Free ADDENDUM TO AFFIDAVIT CONCERNING CHILDREN - Connecticut

ADDENDUM TO AFFIDAVIT CONCERNING CHILDREN
JD-FM-164A Rev. 11-01 C.G.S. § 46b-115S, P.B. § 25-57 CHILD'S NAME (First, middle, last)

STATE OF CONNECTICUT SUPERIOR COURT
(Use this form to list additional children to form JD-FM-164)
DATE OF BIRTH (Mo, day, yr) LOCATION (Town or city, and state, unless confidential) DOCKET NO.

RESIDENCE INFORMATION IS SAME AS FOR PREVIOUS CHILD (If not same, provide information) RELATIONSHIP TO CHILD

DATE(S) OF RESIDENCE

NAME(S) AND PRESENT ADDRESS(ES) OF PERSON(S) CHILD LIVED WITH (UNLESS CONFIDENTIAL)

TO THE PRESENT

TO

TO

TO

TO CHILD'S NAME (First, middle, last) DATE OF BIRTH (Mo, day, yr) LOCATION (Town or city, and state, unless confidential) RESIDENCE INFORMATION IS SAME AS FOR CHILD ABOVE (If not same, provide information) RELATIONSHIP TO CHILD

DATE(S) OF RESIDENCE

NAME(S) AND PRESENT ADDRESS(ES) OF PERSON(S) CHILD LIVED WITH (UNLESS CONFIDENTIAL)

TO THE PRESENT

TO

TO

TO

TO CHILD'S NAME (First, middle, last) DATE OF BIRTH (Mo, day, yr) LOCATION (Town or city, and state, unless confidential) RESIDENCE INFORMATION IS SAME AS FOR CHILD ABOVE (If not same, provide information) RELATIONSHIP TO CHILD

DATE(S) OF RESIDENCE

NAME(S) AND PRESENT ADDRESS(ES) OF PERSON(S) CHILD LIVED WITH (UNLESS CONFIDENTIAL)

TO THE PRESENT

TO

TO

TO

TO

(Continued...)

PRINT

RESET

CHILD'S NAME (First, middle, last)

DATE OF BIRTH (Mo, day, yr) LOCATION (Town or city, and state, unless confidential)

RESIDENCE INFORMATION IS SAME AS FOR PREVIOUS CHILD (If not same, provide information) RELATIONSHIP TO CHILD

DATE(S) OF RESIDENCE

NAME(S) AND PRESENT ADDRESS(ES) OF PERSON(S) CHILD LIVED WITH (UNLESS CONFIDENTIAL)

TO THE PRESENT

TO

TO

TO

TO CHILD'S NAME (First, middle, last) DATE OF BIRTH (Mo, day, yr) LOCATION (Town or city, and state, unless confidential) RESIDENCE INFORMATION IS SAME AS FOR CHILD ABOVE (If not same, provide information) RELATIONSHIP TO CHILD

DATE(S) OF RESIDENCE

NAME(S) AND PRESENT ADDRESS(ES) OF PERSON(S) CHILD LIVED WITH (UNLESS CONFIDENTIAL)

TO THE PRESENT

TO

TO

TO

TO CHILD'S NAME (First, middle, last) DATE OF BIRTH (Mo, day, yr) LOCATION (Town or city, and state, unless confidential) RESIDENCE INFORMATION IS SAME AS FOR CHILD ABOVE (If not same, provide information) RELATIONSHIP TO CHILD

DATE(S) OF RESIDENCE

NAME(S) AND PRESENT ADDRESS(ES) OF PERSON(S) CHILD LIVED WITH (UNLESS CONFIDENTIAL)

TO THE PRESENT

TO

TO

TO

TO JD-FM-164A (Back) Rev. 11-01

PRINT

RESET