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: Division COURT USE ONLY Case Number: Courtroom ORDER RE: ABDUCTION PREVENTION MEASURES PURSUANT TO §14-13.5-101, C.R.S This matter comes before the Court on the Petition/Motion for Abduction Prevention Measures Pursuant to §1413.5-101, C.R.S. of the Petitioner Co-Petitioner/Respondent. Following review of the Petition/Motion and Response, if applicable, or hearing on _______________________________ (date), the Court finds the following: 1. The Court has jurisdiction over the Petitioner and the minor child(ren). 2. The Court states the following regarding personal 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 Respondent was given notice of these proceedings on ________________ (date) at _______ (time). Other jurisdiction/notice: _______________________________________________________________. Mother Father Grandparent Other __________________________ 3. The Petitioner is the biological of the minor children. 4. The Co-Petitioner/Respondent is the biological ______________________ of the minor child(ren). Mother Father Grandparent Other 5. The following minor child(ren) who is/are subject to this Order is/are: Full Name of Child Present Address Sex Date of Birth Age JDF 1231 R7/13 ORDER RE: ABDUCTION PREVENTION MEASURES © 2013 COLORADO JUDICIAL DEPARTMENT FOR USE IN THE COURTS OF COLORADO Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com 6. The child(ren)'s country of habitual _______________________________ residence at the time of this Order is as follows: 7. Below is a detailed description of each party's current allocation of parental responsibility or custody and visitation rights, and residential arrangements for the child(ren), and any allocation of parental responsibility or custody determinations in effect: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 8. The Court has considered the allocation of parental responsibilities of the parties or custody and visitation rights of the parties and the child-custody determination currently in effect at the time of the filing of the petition. The Court has considered the age of the child(ren), the potential harm to the child(ren) from an abduction, the legal and practical difficulties of returning the child to the jurisdiction if abducted, and the reasons for the potential abduction, including evidence of domestic violence, domestic abuse, stalking, or child abuse or neglect. The Court finds a credible risk of abduction of the child(ren) and finding that it is in the best interest of the child(ren) to enter the following Orders in order to prevent abduction of the child(ren): An imposition of travel restrictions that require that a party traveling with the child(ren) outside a designated geographical area provide the other party with the following; The travel itinerary of the child(ren); A list of physical addresses and telephone numbers at which the child(ren) can be reached at specified times; and Copies of all travel documents. A prohibition of the Petitioner or Co-Petitioner/Respondent directly or indirectly from: removing the child(ren) from this State, the United States, or another geographic area without permission of the court or the other party's written consent; removing or retaining the child in violation of a child-custody or allocation of parental responsibility determination; removing the child(ren) from school or a child-care or similar facility; or approaching the child(ren) at any location other than a site designated for supervised visitation, supervised parenting time, or supervised exchange. Petitioner or Co-Petitioner/Respondent is registering this Order in _____________________ (name of State) as a prerequisite allowing the child(ren) to travel to that State. The Court enters the following orders with regard to the child(ren)'s passport: Petitioner Co-Petitioner/Respondent place the child's name in the United States Department of State's child passport issuance alert program; A requirement that the Petitioner Co-Petitioner/Respondent surrender to the Court or to the party's attorney any United States or foreign passport issued in the child's name, including a passport issued in the name of both the parent and the child(ren); and JDF 1231 R7/13 ORDER RE: ABDUCTION PREVENTION MEASURES © 2013 COLORADO JUDICIAL DEPARTMENT FOR USE IN THE COURTS OF COLORADO Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com  A prohibition upon the Petitioner Co-Petitioner/Respondent from applying on behalf of the child(ren) for a new or replacement passport or visa. As a prerequisite to exercising custody, parental responsibilities, or visitation or parenting time, a requirement that the Petitioner Co-Petitioner/Respondent, provide; To the United States Department of State Office of Children's Issues and the Relevant Foreign Consulate or Embassy, an authenticated copy of the Order detailing passport and travel restrictions for the child(ren). To the Court: Proof that the Petitioner Co-Petitioner/Respondent has provided the authenticated copy of the Order detailing passport and travel restrictions for the child(ren) to the Department of State Office of Children's Issues and the Relevant Foreign Consulate or Embassy; and An acknowledgment in a record from the Relevant Foreign Consulate or Embassy that no passport application has been made, or passport issued, on behalf of the child(ren). To the Petitioner Co-Petitioner/Respondent proof of registration with the United States Embassy or other United States Diplomatic Presence in the Destination Country and with the Central Authority for the "Hague Convention on the Civil Aspects of International Child Abduction", if that