Free JD-FM-161 - Connecticut


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Date: August 11, 2008
File Format: PDF
State: Connecticut
Category: Court Forms - State
Author: MPiela
Word Count: 633 Words, 3,840 Characters
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URL

http://www.jud2.ct.gov/webforms/forms/fm161.pdf

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CUSTODY/VISITATION APPLICATION
JD-FM-161 Rev. 3-07 C.G.S. §§ 46b-56, 46b-61, P.B. §§ 25-3, 25-4, 25-5

STATE OF CONNECTICUT SUPERIOR COURT
www.jud.ct.gov

CUSTODY

VISITATION
DOCKET NO.

INSTRUCTIONS: Check box above and complete form. Attach Order to Attend Hearing (JD-FM-162), Notice of Automatic Court Orders (JD-FM-158), and Affidavit Concerning Children (JD-FM-164).
JUDICIAL DISTRICT OF APPLICANT'S NAME (Last, first, middle initial) ADDITIONAL RESPONDENT'S NAME (If applicable) AT (Town)

RESPONDENT'S NAME (Last, first, middle initial)

1. I am the:

Mother

Father

Grandparent Mother Father

Other: Grandparent Other:

2. The respondent(s) is/are the:

3. I want (check one)

custody of the child(ren) listed below: visitation rights with the child(ren) listed below:

CHILD'S NAME (First, middle, last)

DATE OF BIRTH

NAME(S) OF PARENT(S) OR GUARDIAN(S) (First, middle initial, last)

Check here if additional children are listed on the reverse (Page 2). 4. Connecticut has the authority to decide this case and should decide this case because: (Check all that apply) a. b. c. d. Connecticut is the home state of the child(ren) at the time of the filing of this case. The child(ren) has lived in Connecticut for the past six months, or from birth if the child is younger than six months old. The child(ren) lived in Connecticut for at least six months but was taken from Connecticut less than six months ago by a person claiming custody, and a parent or guardian continues to live here. The child(ren) and at least one parent have a significant connection to Connecticut and there is substantial evidence in Connecticut concerning the child's present or future care, protection, training and personal relationships. The child(ren) is in Connecticut now and has been abandoned or there is an emergency affecting the child's well-being. No other state has an interest in hearing this case and it is in the best interest of the child(ren) for a Connecticut court to hear the case. The applicant has/had a relationship with the child(ren) that is similar in nature to a parent-child relationship and denial of visitation would cause real and significant harm to the child(ren).
(Continued...)

e. f. g.

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Complete numbers 5 and 6 below only if you are seeking child support in a custody action: 5. The applicant, respondent or any child(ren) listed has received financial support from the State of Connecticut. (Check one) YES NO DO NOT KNOW

If yes, send a copy of the Application, Order to Attend Hearing, Notice of Automatic Court Orders, and any other document filed with this application to the Office of the Attorney General, 55 Elm St., Hartford, CT 06106 and file the Certification of Notice (JD-FM-175) with the court clerk. 6. The applicant, respondent or any child(ren) listed has received financial support from a city or town in Connecticut. (Check one) YES, State city or town: NO DO NOT KNOW

If yes, send a copy of the Application, Order to Attend Hearing, Notice of Automatic Court Orders, and any other document filed with this application to the City Clerk of the town providing assistance and file the Certification of Notice (JD-FM-175) with the court clerk.

The Applicant asks the Court for: (Check all that apply)
Sole custody Joint legal custody: Primary residence with: Visitation Child Support (If custody application only) An order for the post-majority educational support of the child(ren) pursuant to C.G.S. § 46b-56c.

And anything else that the Court deems fair.
SIGNATURE ADDRESS PRINT NAME OF PERSON SIGNING AT LEFT DATE SIGNED TELEPHONE (Area code first)

Additional children (Continued from page 1, if needed):
CHILD'S NAME (First, middle, last) DATE OF BIRTH NAME(S) OF PARENT(S) OR GUARDIAN(S) (First, middle initial, last)

JD-FM-161 (Back/Page 2) Rev. 3-07

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