Form Jdf 559 - Affidavit And Advisement Concerning The Child'S Potential Placement

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District Court
Denver Juvenile Court
____________________________________County, Colorado
Court Address:
The People of the State of Colorado
In the interest of:
_________________________________________
Child(ren) and Concerning
_________________________________________
▲ COURT USE ONLY
Respondent(s)
Attorney or Party Without Attorney
:
Case Number:
(Name and Address)
Phone Number:
E-mail:
Division
Courtroom
FAX Number:
Atty. Reg. #:
AFFIDAVIT AND ADVISEMENT CONCERNING THE CHILD’S POTENTIAL PLACEMENT
PURSUANT TO §19-3-403, C.R.S.
PART I: ADVISEMENT TO EACH PARENT ATTENDING A TEMPORARY CUSTODY HEARING.
This matter comes before the Court on ___________________________ (date). The Court hereby advises the
parent(s) in this case of the following:
You are required to fill out the below placement information (Part II – Affidavit) fully and completely under
penalties of perjury and contempt of court.
You are required to list the names, addresses and telephone numbers of every grandparent, aunt, uncle,
brother, sister, half-sibling, and first cousin of the child, and any comments concerning the
appropriateness of the child’s potential placement with each person.
If the child cannot be safely returned to the parents’ home, the Court may place the child with appropriate
identified relatives who have a significant relationship with the child.
If the child cannot be safely returned to the home of the child’s parents, failure to identify the relatives in a
timely manner may result in the child being placed permanently outside of the home of the child’s
relatives who have a significant relationship with the child.
The child may risk life-long damage to his or her emotional well-being if the child becomes attached to
one caregiver and is later removed from the caregiver’s home.
The Court may Order the County Department of Social Services to contact appropriate identified relatives
within 90 days after the hearing to inform them about placement possibilities.
The attached placement information (Part II – Affidavit) must be returned to the Court by ______________ (date).
I acknowledge that I have read and understand this advisement.
Date: __________________________________
______________________________________
Signature of Parent
Date: __________________________________
______________________________________
Signature of Parent
This original signed Advisement shall be filed with the Court at the Temporary Custody Hearing and a
copy maintained by the Respondent(s) and their counsel.
JDF 559 7/05 AFFIDAVIT AND ADVISEMENT CONCERNING THE CHILD’S POTENTIAL PLACEMENT
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