‰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): Case Number: Phone Number: FAX Number: Division E-mail: Atty. Reg. #: Courtroom VERIFIED MOTION TO: ‰MODIFY PARENTING TIME, Pursuant to §14-10-129, C.R.S. ‰RESTRICT PARENTING TIME, Pursuant to §14-10-129(4), C.R.S Note to Party responding to a Motion to Modify Parenting Time: If you disagree with this Motion, 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. If this is a Motion to Restrict Parenting Time, a response can be filed on or before the emergency hearing or made at the hearing. The ‰Petitioner parenting time. ‰Co-Petitioner/Respondent states the following for the purpose of modifying/restricting 1. The last Order regarding parenting time was entered by the Court on __________________________ (date). 2. A motion for a substantial modification of parenting time which also changes the party with whom the child resides a majority of the time ‰has ‰has not been filed in the last two years. If one has been filed, please identify the date filed _____________________________. 3. ‰(Check only if this Motion is to Restrict Parenting Time or Parental Contact pursuant to §14-10129(4), C.R.S.) The child(ren) is/are in imminent physical or emotional danger due to the current parenting time or parental contact of a parent and the ‰Petitioner ‰Co-Petitioner/Respondent requests the Court Order that: ‰ This hearing shall be held on an emergency basis within seven days of the filing of this Motion and parenting time shall be supervised until the hearing by an unrelated third party deemed suitable by the Court or by a licensed mental health professional. 4. Information about Petitioner: Date of Birth: __________________________ Current Mailing Address: ___________________________________________________________________ City & Zip: _______________________________________________________________________________ Home Phone #: ____________________ Work Phone #: __________________ Cell #: __________________ JDF 1406 R8/08 VERIFIED MOTION TO MODIFY/RESTRICT PARENTING TIME Page 1 of 4 American LegalNet, Inc. www.FormsWorkflow.com 5. Information about Co-Petitioner/Respondent: Date of Birth: __________________________ Current Mailing Address: ___________________________________________________________________ City & Zip: _______________________________________________________________________________ Home Phone #: ____________________ Work Phone #: __________________ Cell #: __________________ 6. The parties have _____ minor child(ren): Full Name of Child 7. Present Address Sex Date of Birth ‰(Check only if applicable.) ________________________________________ (name of party) has been convicted of a crime set forth in §14-10-129(3)(a), C.R.S. in the County of ____________________, State of ____________________, in case number __________________ on _____________________ (date) that constitutes a potential threat or endangerment to the child(ren). 8. The ‰Petitioner ‰Co-Petitioner/Respondent now has parenting time with the minor child(ren) under the following parenting plan and under the following conditions (if any): _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 9. Required Notice of Prior Protection/Restraining Orders. Have any Temporary or Permanent Protection/Restraining Orders to prevent domestic abuse or any Criminal Protection/Restraining Orders or Emergency Protection Orders been issued against either party by any Court within two years prior to the filing of this Motion? ‰No ‰Yes If your answer was Yes, complete the following: The Protection/Restraining Order was ‰Temporary ‰Permanent and issued against __________________________________________, in the County of ____________________, State of __________________, in case number _________________ on ________________________ (date). What was the subject matter of the Civil Protection/Restraining Order or Emergency Protection Order? _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ JDF 1406 R8/08 VERIFIED MOTION TO MODIFY/RESTRICT PARENTING TIME Page 2 of 4 American LegalNet, Inc. www.FormsWorkflow.com I request that this Court enter an order modifying/restricting the parenting time for the ‰Petitioner ‰CoPetitioner/Respondent as described below. Complete number 10 if requesting to modify parenting time and number 11 if requesting to restrict parenting time. 10. a. I request the Court to modify the current parenting time order to provide for the following new parenting plan schedule and this plan is in the best interests of the minor child(ren) for the following reasons: (Attach additional documentation, if necessary.) _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ b. The above new parenting plan is in the best interests of the minor child(ren) as follows: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 11. a. I allege that the minor child(ren) is/are in imminent physical or emotional danger due to the current parenting time as follows: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ b. I request that the parenting time plan be restricted as follows: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ 12. ‰Check only if applicable. Due to this request to modify/restrict parenting time, I request that child support also be modified as supported in the Verified Motion to Modify Child Support filed along with this Motion. ‰ Under the current child support order, the ‰Petitioner’s ‰Co-Petitioner’s/Respondent’s child support obligation is $ __________ and is paid ‰ ‰ ‰ JDF 1406 ‰Other: ________. ‰weekly ‰bi-weekly ‰twice a month ‰monthly The new child support obligation requested ‰is ‰is not more than a 10% change from the current child support order. I have completed a child support worksheet that shows what the new child support obligation should be. The child support worksheet is attached to this motion. I have attached current sworn financial statements. R8/08 VERIFIED MOTION TO MODIFY/RESTRICT PARENTING TIME Page 3 of 4 American LegalNet, Inc. www.FormsWorkflow.com 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. Date: __________________________ _____________________________________________ ‰Petitioner or ‰Co-Petitioner/Respondent ____________________________________________ Address ____________________________________________ City, State, Zip Code ____________________________________________ (Area Code) Telephone Number (home) ____________________________________________ (Area Code) Telephone Number (work) Subscribed and affirmed, or sworn to before me in the County of ______________________, State of __________________, this ___________ day of _______________, 20______. My Commission Expires: ___________________ ____________________________________________ Notary Public/Deputy 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 ‰Restrict Parenting Time 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 ‰ If the Child Support Enforcement Unit is involved in the case, you must provide them a copy of this Motion. JDF 1406 R8/08 VERIFIED MOTION TO MODIFY/RESTRICT PARENTING TIME Page 4 of 4 American LegalNet, Inc. www.FormsWorkflow.com