attorneys of record, and the court any familial, financial, or social relationship that the appointed person has or has had with the child, either party, the attorneys of record, or the Judicial Officer (JDF1338) The evaluation shall be conducted and the report written, pursuant to the criteria outlined in §14-10-127, C.R.S. The report shall be filed with the Court, and a copy to counsel, and any parties not represented by counsel by ___________________________ (Date), or at least 21 days prior to the hearing date. This report shall be considered confidential and shall not be available for public inspection unless ordered by the Court. Petitioner, Co-Petitioner/Respondent, or both parties, shall deposit monies for the evaluation either directly to the evaluator, or with the Court by _________________________ (Date). The Name of Child(ren): __________________________________________ Date(s) of Birth: __________________ Date: ______________________________ _____________________________________ Judge Magistrate CERTIFICATE OF SERVICE I certify that on __________________ (Date), I mailed, faxed, e-filed, or hand-delivered a copy of this Order to the following: Attorney for Petitioner or Petitioner pro se Attorney for Co-Petitioner/Respondent or Co-Petitioner/Respondent pro se Professional Evaluator Other: ____________________________________ _____________________________________ Clerk JDF 1332 R7-13 ORDER FOR AN EVALUATION AND REPORT PURSUANT TO §14-10-127, C.R.S. © 2012, 2013 Colorado Judicial Department for use in the Courts of Colorado American LegalNet, Inc. www.FormsWorkFlow.com