J DF 1824 8/17 VERIFIED MOTION AND AFFIDAVIT FOR NAME RESTORATION AFTER DISSOLUTION OF MARRIAGE/CIVIL UNION OR LEGAL SEPARATION PURSUANT TO 24714 - 10 - 120.2, C.R.S. District Court County, Colorado Court Address: In re: The Marriage of: The Civil Union of: The Legal Separation of: Petitioner: and Co - Petitioner/Respondent: COURT USE ONLY Attorney or Party Without Att orney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom VERIFIED MOTION AND AFFIDAVIT FOR NAME RESTORATION AFTER DISSOLUTI ON OF MARRIAGE/CIVIL UNION OR LEGAL SEPARATION PURSUANT TO 247 14 - 10 - 120.2 , C.R.S. The Petitioner Co - Petitioner/Respondent states the following for the purposes of a name restoration pursuant to 247 14 - 10 - 120.2, C.R.S. 1. In this case, o n (date), the court entered a (check one) Decree for Dissolution of Marriage Decree for Dissolution of Civil Union Decree for Legal Separation 2. My current full name is: 3. I wish to restore my name to the prior full name of : 4. The restoration of my prior name is not detrimental to the interests of any other person. By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form. By checking th is box, I am acknowledging that I have made a change to the original content of this form. American LegalNet, Inc. www.FormsWorkFlow.com J DF 1824 8/17 VERIFIED MOTION AND AFFIDAVIT FOR NAME RESTORATION AFTER DISSOLUTION OF MARRIAGE/CIVIL UNION OR LEGAL SEPARATION PURSUANT TO 24714 - 10 - 120.2, C.R.S. VERIFICATION AND ACK NOWLEDGMENT I swear/affirm under oath that I have read the foregoing Motion and that the statements set forth therein are true and correct. Signature of Attorney, if applicable Date Signature of Petitioner or Date Signature of Co - Petitioner/Respondent Address Cit y, State, Zip Code (Area Code) Telephone Number (home) (Area Code) Telephone Number (work) Subscribed and affirmed, or sw orn to before me by in the County of , State of , this day of , 20 . My Commission Expires: Notary Public/Depu ty Clerk American LegalNet, Inc. www.FormsWorkFlow.com