Court of Appeals, State of Colorado
101 W. Colfax Suite 800, Denver, CO 80202
Name of Lower Court(s): ______
Trial Court Judges(s): ______
Case Number(s): ______
THE PEOPLE OF THE STATE OF COLORADO
In the Interest of :
______[initials pursuant to § 19-1-109(1)]
Minor Child(ren),
And Concerning:
______[initials pursuant to § 19-1-109(1)]
Appellant/Respondent: ______ /

COURT USE ONLY

Attorney or Party Without Attorney (Name and Address):
Phone Number: E-mail:
FAX Number: Atty. Reg. #: / Case Number:
Division Courtroom
PETITION ON APPEAL
  1. This Petition on Appeal is filed on behalf of ______(initials), the mother father child State Intervenor other ______(initials), with respect to child(ren):

Child(ren)’s InitialsDate(s) of Birth

______

______

  1.  Parental rights were terminated by the trial court pursuant to § 19-3-604(1)(___), C.R.S. or

 The children were adjudicated dependent or neglected pursuant to §19-3-505, C.R.S., and a dispositional decree was entered pursuant to §§19-3-507 and 19-3-508, C.R.S.

  1. Appellant’s attorney, ______, is is not the attorney who represented appellant at trial.
  1. Are there any other pending appeals involving the child (ren)? Yes No If Yes, list below:

Case Name and Number: ______

Type of Appeal: adjudication disposition dissolution

  1. Relevant dates regarding this appeal are the following:

D & N petition filed: ______ Termination hearing: ______

Adjudication order: ______ Termination order: ______

Disposition: ______ Notice of Appeal filed: ______

Permanency hearing: ______ Other material hearing: ______

Motion to terminate filed: ______

  1. Nature of the case and relief sought: The appellant seeks reversal of the: adjudicatory order. dispositional decree. order: granting denying termination.
  1. State the material facts as they relate to the issues presented on appeal:

______

______

______

______

______

______

  1. State the legal issues presented for appeal, including a statement of how the issues arose:

The issues statement should be concise in nature and set forth the specific legal questions. General conclusions, such as “the trial court’s ruling is not supported by the law or the facts,” are not acceptable. Include supporting legal authority for each issue raised.

Issue 1: ______

______

______

______

Supporting legal authority for Issue 1: ______

______

______

______

Issue 2: ______

______

______

______

Supporting legal authority for Issue 2: ______

______

______

______

(Additional issues may be added.)

The undersigned requests that the Court of Appeals issue an opinion reversing the order of the trial court in this matter, or, in the alternative, enter an order setting this case for full briefing.

______

Signature, attorney for appellantDate

ATTACHMENTS:

______

______

______

______

______

______

CERTIFICATE OF MAILING

I certify that on ______(date) the original and five copies of this PETITION ON APPEAL were filed with the Court; and a true and accurate copy of this PETITION ON APPEAL was served on the other party(ies) by placing it in the United States mail, postage pre-paid and addressed to the following:

______

______

______

Signature

Form 4 JDF 548 R8/11 PETITION ON APPEALPage 1 of 3