JDF 1813 R 2 / 1 8 VERIFIED ENTRY OF SUPPORT JUDGMENT Page 1 of 2 District Court Juvenile Court County, Colorado Court Address: In re: The Marriage of: The Civil Union of: Parental Responsibilities concerning: Petitioner: 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 VERIFIED ENTRY OF SUPPORT JUDGMENT The Obligee, , submits this Verified Entry of Support Judgment pursuant to 24714 - 10 - 122, C.R.S.: 1. The Obligor, , is currently ordered to pay $ per month, commencing (date). All previous modifications are as follows: $ per month, commencing $ per month, commencing $ per month, commencing 2. During the period of (date) through (date), the Obligor should have paid $ . 3. Through (date) , the Obligor paid the sum of $ , leaving an arrearage due and owing to the Obligee in the amount of $ . Pursuant to 2475 - 12 - 102, C.R.S. and 24714 - 14 - 106, C.R.S., the Obligor owes accrued interest in the sum of $ for this t ime period, for a total due of $ to the Obligee. 4. Interest shall continue to accrue at the statutory rate. 5. As evidence of payment, a copy of the Family Support Registry record is attached, pursuant to 24714 - 14 - 111.5(3)(b)(III), C.R.S. American LegalNet, Inc. www.FormsWorkFlow.com JDF 1813 R 2 / 1 8 VERIFIED ENTRY OF SUPPORT JUDGMENT Page 2 of 2 WHER EFORE, the Obligee submits to the Court that the sum of $ should be entered as a consolidated judgment against the Obligor , and in favor of the Obligee . 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 Obligee) Signature of Obligee City State Zip Code (Area Code) Daytime Phone Number (Area Code) Work Phone Number Signature of Attorney (if any) CERTIFICATE OF SERVICE I certify that on (date) a true and accurate copy of the VERIFIED ENTRY OF SUPPORT JUDGMENT was served on the other party by: Hand Delivery , E - Filed, or Faxed to this number or by placing it in the United States mail, postage pre - paid, and addressed to the following: To: (Your Signature) American LegalNet, Inc. www.FormsWorkFlow.com