District Court Denver Juvenile Court __________________________________County, Colorado Court Address: In re: The Marriage of: Parental Responsibilities concerning: ______________________________________________________ Petitioner: and Respondent/Co-Petitioner: Attorney or Party Without Attorney (Name and Address): COURT USE ONLY Case Number:
Phone Number: FAX Number:
E-mail: Atty. Reg. #:
TEMPORARY ORDERS AGREEMENT OR
Division
Courtroom
INFORMATION FOR THE COURT
The
Petitioner Petitioner:
Respondent/Co-Petitioner or
both state the following:
Date of Birth: ___________________
Social Security Number: _______________________
Mailing Address: _____________________________________________________________________ Residential Address: __________________________________________________________________ Phone Numbers: Home: ___________________ Work: ___________________ Cell: _______________ Respondent/Co-Petitioner: Date of Birth: ___________________ Social Security Number: _______________________ Mailing Address: _____________________________________________________________________ Residential Address: __________________________________________________________________ Phone Numbers: Home: ___________________ Work: ___________________ Cell: _______________ 1. The names(s), address(es), birth date(s) and social security numbers of the minor child(ren) is/are: Name Present Address Sex Date of Birth Soc. Sec. No.
2. Allocation of temporary parental responsibilities (decision-making and parenting time). A. Decision-making should be as follows. Select only one of the 3 following options. 1. The Petitioner Respondent/Co-Petitioner (check one) will make all of the major decisions regarding the child(ren). 2.
JDF 1109 R6/04
Both parties will make ALL major decisions regarding the child(ren) together.
TEMPORARY ORDERS AGREEMENT OR INFORMATION FOR THE COURT Page 1 of 4
3.
The parties will divide decision-making as set forth in the attached identified below:
Parenting Plan or
as
Education issues shall be determined by Petitioner Respondent/Co-Petitioner Both Medical, dental and mental health issues shall be determined by Petitioner Respondent/CoPetitioner Both Religious issues shall be determined by Petitioner Respondent/Co-Petitioner Both Extracurricular and recreational issues shall be determined by Petitioner Respondent/CoPetitioner Both Other significant decisions (General Welfare, Driving, Car, Car Insurance, College, etc.) shall be determined by Petitioner Respondent/Co-Petitioner Both _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ B. Parenting time (visitation) should be (check all that apply): 1. As set forth in the attached Parenting Plan or select either 2, 3, or 4. 2. Petitioner every ________________ from _____________________ to ____________________ 3. Respondent/Co-Petitioner every_______________ from _______________ to _______________ 4. Other (include holidays, birthdays, special occasions): _________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________
3. Child Support (A Child Support Obligation Worksheet must be filed.) Both parties agree on this issue. (If you agree, please indicate the terms of agreement below.) The Petitioner Respondent/Co-Petitioner shall pay child support to the Petitioner Respondent/Co-Petitioner (check one) in the sum of $ ____________ per month pursuant to the Colorado Child Support Guidelines, beginning on _________________ (date). Child support payments will be paid to: (check one) Family Support Registry P. O. Box 2171, Denver, CO 80201-2171. The Parties request that the Court order the payment to be made directly to the appropriate person. Child support payments will be paid as follows: Monthly Bi-weekly Weekly Other _________________________________________ The parties do not agree on this issue. 4. Information on any prior child(ren), spousal abuse allegations or protection/restraining orders: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________
JDF 1109
R6/04
TEMPORARY ORDERS AGREEMENT OR INFORMATION FOR THE COURT
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5. Temporary maintenance (alimony) shall be paid by Petitioner Respondent/Co-Petitioner in the amount of $ per month, commencing on __________________ (date). For combined gross incomes of $75,000.00 or less per year, use the formula on page 4 or double click the box above if completing this form electronically. 6. A. The following debts shall be temporarily paid by the Petitioner: Creditor/Debt Account Number To by Paid by
B. The following debts shall be temporary paid by the Co-Petitioner/Respondent: Creditor/Debt Account Number To by Paid by
C. Each party shall provide proof to the other party of the above-stated payments made within _____days of payment date. 7. Property you need use of (home, car, business property, tools, etc.): Both parties agree on this issue. (If you agree, please indicate the terms of agreement below.) The parties do not agree on this issue. Petitioner: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Respondent/Co-Petitioner: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ Property that needs immediate protection: _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________
JDF 1109
R6/04
TEMPORARY ORDERS AGREEMENT OR INFORMATION FOR THE COURT
Page 3 of 4
8. Other issues: ____________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________
I We believe this would be a fair and equitable division of our property and debts on a temporary basis and that the temporary allocation of parental responsibilities is in the best interest of the child(ren). (Both parties must sign if this is an agreement.) I We have attached the required financial affidavits. I We have attached the required child support worksheets (A or B). I swear/affirm under oath that I have read the foregoing temporary agreement/information and that the statements set forth therein are true and correct to the best of my knowledge.
Petitioner Signature
Date
Co-Petitioner Signature
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 ____.
Subscribed and affirmed, or sworn to before me in the County of _________________________, State of ___________________, this ________ day of ________________, 20 ____.
My commission expires: ___________________ _______________________________________
Notary Public/Clerk
My commission expires: ___________________ ______________________________________
Notary Public/Clerk
NOTE: COMBINEDINCOME MUST BE $75,000 ORLESS PERYEA TOUSE THIS W R ORKSHEET.
Presum Tem ed porary M aintenance Calculation
(enter all information belowor double click to complete electronically)
$ $ $ $ $ $ $ $ $ $
$
-
1. Husband's Gross M onthly Incom e a. Husband's pre-existing M aintenance Payments (actually paid and not in this marriage) b. Husband's pre-existing Child Support Payments (actually paid and not in this marriage) 2. Wife's Gross M onthly Income a. Wife's pre-existing M aintenance Payments (actually paid and not in this marriage) b. Wife's pre-existing Child Support Payments (actually paid and not in this marriage) 3. Husband's M onthly Income less pre-existing maintenance or child support (1-(1a+1b)) 4. Wife's M onthly Income less pre-existing maintenance or child support (2-(2a+2b)) 5. 40%of income fromhigher earning spouse (highest income times .40) 6. 50%of the income fromlower earning spouse (lowest income times .50) Line 5 minus Line 6 (if this number is less than or equal to zero, no temporary maintenance awarded)
JDF 1109
R6/04
TEMPORARY ORDERS AGREEMENT OR INFORMATION FOR THE COURT
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