JDF 1230 R 2 /1 8 PETITION/MOTION FOR ABDUCTION PREVENTION MEASURES Page 1 of 4 District Court Denver Juvenile Court County, Colorado Court Address: In re: The Marriage of: The Civil Union of: Parental Responsibilities concerning: P etitioner: and Co - Petitioner/Respondent: COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom PETITION M OTION FOR ABDUCTION PREVENTION MEASURES PURSUANT TO 2471 4 - 13.5 - 101, C.R.S. Th is Petition /Motion s eeks abduction prevention measures and any other orders necessary to effectuate the best interests of the child ( ren ) pursuant to 24714 - 13.5 - 101 , et seq., C.R.S. The Petitioner Co - Petitioner/Respondent s tates the following for the purpose of seeking abduction prevention measures: 1. Information abo ut Petitioner: Check if in Military Date of Birth: Current Mailing Address: City, State & Zip Code: Home Phone #: Work Phone #: Cell #: 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 2. Information about Co - Petitioner / Respondent: Check if in Military Date of Birth: Current Mailing Address: City, State & Zip Code: Home Phone #: Work Phone #: Cell #: Co - Petitioner/ Respondent has the following relationship with the minor child(ren): American LegalNet, Inc. www.FormsWorkFlow.com JDF 1230 R 2 /1 8 PETITION/MOTION FOR ABDUCTION PREVENTION MEASURES Page 2 of 4 non - parent, and the child(r en) 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: 3. The minor child(ren) is/are: Full Name of Child Present Address Sex Date of Birth Age 4. Each party has a continuing duty to inform the Court of any proceeding(s) in this or any other state that co uld affect the current proceeding. 5. I am identifying below the name and address of each person that the child(ren) has/have lived with over the past five years and their re lationship to the child(ren). Name of Person Current Address (City/State/Zip Cod e) Time Period (Month/Year) Type of Relationship 6. I 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 - makin g, or visitation/parenting time with the child(ren). I am identifying the name of court, case number, city/ state, date and type of proceeding. (If it was not a Colorado proceeding, please attach copies ) . Name of Court Case Number City/ State Date of Proc eeding Type of Proceeding 7. I know of the following proceeding(s) filed by a party or other individual or entity having cus tody of the child to prevent abduction, domestic violence, or domestic abuse. Identify name of court, case number, city/ state, type of proceeding and disposition . (If it was not a Colorado proceeding, please attach copies). Name of Court Case Number City/ State Type of Proceeding Disposition 8. The following people are not parties in this matter but have physical custody of the child(ren) or claim rights of parental responsibilities or visitation with the child(ren). Identify name and address of those persons. Name of Person Address (City/State & Zip Code) American LegalNet, Inc. www.FormsWorkFlow.com JDF 1230 R 2 /1 8 PETITION/MOTION FOR ABDUCTION PREVENTION MEASURES Page 3 of 4 9. Has a party t o this case ever been arrested for a crime related to domestic violence, stalking, or child abuse or neglect? Yes No If Yes , identify the name of party, date, location and disposition of the case : Name of Party Date Location Disposition 10. Petitioner or Co - Petitioner / R espondent has engaged in the following activities: (Check any that apply) has previously abducted or attempted to abduct the child; has threatened to abduct the child; has recently engaged in activities that may indicate a planned abduction, including: abandoning employment ; selling a primary residence; terminating a lease; clos ing a bank account or other financial management accounts, liquidating assets, hiding or destroying financial documents, conducting unusual financial activities ; applying for a passport, visa or obtaining travel documents for the respondent, a family membe r or the child; has engaged in domestic violence, domestic abuse, stalking, or child abuse and neglect; h as refused to follow a child - custody/allocation of parental responsibilit y determination; lacks strong familial, financial, emotional, or cultural ties to the State or the United States; has strong familial, financial, emotional, or cultural ties to another state or country; is likely to take a child to a country that: is not and does not provide for the extradition of an abducting parent or for the return of an abducted child; between the United States and that Country; is noncompliant according to the most recent compliance report issued by the United Stat es Department of State; or lacks legal mechanisms for immediately and effectively enforcing a return order under the ; ety would be endangered in the country because of human rights violations committed against children ; has laws or practices that would: enable the respondent, without due cause , to prevent the petitioner f rom contacting the child; restrict the petitioner f rom freely traveling to or exiting from gender, nationality or religion ; is included by the United States department of state on a current list of state sponsors of terrorism; does not have an official Untied States diplomatic presence in the country; is engaged in active military action or w ar, including a civil war, to which the child may be exposed; is undergoing a change in immigration or citizenship status that would adversely affect the has had an application for United States citizenship denied; American LegalNet, Inc. www.FormsWorkFlow.com JDF 1230 R 2 /1 8 PETITION/MOTION FOR ABDUCTION PREVENTION MEASURES Page 4 of 4 has forged or presented misleading or false evidence on government forms or supporting documents to obtain or attempt to obtain a passport, a visa, travel documents, a social security car d , a d or other government - issued identification card or has made a misrepresentation to the United States government; has used multiple names to attempt to mislead or defraud; or h as engaged in any other conduct the court considers relevant to the risk of abduction 11. I allege that the minor child(ren) is/are in imminent danger of abduction f or the following additional reasons: 12. I request that the Court enter the following abduction prevention measures: Wherefore, the Petitioner or Co - Petitioner /Respondent seek s an order entering abduction prevention measures 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 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 or Co - Petitioner /Respondent ) Signature of Petitioner or Co - Petitioner/Respondent American LegalNet, Inc. www.FormsWorkFlow.com