JDF 1104 R12/19 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:
❑The Civil Union of:
❑Parental Responsibilities concerning:
______________________________________________________
Petitioner:
and
Co-Petitioner/Respondent:
Attorney or Party Without Attorney (Name and Address):
Phone Number: E-mail:
FAX Number: Atty. Reg. #:
Case Number:
Division Courtroom
CERTIFICATE OF COMPLIANCE WITH MANDATORY FINANCIAL DISCLOSURES
*****EACH PARTY MUST COMPLETE AND FILE THIS FORM WITH THE COURT*****
I, the ❑Petitioner ❑Co-Petitioner/Respondent (check one) hereby certify that I have sent the other party the
following Mandatory Disclosures as required by Rule 16.2(e)(7) of the Colorado Rules of Civil Procedure.
See JDF 1125: Mandatory Disclosure – Form 35.1 for explanation on what is required by the disclosures being
listed. Check those that you have furnished to the other party. (Note: Only the Sworn Financial Statement and
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, the disclosures I have made are complete and correct as of this
date.
❑ By checking this box, I am acknowledging I am filling in the blanks and not changing anything else on the form.
❑ By checking this box, I am acknowledging that I have made a change to the original content of this form.
