District Court Denver Juvenile Court _________________________________________ County, Colorado Court Address: In re: The Marriage of: Parental Responsibilities concerning: ______________________________________________________ Petitioner: COURT USE ONLY and Co-Petitioner/Respondent: Attorney or Party Without Attorney (Name and Address): Phone Number: FAX Number: Case Number: E-mail: Division Courtroom Atty. Reg.#: STIPULATION REGARDING PARENTING TIME MODIFICATION The ________________________ (Petitioner) and _________________________ (Co-Petitioner/Respondent) stipulate and agree to the following Stipulation Regarding Parenting Time Modification: 1. The parties have _____ minor child(ren): Full Name of Child Present Address Sex Date of Birth 2. We request the Court to change the current parenting time order to provide for the following new parenting plan schedule: (Attach additional documentation, if necessary.) _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 3. We believe that the modification of the current parenting time order is in the best interests of the minor child(ren) for reason(s) which were unknown to the Court, or that have arisen since the last order. They are as follows: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ JDF 1423 12/04 STIPULATION REGARDING PARENTING TIME MODIFICATION Page 1 of 2 American LegalNet, Inc. www.USCourtForms.com _______________________________________________________________________________________ _______________________________________________________________________________________ 4. Other Information: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 5. We request that this Stipulation Regarding Parenting Time Modification be entered as an Order of this Court. VERIFICATION AND ACKNOWLEDGEMENT I swear/affirm under oath that I have read the foregoing petition and that the statements set forth therein are true and correct to the best of my knowledge. _______________________________________ ______________________________________ Petitioner Signature Co-Petitioner/Respondent Signature Date Date _______________________________________ _______________________________________ Address Address _______________________________________ _______________________________________ City, State, Zip Code City, State, Zip Code _______________________________________ _______________________________________ (Area Code) Telephone Number (home) (Area Code) Telephone Number (home) _______________________________________ ______________________________________ (Area Code) Telephone Number (work) (Area Code) Telephone Number (work) Subscribed and affirmed, or sworn to before me Subscribed and affirmed, or sworn to before me in the County of ________________________, in the County of _________________________, State of ____________________, this _______ State of ___________________, this ________ day of ________________, 20 ____. day of ________________, 20 ____. My Commission Expires: My Commission Expires: _______________________________________ _____________________________________ Notary Public/Clerk Notary Public/Clerk Petitioner’s Attorney Signature, if any Co-Petitioner/Respondent’s Attorney Signature, if any JDF 1423 12/04 STIPULATION REGARDING PARENTING TIME MODIFICATION Page 2 of 2 American LegalNet, Inc. www.USCourtForms.com