Official Connecticut Custody Application Template in PDF
Structure
When navigating the complexities of child custody and visitation in Connecticut, understanding the Connecticut Custody Application form is essential. This form serves as a critical tool for parents seeking legal recognition of their rights regarding their children. It allows individuals to request either custody or visitation, depending on their specific circumstances. Applicants must check the appropriate box at the top of the form and complete the first two pages, ensuring that they attach necessary documents like the Order to Attend Hearing and the Affidavit Concerning Children. It’s important to establish a legal relationship with the child, which can be evidenced through various documents such as birth certificates or court orders. Additionally, if a grandparent or third party wishes to seek visitation, a different form is required. The application requires clear identification of all parties involved, including the child’s other parent and any additional respondents. Applicants must also articulate why Connecticut has jurisdiction over the case, citing factors such as residency or significant connections to the state. Furthermore, the form addresses financial support considerations, ensuring that any relevant assistance from the state is disclosed. By following the outlined instructions and providing the necessary information, parents can effectively present their case to the court, paving the way for a resolution that prioritizes the best interests of the child.
Connecticut Custody Application Example
Page 1 of 2
Use for visitation
applications
Use for custody
applications
a.
b.
c.
Connecticut is the home state of the child (or children) at the time of the filing of this case.
The child (or children) has (or have) lived in Connecticut for the past 6 months, or from birth if the child (or children)
is (or are) younger than 6 months old.
The child (or children) lived in Connecticut for at least 6 months but was (or were) taken from Connecticut less than
6 months ago by a person claiming custody, and a parent or guardian continues to live here.
The child (or children) and at least one parent have a significant connection to Connecticut, and there is substantial
evidence in Connecticut concerning the child's (or children's) present or future care, protection, training, and
personal relationships.
The child (or children) is (or are) in Connecticut now and has (or have) been abandoned, or there is an emergency
affecting the child's (or children's) well-being.
No other state has an interest in hearing this case, and it is in the best interest of the child (or children) for a
Connecticut court to hear the case.
5. Connecticut has the authority to decide this case and should decide this case because: (Select all that apply)
CUSTODY/VISITATION
APPLICATION - PARENT
JD-FM-161 Rev. 4-23
C.G.S. §§ 46b-56, 46b-61;
P.B. §§ 25-3, 25-4, 25-5
1. I am the child's or children's parent.
4. I want: (Select one)
Child's name (First, middle, last)
Date of birth
3. The respondent(s) is/are the:
Instructions
1. Select the “Custody” or “Visitation” box above, and complete pages 1 and 2 of this form. Attach the Order to Show Cause and Notice to the
Respondent (form JD-FM-162), Notice of Automatic Court Orders (form JD-FM-158), and Affidavit Concerning Children (form JD-FM-164).
2. By the first scheduled court date for this case, you must file the accompanying document(s) listed in number 2 below that prove the existing legal
relationship between the parents and the child or children. You must redact (remove) any personal identifying information, as defined by Section
4-7 of the Connecticut Practice Book, from the accompanying document(s). If you plan to file a copy of an acknowledgment of parentage, make
sure the original is completed and filed with the Department of Public Health before filing this Application. (Contact the Department of Social
Services or the Department of Public Health Vital Records Office for assistance with acknowledgments of parentage.)
3. If you are a grandparent or a third party (not a legal parent), and you want to file for visitation with the child or children, use the Verified Petition
for Visitation - Grandparents & Third Parties (form JD-FM-221).
(Attach additional sheets if necessary)
Name(s) of parent(s) or guardian(s) (First, middle initial, last)
STATE OF CONNECTICUT
SUPERIOR COURT
www.jud.ct.gov
d.
e.
f.
Docket numberJudicial District of
At (Town)
Applicant's name (Last, first, middle initial) Respondent's name (Last, first, middle initial)
Additional respondent's name (If applicable) (Last, first, middle initial)
Parent Grandparent
Other: (Specify)
custody of the child (or children) listed below
visitation rights with the child (or children) listed below
Court use only
*APPLCUS* *APPLVIS*
APPLCUS APPLVIS
2. I understand that by the first scheduled date for this case, I must file the applicable accompanying document(s) from this
list that prove the existing legal relationship between the parents and the child or children named in this application with
any personal identifying information, as defined by Section 4-7 of the Connecticut Practice Book, redacted (removed) or
the case may be dismissed. I plan to file the following document(s) to prove parentage: (Select all that apply)
Other parent's name (If other parent is not the respondent)(Last, first, middle initial) Other parent's address (If other parent is not the respondent)
VisitationCustody
A copy of the birth certificate of the child or children naming the parents;
A copy of a properly executed (finalized) acknowledgement of parentage;
A court order or decree naming the legally responsible parents (including an adoptive parent);
A surrogacy agreement naming the parents (see General Statutes Section 7-36);
Document(s) showing that the child or children was/were born during my marriage to the respondent; or
Any other evidence sufficient (enough) to prove legal parentage of the child or children.
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JD-FM-161 Rev. 4-23
Page 2 of 2
If you selected yes for Financial Support and/or HUSKY, send a copy of this Application, Order to Show Cause and Notice to the
Respondent, Notice of Automatic Court Orders, and any other document filed with this application to the Office of the Attorney
General, 165 Capitol Avenue, Hartford, CT 06106, and file the Certification of Notice (form JD-FM-175) with the court clerk.
6. The applicant, respondent, or any child (or children) listed has (or have) received financial support and/or HUSKY from
the State of Connecticut:
7. The applicant, respondent, or any child (or children) listed has (or have) received financial support from a city or town in
Connecticut: (Select one)
Claim for Relief
Signature of Applicant or Petitioner
If you selected yes, send a copy of this Application, Order to Show Cause and Notice to the Respondent, Notice of Automatic
Court Orders, and any other document filed with this application to the City or Town Clerk of the city or town providing assistance,
and file the Certification of Notice (form JD-FM-175) with the court clerk.
Regarding decision-making responsibility:
For Custody: (The Applicant asks the Court for custody orders) (Select all that apply)
Print name of person signing at left Date signed
Address
Telephone (Area code first)
Yes No Do not know
Yes No Do not know
Yes (City or town):
No Do not know
Sole legal custody
Joint legal custody
A parenting responsibility plan, which includes a plan for the parental decision-making regarding the child or children
And
Regarding physical custody:
Primary residence with:
A parental physical access schedule and/or visitation
Child Support
Regarding child support: (If custody application — includes cash medical, health insurance, unreimbursed medical
expenses, and qualifying child care)
For Visitation: (The Applicant asks the Court for visitation orders as follows)
An order for the educational support of my child (or children) for post-high school education or training under General
Statutes Section 46b-56c.
Additional Instructions:
• If you are the parent and want custody, go to Number 6 below, and continue from there.
• If you are the parent and want visitation, go to the Claim For Relief section below, and continue from there.
Financial Support: (Select one)
HUSKY Health Insurance: (Select one)
ADA NOTICE
The Judicial Branch of the State of Connecticut
complies with the Americans with Disabilities Act
(ADA). If you need a reasonable accommodation
in accordance with the ADA, contact the
Centralized ADA Office at 860-706-5310 or go to:
www.jud.ct.gov/ADA/
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Document Specifications
| Fact Name | Description |
|---|---|
| Form Purpose | The Connecticut Custody Application form is used for filing custody or visitation applications in family court. |
| Governing Laws | This form is governed by Connecticut General Statutes §§ 46b-56, 46b-61 and Practice Book §§ 25-3, 25-4, 25-5. |
| Required Attachments | Applicants must attach several documents, including the Order to Attend Hearing and the Affidavit Concerning Children. |
| Filing Deadline | All accompanying documents must be filed by the first scheduled court date for the case. |
| Eligibility for Visitation | Grandparents and third parties can file for visitation using a separate form, the Verified Petition for Visitation. |
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