J DF 1250 R 2 - 1 8 PETITION FOR DISSOLUTION OR LEGAL SEPARATION OF CIVIL Page 1 of 4 District Court County, Colorado Court Address: In re the Civil Union of: Petitioner: a nd 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 FOR : DISSOLUTION OF CIVIL UNION LEGAL SEPARATION OF CIVIL UNION PURSUANT TO 247 14 - 10 - 106 .5 , C.R.S. AND 247 14 - 15 - 115, C.R.S. ****** IF CHILDREN ARE PART OF THIS ACTION , PLEASE CHECK HERE ****** 1. This Petition is for Dissolution of Civil Union or Legal Sepa ration of Civil Union . 2. The Civil Union is irretrievably broken. 3. Information about the Petitioner : Check if in Military Full Legal Name: Date of Birth: Length of Current Residenc y in Colo rado: (Years/months) Dates: Current Mailing Address : City: State: Zip Code: Home Phone #: Email Address: Cell Phone #: 4. Information about the Co - Petitioner/Respondent : Check if in Military Full Legal Name: Date of Birth: Length of Current Residency in Colorado: (Years/months) Dates: Current Mailing Address : City: State: Zip Code: Home Phone #: Email Address: Cell Pho ne #: 5. Date of the Civil Union : Place of Civil Union : (City/State) 6. Date the parties physically separated: 7. A party of the Civil Union is presently expecting a child not presently expecting a child . American LegalNet, Inc. www.FormsWorkFlow.com J DF 1250 R 2 - 1 8 PETITION FOR DISSOLUTION OR LEGAL SEPARATION OF CIVIL Page 2 of 4 8. The following child(ren) was/were born or adopted of this union . (attach a second sheet, if necessary): Full Name of Child Present Address Sex Date of Birth 9. The child( ren) listed above have lived in Colorado for a minimum of 182 days prior to the filing of this Petition or since birth if under six months of age . Yes No If No, please state the name of child, name of person child lived with and the month, date and ye ar when each child most recently moved to Colorado. Full Name of Child Name of Person Child Lived with State Moved From Month Day Year 10. I/We understand that a request for genetic tests shall not prejudice the requesting party in matters concerning allocation of parental responsibilities pursuant to 247 14 - 10 - 124(1.5), C.R.S and 247 14 - 15 - 107(4). If genetic tests are not obtained prior to a legal establishment of parentage and submitted into evidence prior to the entry of the final decree of dissolution or legal separation , the genetic tests may not be allowed into evidence at a later date. 11. Each party has a continuing duty to inform the C ourt of any proceeding in this or any other state that could affect the current proceeding. 12. 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. 13. 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 the allocation of parental responsibilities including d ecision - making , child support and parenting time with the child(ren) . Identify name of court , case number, state, date , and type of proceeding if any . Name of Court Case Number State Date of Proceeding Type of Proceeding 14. I/We know of the following proceeding (s) that could affect the current proceeding including, but not limited to proceedings relati ng to domestic violence or domestic abuse, enforcement of Court orders, protection/restraining orders, termination of parental rights, and adoptions . Identify name of court, case number, state, date, and type of proceeding if any. Name of Court Case Numbe r State Date of Proceeding Type of Proceeding American LegalNet, Inc. www.FormsWorkFlow.com J DF 1250 R 2 - 1 8 PETITION FOR DISSOLUTION OR LEGAL SEPARATION OF CIVIL Page 3 of 4 15. 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 vis itation/parenting time with the child(ren) . Identify n ame and address of those persons , if any. Full Name of Person Address (Street, City/State, Zip Code) 16. R equired Notice of Human Services Involvement . The parents or dependent child(ren) list ed on this Petition 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 following: Name of Person Receiving Benefit Name of County and State Case Number Month/Year 17. R equired Notice of Prior Protection/Restraining Orders. Have any Temporary or Permanent Pro tection/Restraining Orders to prevent domestic abuse or any Criminal Mandatory Protection/Restraining Orders (MRO) or Emergency Protection Orders been issued against either party within two years prior to the filing of this P etition? No Yes If your ans wer was Yes , complete the following: The Protection/Restraining Order was Temporary Pe rmanent MRO and issued against i n 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? 18. Notice of Existing Case with Child Support Enforceme nt (CSE) The parents have filed a case with CSE? No Yes If Yes , identify the case number: 19. I/We ask that the Court enter orders regarding the status of the civil union , best interests of the child(ren), maintenance ( partner support) child support, division of property and debts, at torney fees and costs, if appropriate, restoration of the previous name of a party, and any other necessary orders. 20. The Petitioner Co - Petitioner requests that the Court restore his/her prior full name to . American LegalNet, Inc. www.FormsWorkFlow.com J DF 1250 R 2 - 1 8 PETITION FOR DISSOLUTION OR LEGAL SEPARATION OF CIVIL Page 4 of 4 N otice : Colorado Revised Statutes 24714 - 10 - 107, provides that upon the filing of a Petition for Dissolution of Civil Union or Legal Separation of Civil Union by the Petitioner and Co - P etitioner , or upon personal service of the Petition and Summons on the Responde nt, or upon waiver and acceptance of service by the Respondent, an automatic temporary injunction shall be in effect against both parties until the F inal D ecree is entered, or the Petition is dismissed, or until further Order of the Court. Either party ma y apply to the Court for further temporary orders, an expanded automatic temporary injunction, or modification or revocation under 24714 - 10 - 108, C.R.S. or any other appropriate statute. 1. Both parties are restrained from transferring, encumbering, concealing, or in any way disposing of, without the consent of the other party, or an Order of the Court, any property of the union , except in the usual course of business or for the necessities of life. Each party is required to notify the other party of any propos ed extraordinary expenditures and to account for all extraordinary expenditures made after the injunction is in effect; and 2. Both parties are enjoined from molesting or disturbing the peace of the other party or the minor child(ren); and 3. Both parties are restrained from removing the minor child(ren) of the parties, if any, from the state without the consent of the other party or an Order of the Court; and 4. Both parties are restrained, without at least 14 days advance notification and the written consent o f the other party or an Order of the Court, from canceling, modifying, terminating, or allowing to lapse for automobile insurance that provides coverage to either of the parties or the minor child(ren) or any policy of life insurance that names either of the parties or the minor child(ren) as a beneficiary. N othing in this automatic injunction shall prohibit either party from applying to the Court for further ord ers, an expanded automatic temporary injunction, or orders modifying or revoking this injunction. P etitioner and C