Colorado Child Custody Form

Use this template/form to file for child custody in the state of Colorado

colorado-child-custody-form

Text version of this Form

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District Court Denver Juvenile Court

_________________________________ County, Colorado

Court Address:

In re:

The Marriage of:

Parental Responsibilities concerning:

______________________________________________________

Petitioner:

and COURT USE ONLY

Co-Petitioner/Respondent:

Attorney or Party Without Attorney (Name and Address): Case Number:

Phone Number: E-mail:

FAX Number: Atty. Reg.#: Division Courtroom

VERIFIED MOTION TO MODIFY CHILD SUPPORT PURSUANT TO §14-10-122, C.R.S.

Note to Responding Party: If you disagree with this Motion, the Colorado Rules of Civil Procedure

allow you to file a written response with the Court which must be filed within 21 days of the date this

Motion was served on you or mailed to you.

The Petitioner Co-Petitioner/Respondent states the following for the purpose of modifying child support.

1. Information about Petitioner: Date of Birth: __________________________

Current Mailing Address: __________________________________________________________________

City & Zip: ______________________________________________________________________________

Home Phone #: ___________________ Work Phone #: __________________ Cell #: __________________

2. Information about Co-Petitioner/Respondent: Date of Birth: __________________________

Current mailing address: ___________________________________________________________________

City & Zip: ______________________________________________________________________________

Home Phone #: ___________________ Work Phone #: ___________________ Cell #: _________________

3. The parties have ______ minor child(ren):

Full Name of Child Present Address Sex Date of Birth

4. Under the current Support Order, the Petitioner has________ overnights per year with the children and the

Co-Petitioner/Respondent has ________ overnights per year with the children.

5. Under the current child support order, the Petitioner’s Co-Petitioner’s/Respondent’s child support

obligation is $ _________and is paid weekly bi-weekly twice a month monthly Other: ________ .

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6. (Check only if applicable.) The current support order does not contain a provision regarding medical

insurance (medial, dental, and/or vision) coverage.

7. A change in the current Support Order is appropriate because of the following change(s) in circumstance(s).

Please check the appropriate box.  Day Care costs Change in Income 

Change in Parenting Time Change in Residence Emancipation of a Child

 Medical insurance coverage Other: ______________________________________________________

Describe why you are requesting the modification.

8. The new child support obligation that I am requesting is is not more than a 10% change from the current

child support order. The proposed child support obligation should be $____________ to be paid weekly

bi-weekly twice a month monthly other: ________ .

9. I/We have completed a child support worksheet that shows what the new child support obligation should be.

The child support worksheet is  is not attached to this Motion.

10. I/We have attached current Sworn Financial Statements to this Motion.

11. Is either party currently receiving public assistance? Yes No If you checked Yes, answer the following:

Name of Person Receiving Benefit Name of County or State

12. Is either party receiving child support enforcement services. Yes No If Yes, identify

____________________________ (County) ______________________ (State).

13. Does either parent live in another state? Yes No If Yes, identify __________________________

(name of person) and ___________________________________ (City and State) they are currently living in.

14. (Check only if applicable.) I request a change in the current tax exemption because of the reallocation of

the costs of raising the dependent children, pursuant to §14-10-115(12), C.R.S.

I respectfully request that this Court enter an Order modifying the Petitioner’s Co-Petitioner’s/Respondent’s

child support obligation as described above.

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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.

_____________________________________ ____________________________________________

Signature of Attorney, if applicable 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) a true and accurate copy of the Verified Motion to Modify

Child Support 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.

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