Form Jdf 1104 - Certificate Of Compliance With Mandatory Financial Disclosures

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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
:
Case Number:
(Name and Address)
Phone Number:
E-mail:
Division
Courtroom
FAX Number:
Atty. Reg. #:
CERTIFICATE OF COMPLIANCE WITH MANDATORY FINANCIAL DISCLOSURES
I, the
Petitioner
Co-Petitioner/Respondent (check one) hereby certify that I have sent the other party the following
Mandatory Disclosures as required by C.R.C.P. 16.2(e)(7).
See JDF 1125: Mandatory Disclosure – Form 35.1 for explanation on what is required by the disclosures being
: Only the Sworn Financial Statement and
listed. Check those that you have furnished to the other party. (Note
Child Support Worksheet should be filed with the Court.)
Sworn Financial Statement
Retirement Plans
Income Tax Returns (most recent 3 years)
Bank/Financial Institution Accounts
Personal Financial Statements (last 3 years)
Income Documentation (Pay Stubs, etc.)
Business Financial Statements (last 3 years)
Employment and Education – Related child
Real Estate Documents (Appraisal, Title, etc.)
Care Documentation
Personal Debt (Loans, Title, Credit Card Statements, etc.)
Insurance Documentation
Investments
Extraordinary Children’s Expense
Employment Benefits
Documentation
If I have not provided information, it is because:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
I hereby certify that, to the best of my knowledge, information, and belief, the disclosures I have made are
complete and correct as of this date.
__________________________________________
________________________________________________
Petitioner Signature
Date
Co-Petitioner/Respondent Signature
Date
__________________________________________
________________________________________________
Petitioner’s Attorney Signature, if any
Date
Co-Petitioner/Respondent’s Attorney Signature, if any
Date
CERTIFICATE OF SERVICE
I certify that on _______________________ (date) an original was filed with the Court; and, a true and accurate copy of the
CERTIFICATE OF COMPLIANCE WITH MANDATORY FINANCIAL DISCLOSURES 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 1104
R3/06
CERTIFICATE OF COMPLIANCE WITH MANDATORY FINANCIAL DISCLOSURES

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