JDF 1703 R 2 - 1 8 PETITION FOR ALLOCATION OF PARENTAL RESPONSIBILITIES TO GRANDPARENT(S) PURSUANT TO 24714 - 10 - 124(1.5), C.R.S. Page 1 of 5 District Court County, Colorado Court Address: In re the Parental Responsibilities concerning: Petitioner(s): v. Respondent(s): COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom PETITION FOR ALLOCATION OF PARENTAL RESPONSIBILITIES TO GRANDPARENT(S) (PURSUANT TO 24714 - 10 - 123, C.R.S.) The Petitioner(s), as grandparent(s) of the minor child(ren) named above, seek(s) allocation of parental responsibilities for the minor child(ren), i ncluding decision - making and parenting time, and any other orders necessary to effectuate the best interest of the children, pursuant to 24714 - 10 - 123, C.R.S. 1. Information about Petitioner (1): Check if in Military Full Legal Name: Date of Birth: Current Mailing Address: City & Zip: Home Phone #: Work Phone #: Cell #: Email: Petitioner has the following relationship with the minor child(ren): Information about Petitioner (2): Check if in Military Full Legal Name: Date of Bi rth: Current Mailing Address: City & Zip: Home Phone #: Work Phone #: Cell #: Email: Co - Petitioner has the following relationship with the minor child(ren): American LegalNet, Inc. www.FormsWorkFlow.com JDF 1703 R 2 - 1 8 PETITION FOR ALLOCATION OF PARENTAL RESPONSIBILITIES TO GRANDPARENT(S) PURSUANT TO 24714 - 10 - 124(1.5), C.R.S. Page 2 of 5 2. Information about Respondent (1): Full Legal Name: Date of Bi rth: Current Mailing Address: City & Zip: Home Phone #: Work Phone #: Cell #: Email: Respondent has the following relationship with the minor child(ren): child(ren other relationship please identify Information about Respondent (2): Full Legal Name: Date of B irth: Current Mailing Address: City & Zip: Home Phone #: Work Phone #: Cell #: Email: Respondent has the following relationship with the minor child(ren): other relationship please identify 3. The minor child(ren) is/are: Name Present Address Sex Date of Birth Soc. Sec. No. 4. Check one: The child(ren) is/are not in the physical care of the parent(s). The child(ren) has/have been in the physical care of Petitioner(s) for a least 182 days or more, if such action is commenced within 182 days of the termination of such physical care. 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). American LegalNet, Inc. www.FormsWorkFlow.com JDF 1703 R 2 - 1 8 PETITION FOR ALLOCATION OF PARENTAL RESPONSIBILITIES TO GRANDPARENT(S) PURSUANT TO 24714 - 10 - 124(1.5), C.R.S. Page 3 of 5 Name Address (City/Sate/Zip Code) Time Period (Month/Year) Type of Relationship to Child(ren) 6. The Petitioner(s) are requesting allocation of parental responsibility for the following reasons: 7. I/we have participated in the following 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) (list the Court name, case number, state, date and type of proceeding): Name of Court Case Number State Date of Proceeding Type of Proceeding 8. I/we know of the following proceeding(s) that could affect the current proceeding including, but not limited to proceedings for Dissolution of Marriage/Legal Separation or Dissolution of Civil Union/Legal Separation , enforcement or Court orders, dom estic violence or domestic abuse, protection/restraining orders, termination of parental rights, and adoptions (list the Court name, case number, state, type of proceeding): Name of Court Case Number State Type of Proceeding American LegalNet, Inc. www.FormsWorkFlow.com JDF 1703 R 2 - 1 8 PETITION FOR ALLOCATION OF PARENTAL RESPONSIBILITIES TO GRANDPARENT(S) PURSUANT TO 24714 - 10 - 124(1.5), C.R.S. Page 4 of 5 9. Each party has a continuing duty to inform the Court of any proceeding(s) in this or any other state that could affect the current proceeding. 10. The following people are not parties in this matter but have physical custody of the child(ren) or claim rights of parental responsibilities, legal custody or physical custody, or visitation/parenting time with the child(ren) (names and addresses of those persons): Name of Person Address (City/State & Zip Code) 11. 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: 12. REQUIRED NOTICE OF PRIOR PROTECTION/RESTRAINING ORDERS. Have any Temporary or Permanent Protection/Restraining Orders to prevent domestic abuse or any Criminal Protection/Restraining Orders or Emergency Protection Orders been issued against any of the parties 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 and issued against in the County o f , State of , in case number . What was the subject matter of the Protection/Restraining Order or Emergency Protection Order? 13. Provide any information on any past or current criminal child abuse cases, if applicable: Wherefore, the Petitioner(s) seek(s) an order regarding an alloca tion of parental responsibilities, including decision - making and parenting time, and any other orders necessary to effectuate the best interests of the child(ren). American LegalNet, Inc. www.FormsWorkFlow.com JDF 1703 R 2 - 1 8 PETITION FOR ALLOCATION OF PARENTAL RESPONSIBILITIES TO GRANDPARENT(S) PURSUANT TO 24714 - 10 - 124(1.5), C.R.S. Page 5 of 5 By checking this box, I am acknowledging I am filling in the blanks and not changing any thing 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 penalty of perjury under the law of Colorado that the foregoing is true and correct. Executed on the day of , , at (date) (month) (year) (city or other location, and state OR country ( P rinted name of Petitioner) Signature of Petitioner I declare under penalty of perjury under the law of Colorado that the foregoing is true and correct. Executed on the day of , , at (date) (month) (year) (city or other location, and state OR country ( P rinte d name of Co - Petitioner) Signature of Co - Petitioner American LegalNet, Inc. www.FormsWorkFlow.com