Colorado > Statewide > Adoption
Verified Statement Of Fees Charged JDF 454 - Colorado
| Verified Statement Of Fees Charged Form. This is a Colorado form and can be used in Adoption Statewide . |
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District Court Denver Juvenile Court _________________________________County, Colorado Court Address: IN THE MATTER OF THE PETITION OF: ______________________________ (name of person(s) seeking to adopt) FOR THE ADOPTION OF A CHILD Attorney or Party Without Attorney (Name and Address): COURT USE ONLY Case Number: Phone Number: FAX Number: E-mail: Atty. Reg.#: Division Courtroom VERIFIED STATEMENT OF FEES CHARGED The following fees have been charged to the Petitioner(s) relative to the adoption proceeding pursuant to ยง19-5208(4), C.R.S. and C.R.J.P. 6(b)(4): Attorney's fees: Filing fees: Publication fees: Personal service fees: Birth certificates: Hospital charges and medical fees: County department of social services fees: Child placement agency fees: Charges, gifts or charitable contributions: Other considerations or things of value: $ _______________________________ $ _______________________________ $ _______________________________ $ _______________________________ $ _______________________________ $ _______________________________ $ _______________________________ $ _______________________________ $ _______________________________ $ _______________________________ $ _______________________________ Total Fees Charged: I have read the foregoing and that the statements set forth herein are true and correct to the best of my knowledge and belief. ______________________________________ Petitioner Signature Date ______________________________________ Petitioner Signature Date ______________________________________ Petitioner's Attorney Signature, if any ______________________________________ Petitioner's Attorney Signature, if any 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 JDF 454 R9/06 VERIFIED STATEMENT OF FEES CHARGED 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 American LegalNet, Inc. www.FormsWorkflow.com
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