Free PC-500 - Connecticut


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State: Connecticut
Category: Court Forms - State
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http://www.jud2.ct.gov/webforms/forms/pc-500ar.pdf

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APPLICATION/ REMOVAL OF GUARDIAN PC-500 REV. 10/04 Page 1

STATE OF CONNECTICUT COURT OF PROBATE [Type or print in black ink. File in duplicate.]

RECORDED(CONFIDENTIAL VOLUME):

TO: COURT OF PROBATE, DISTRICT OF IN THE MATTER OF [Name, address where residing, zip code, and telephone number.]

DISTRICT NO. MINOR CHILD'S BIRTH DATE

Hereinafter referred to as the minor child. PETITIONER [Name, address, zip code, telephone number, and legal status of petitioner (e. g. adult relative, counsel for minor, Court on its own motion). C.G.S. §45a-614. If adult relative, also give date of birth and social security number. If counsel for minor, also list juris number.]

The minor child is the subject of a pre-existing child support order.

PERSON(S) TO BE REMOVED AS GUARDIAN [Name(s), address(es), zip code(s), telephone number(s), RELATIONSHIP TO social security number(s), and tribe and reservation if American Indian as defined by P.L. 95-608. If MINOR CHILD parent, also give date of birth and social security number.] Hereinafter referred to as the respondent(s).

OTHER PERSON(S) WITH GUARDIANSHIP RIGHTS [Name(s), address(es), zip code(s), telephone number(s), and tribe and reservation if American Indian as defined by P.L. 95-608.]

RELATIONSHIP TO MINOR CHILD

THE PETITIONER ALLEGES that the whereabouts of the respondent(s) are unknown. The last-known address(es) of the respondent(s) is/are:

THE PETITIONER STATES that the following efforts have been made to obtain a current address for the respondent(s): [To be completed only if the above box is checked.]

THE PETITIONER REPRESENTS that the minor child presently resides in the town written above, was born on the date written above, and the persons who have guardianship rights are stated above, and that the respondent(s) named above should be removed as guardian(s) of the person of the minor child for the following reason(s) as provided by law. C.G.S. §§45a-613 and 45a-610. The respondent(s) consent(s) to removal as guardian(s) of the minor child. [No further allegation against a consenting guardian is necessary.] The minor child has been abandoned by the parent or guardian in the sense that the parent or guardian has failed to maintain a reasonable degree of interest, concern, or responsibility for the child's welfare. The minor child has been denied the care, guidance, or control necessary for physical, educational, moral, or emotional well-being as a result of acts of parental commission or omission, as defined by law. The minor child has had physical injury or injuries inflicted upon him or her, other than by accidental means, as defined by law. The minor child has been neglected or uncared for, as defined in C.G.S. §46b-120. APPLICATION/REMOVAL OF GUARDIAN PC-500 Page 1 of 2 Continued

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APPLICATION/ REMOVAL OF GUARDIAN PC-500 REV. 1/03 Page 2

STATE OF CONNECTICUT COURT OF PROBATE [Type or print in black ink. File in duplicate.]

RECORDED(CONFIDENTIAL VOLUME):

THE PETITIONER FURTHER REPRESENTS that the respondent(s) is/are NOT under a legal disability or in the military service of the United States or Allied Nation (Title 50 Appendix, U.S.C. 520) and that there is a no proceeding pending or contemplated in another court affecting the custody of said minor child to the best knowledge and belief of the petitioner. C.G.S. §52-231a. [If such proceeding is pending or contemplated, give full details using Second Sheet, PC-180.]

WHEREFORE THE PETITIONER REQUESTS that this Court remove the respondent(s) as guardian(s) of the person of said minor child and PETITIONS the Court to: Grant immediate temporary custody/temporary custody of said minor child to [File PC-501 or PC-502.] Appoint a guardian of the person of said minor child. Name , parent, the sole guardian. The representations contained herein are made under the penalties of false statement.

Date:

........................................................................ Petitioner:

PROPOSED GUARDIAN IF APPOINTED, I WILL ACCEPT SAID POSITION OF TRUST.

Signature ....................................................................................................................................................................... Name [Type or print. Include maiden name, if applicable.] Address and zip code:

Telephone Number:

Date of Birth: CONSENT TO REMOVAL OF GUARDIANSHIP

I do consent to the removal of my guardianship rights with respect to said minor child. [Any consent for an incompetent or minor parent must be approved by a guardian ad litem. C.G.S. § 45a-621. To waive personal service, form PC-633, Waiver of Personal Service Parental Rights Matters, must be filed.] DATE ............................................................... Parent's/Guardian's Signature Type Name: .............................................................. Parent's/Guardian's Signature Type Name: .............................................................. Parent's/Guardian's Signature Type Name: I, the undersigned minor, being at least twelve years of age, hereby consent to the appointment of the proposed guardian as my guardian. DATE DULY ACKNOWLEDGED BEFORE ME ....................................................................................... Judge, Ass't Clerk, Notary Public, Comm. Sup. Ct. ..................................................................................... Judge, Ass't Clerk, Notary Public, Comm. Sup. Ct. DULY ACKNOWLEDGED BEFORE ME ..................................................................................... Judge, Ass't Clerk, Notary Public, Comm. Sup. Ct.

............................................................... Minor's Signature Type Name: APPLICATION/REMOVAL OF GUARDIAN PC-500 Page 2 of 2

..................................................................................... Judge, Ass't Clerk, Notary Public, Comm. Sup. Ct.

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