District Court Denver Juvenile Court _________________________________ County, Colorado Court Address: ____________________________ _________________________________________ In re: The Marriage of: Parental Responsibilities concerning: ______________________________________________________ Petitioner: ___________________________________ and Co-Petitioner/Respondent: _______________________________ Attorney or Party Without Attorney (Name and Address): COURT USE ONLY Case Number: _______________ ________________________________________________ ________________________________________________ Phone Number: _________________E-mail: __________________ FAX Number:___________________Atty. Reg. #: ______________ Division __________Courtroom ___ VERIFIED MOTION STIPULATION TO MODIFY DECISION-MAKING RESPONSIBILITY PURSUANT TO §14-10-131, C.R.S. Note to Responding Party: If you disagree with this Motion, the Colorado Civil Rules of Procedure allow you to file a written response with the Court which must be filed within 15 days of the date this Motion was served on you or mailed to you. Petitioner Co-Petitioner/Respondent Both requests that this Court modify Allocation of Parental The Responsibilities previously entered in this case, pursuant to §14-10-131, C.R.S., and state the following: 1. The last Order regarding allocation of parental responsibilities was entered by the Court on _____________________________ (date). 2. A motion for a substantial modification of allocation of parental responsibilities has has not been filed in the last two years. If one has been filed, please identify the date filed _____________________________. 3. Information about Petitioner: Date of Birth: _______________________ Current Mailing Address: _________________________________________________________________ City & Zip: _____________________________________________________________________________ Home Phone #: ____________________ Work Phone #: _________________ Cell #: _________________ 4. Information about Co-Petitioner/Respondent: Date of Birth: _______________________ Current Mailing Address: __________________________________________________________________ City & Zip: __________________________________________________________________________ Home Phone #: ____________________Work Phone # _________________ Cell #: __________________ JDF 1415 R9/08 VERIFIED MOTION/STIPULATION TO MODIFY DECISION-MAKING RESPONSIBILITIES Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com 5. This Motion concerns the following child(ren) of the parties: Full Name Present Address 6. Are there other child(ren) of the parties, who are not part of the motion? Full Name Present Address Sex Yes Date of Birth No If Yes please identify: Sex Date of Birth 7. What new arrangements are you requesting? 8. Why are you requesting modification of allocation of parental responsibilities? See the requirements of §1410-131, C.R.S. Use additional paper, if necessary: 9. Have you talked to the other party about this modification of allocation of parental responsibilities? Yes No If Yes, what is her/his position? 10. Have any Temporary or Permanent Protection/Restraining Orders to prevent domestic abuse, any Criminal Protection/Restraining Orders or Emergency Protection Orders been issued against either party in any Court JDF 1415 R9/08 VERIFIED MOTION/STIPULATION TO MODIFY DECISION-MAKING RESPONSIBILITIES Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com within two years prior to the filing of this motion? No Yes If your answer was Yes, complete the following: Temporary Permanent and issued against The Protection/Restraining Order was __________________________________________, in the County of ____________________, State of ___________________, in case number ___________________. What was the subject matter of the Protection/Restraining Order or Emergency Protection Order? 11. Is either party currently receiving Temporary Aid to Needy Families (TANF) or public assistance? Yes No Not Sure 12. Does the other party live in another state? Yes No If Yes, what state? _______________________ VERIFICATION AND ACKNOWLEDGMENT I swear/affirm under oath that I have read the foregoing Motion and that the statements set forth therein are true and correct to the best of my knowledge. _______________________________________ ______________________________________ Petitioner Signature Co-Petitioner Signature Date Date ______________________________________ ____________________________________ Petitioner’s Attorney Signature, if any Co-Petitioner’s Attorney Signature, if any Subscribed and affirmed, or sworn to before me in the County of ________________________, State of ____________________, this _______ day of ___________________, 20 _____. My Commission Expires: _________________ Subscribed and affirmed, or sworn to before me in the County of _______________________, State of ___________________, this _______ day of ___________________, 20 _____. My Commission Expires: __________________ ______________________________________ ______________________________________ Notary Public/Clerk Notary Public/Clerk CERTIFICATE OF SERVICE I certify that on _________________________ (date) the original was filed with the Court and a true and accurate copy of the Verified Motion to Modify Decision-Making Responsibilities was served on the other party by: Hand Delivery E-filed Faxed to this number ___________________ or by placing it in the United States mail, postage pre-paid, and addressed to the following: To: ______________________________________ ______________________________________ ______________________________________ ______________________________________ (Your Signature) JDF 1415 R9/08 VERIFIED MOTION/STIPULATION TO MODIFY DECISION-MAKING RESPONSIBILITIES Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com