JDF 141 3 R 2 /1 8 PETITION FOR ALLOCATION OF PARENTAL RESPONSIBILITIES Page 1 of 4 District Court Denver Juvenile Court County, Colorado Court Address: In re the Parental Responsibilities concerning: Petitioner: and Co - Petitioner /Respondent : COU RT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Cou rtroom PETITION FOR ALLOCATION OF P ARENTAL RESPONSIBILITIES Th is Petition seeks allocation of parental responsibilities including decision - making responsibilities and parenting time for the minor child(ren), establishment of a child support order, and any other orders necessary to effect uate the best interests of the children pursuant to 24714 - 10 - 12 3 , C.R.S. and states: 1. Information about Petitioner: Check if in Military Full Legal Name: Date of Birth: Current Mailing Address : Apt. # City: State: Zip Code: Home Phone #: Email Address: Cell Phone #: Petitioner has the following relationship with the minor child(ren): non - parent, and the child(ren) is/are not in the physical custody of one of the parents non - parent, who has had physical custody of the child(ren) for 182 days or more, and the physical custody did not end more than 182 days before the filing of this action other (please specify): 2. Information abo ut Co - Petitioner /Respondent : Check if in Military Full Legal Name: Date of Birth: Current Mailing Address : Apt. # City: State: Zip Code: Home Phone #: Email Address: Cell Phone #: Co - Petitioner/ Re spondent has the following relationship with the minor child(ren): non - parent, and the child(ren) is/are not in the physical custody of one of the parents non - parent, who has had physical custody of the child(re n) for 182 days or more, and the physical custody did not end more than 182 days before the filing of this action other (please specify): American LegalNet, Inc. www.FormsWorkFlow.com JDF 141 3 R 2 /1 8 PETITION FOR ALLOCATION OF PARENTAL RESPONSIBILITIES Page 2 of 4 3. The minor child(ren) is/are: Full Name of Child Present Address Sex Date of Birth 4. The child(ren) listed above have lived in Colorado for a minimum of six months prior to the filing of this Petition or since birth if under six months of age? No Yes If No, please state the name of child, name of person child lived w ith and the month, date and year when each child most recently moved to Colorado. Full Name of C hild Name of Person Child Lived with State Moved From Month Day Year 5. Identify below the name and address of each person that the child(ren) has/have lived with over the past five years. Please identify the relationship to the child(ren). Name Address (City/S t ate/Zip Code) Time Period (Month/Year) Type of Relationship to Child(ren) 6. I/We understand tha t a request by either party for genetic testing shall not prejudice the requesting party in the allocation of parental responsibilities. 7. Each party has a continuing duty to inform the Court of any proceeding(s) in this or any other state that could affec t the current proceeding. 8. I/We understand that the Court may review any case involving the children, Petitioner, Co - Petitioner/ Respondent and other parties named in this Petition that have be e n filed in any Court . 9. I /We have participated in the followin g proceeding(s) regarding the child(ren) as a party or a witness, or in any other capacity concerning issues of custody/allocation of decision - making, or visitation/parenting time with the child(ren) . Identify name of court , case number, state, date and t ype of proceeding . Name of Court Case Number State Date of Proceeding Type of Proceeding 10. I/ W e know of the following proceeding(s) that could affect the current proceeding including, but not limited to proceedings for Dissolution of Marriage or Civil Union, Legal Separation (Marriage or Civil Union) , American LegalNet, Inc. www.FormsWorkFlow.com JDF 141 3 R 2 /1 8 PETITION FOR ALLOCATION OF PARENTAL RESPONSIBILITIES Page 3 of 4 enforcement of Court orders, domestic violence or domestic abuse, protection/restraining orders, termination of parental rights, and adoptions. Identify name of court , case number, s tate, date and type of proceeding . Name of Court Case Number State Date of Proceeding Type of Proceeding 11. The following people are not parties in this matter but have physical custody of the child(ren) or claim rights of parental responsibilities with the child(ren) . Identify name and address o f those persons . Name of Person Address (City/State & Zip Code) 12. The best interests of the child(ren) would be served by allocating parental responsibilities to the Petitioner(s) as follows and for the following reasons: 13. Required Notice of Human Services Involvement . The parents or dependent child(ren) listed on this Pe tition has/have received within the last five years, or is/are currently receiving benefits or public assistance from the state Department of Human Services or the County Department of Social Services . No Yes If your answer was Yes , complete the foll owing: Name of Person Receiving Benefit Name of County and State Case Number Month/Year 14. R equired Notice of Prior Protection/Restraining Orders. Have any Temporary or Permanent Protection/Restraining Orders to prevent domestic abuse or any Criminal Mandatory Protection/Restraining (MRO) Orders or Emergency Protection Orders been issued against either party by any Court within two years prior to the filing of this Petition? No Yes If your answer was Yes , complete the following: The Protection/Restraining Order was Temporary Permanent MRO and issued against in a Municipal Court County Court District Court in the County of , State of , in case number on (date) . What was the subject matter of the Protection/Restraining Order or Emergency Protection Order? American LegalNet, Inc. www.FormsWorkFlow.com JDF 141 3 R 2 /1 8 PETITION FOR ALLOCATION OF PARENTAL RESPONSIBILITIES Page 4 of 4 Notice of Existing Case with Child Support Enforcement (CSE) The parents have filed a case with CSE? No Yes If Yes , identify the case number: Notice: Colorado Revised Statutes 24714 - 10 - 123, provides that upon the filing of a Petition for Allocation of Parental Responsibilities by the Petitioner and Co - Petitioner, or upon personal service of the Petition and Summons on the Respondent, or upon waiver and acceptance of service by the Respondent, an automatic temporary injunction shall be in effect against both parties until the Final Order is entered, or the Petition is dismissed, or until furt her Order of the Court. Either party may apply to the Court for further temporary orders, an expanded automatic temporary injunction, or modification or revocation under 24714 - 10 - 125, C.R.S. 1. Both parties are enjoined from molesting or disturbing the peace of the other party; and 2. Both parties are restrained from removing the minor child(ren) from the state without the consent of all parties or an Order of the Court modifying the injunction ; and 3. Both parties are restrained, without at least 14 days advanc e notification and the written consent of all other part ies or an Order of the Court, from cance l ling, modifying, terminating, or allowing to lapse for nonpayment of premiums, any policy of health insurance or life insurance that provides coverage to t he m inor child(ren) as a beneficiary of a policy . Petitioner and Co - Petitioner, if any, acknowledge that he or she has received a copy of, has read, and understands the terms of the automatic temporary injunction set forth in this Petition . I/We seek an orde r granting the allocation of parental responsibilities, the establishment of child support, and any other orders necessary to effectuate the best interests of the child(ren). 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. VERIFICATION I declare under pena lty of perjury under the law of Colorado that the foregoing is true and correct. Executed on the day of , , at (date) (mo