Form Jd Fm 164 PDF Details

The JD-FM-164 form, titled "Affidavit Concerning Children," is a crucial document in the Connecticut legal landscape, particularly within family law proceedings. Drafted to align with Connecticut General Statutes § 46b-115s and Probate Court Rules § 25-57, this affidavit aids the court in understanding the dynamics concerning the children involved in a case. It requires a detailed account of the children's past five years of residency, including who they lived with and their relationship to these individuals. This sworn statement must be thoroughly completed and signed before a court clerk, notary public, or attorney, ensuring all declarations are truthful. The form delves into prior involvements in custody or visitation cases, information on any other relevant civil or criminal cases, and clarifies if any parties other than the plaintiff/applicant and defendant/respondent claim custody or visitation rights. Additionally, it inquires about any recent or pending births to the mother named in the application or complaint. The JD-FM-164 form, functioning as a comprehensive tool, underscores the importance of transparency in legal proceedings involving minors, paving the way for informed decisions regarding custody and visitation. Its design reflects the judicial branch's commitment to accommodating individuals under the Americans with Disabilities Act (ADA), emphasizing a considerate approach to all participants within the legal process.

QuestionAnswer
Form NameForm Jd Fm 164
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other nameschild connecticut any, jd fm 164, connecticut concerning latest, jd 164

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AFFIDAVIT CONCERNING CHILDREN

JD-FM-164 Rev. 2-15

C.G.S. § 46b-115s

P.B. § 25-57

STATE OF CONNECTICUT

SUPERIOR COURT

COURT OF PROBATE

Instructionswww.jud.ct.gov

Fill out this form completely. You must swear that your statements are true and sign this form in front of a court clerk, a notary public, or an attorney who will also sign and date the affidavit.

Court Use Only

AFFACUS

* AFFACUS*

Judicial District of

At (Town)

Probate District name and number

Docket number

Plaintiff/Applicant's (Last, first, middle initial)

Defendant/Respondent's (Last, first, middle initial)

You must provide information about the past five years for each child affected by this case. Provide the information below. If you need more space, use form JD-FM-164A.

Child's name (First, middle, last)

Date of birth (Month, day, year)

 

 

 

 

 

Place of residence

Name(s) and present address(es) of

Relationship

 

Date(s) of residence

 

(Town or city, and state, unless

person(s) child lived with

 

 

to child

 

 

 

 

 

confidential by court order)

(unless confidential)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From

To The present

 

 

 

 

 

 

 

 

 

(date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From

To

 

 

 

 

 

 

 

 

 

(date)

 

(date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From

To

 

 

 

 

 

 

 

 

 

(date)

 

(date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From

To

 

 

 

 

 

 

 

 

 

(date)

 

(date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From

To

 

 

 

 

 

 

 

 

 

(date)

 

(date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Child's name (First, middle, last)

Date of birth (Month, day, year)

 

 

Residence information is same as for child above.

 

 

 

 

 

 

(If not same, provide information)

 

 

 

 

 

 

 

 

 

 

 

 

 

Place of residence

Name(s) and present address(es) of

Relationship

 

 

 

Date(s) of residence

(Town or city, and state, unless

person(s) child lived with

 

 

 

to child

 

 

 

 

 

 

confidential by court order)

(unless confidential)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From

To The present

 

 

 

 

 

 

 

 

 

(date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From

To

 

 

 

 

 

 

 

 

 

(date)

 

(date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From

To

 

 

 

 

 

 

 

 

 

(date)

 

(date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From

To

 

 

 

 

 

 

 

 

 

(date)

 

(date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From

To

 

 

 

 

 

 

 

 

 

(date)

 

(date)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Check here if additional children are listed on JD-FM-164A.

 

Page 1 of 2

 

 

 

1. (Check one)

I have

I have not

been involved as a party or a witness or in any other capacity in a case

or cases in Connecticut or in another state concerning custody of or visitation with any child listed in this affidavit. If you checked "I have," give the name of the court, the court case number and the date of the decision in the case or cases:

(Check item 2 or 3 below)

2.

I do not know of other civil or criminal cases in Connecticut or another state, now or in the past, that could affect the current case, including enforcement cases and family violence, protective order, termination of parental rights and adoption cases.

3.

I know of the following civil or criminal cases, in Connecticut or another state, now or in the past, that could affect the current case, including enforcement cases and family violence, protective order, termination of parental rights and adoption cases.

Case name

Docket number

Court location (Including state)

Nature of proceeding

Case name

Docket number

Court location (Including state)

Nature of proceeding

4.(Check one)

No one except the plaintiff/applicant and defendant/respondent has physical custody or claims to have custody or visitation rights regarding any child listed here.

The following person(s) has physical custody or claims to have custody or visitation rights regarding any child listed here:

Name:

Address:

(unless confidential)

5. The mother of the child(ren) named in the Complaint or Application is pregnant.

Yes

No

Do not know

6. A child has been born to the mother named in the Complaint or Application after the filing of the Complaint or Application.

Yes

No

Do not know

If yes, fill in the following:

Child's name

Date of birth (Month, day, year)

Signature

Print name of person signing

Sworn to before me (Assistant Clerk/Commissioner of Superior Court/Notary Public)

Date signed

JD-FM-164 Rev. 2-15

Page 2 of 2

 

You must tell the court about any case in Connecticut or another state that could affect this case, if you learn about it during this case.

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 a court clerk or an ADA contact person listed at www.jud.ct.gov/ADA.

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1. It's very important to complete the jd 164 form correctly, hence take care while filling in the parts that contain all these blank fields:

jd 164 conclusion process clarified (step 1)

2. Now that this part is complete, you should add the required details in date, From, date, date, date, Childs name First middle last, Date of birth Month day year, Residence information is same as, Dates of residence, Place of residence, Town or city and state unless, confidential by court order, Names and present addresses of, persons child lived with, and unless confidential in order to go to the next stage.

Stage number 2 for filling in jd 164

3. In this particular step, have a look at Check here if additional children, and Page of. These will have to be taken care of with highest precision.

Tips on how to fill out jd 164 step 3

4. The subsequent subsection requires your information in the subsequent parts: Check one, I have, I have not, been involved as a party or a, or cases in Connecticut or in, Check item or below, I do not know of other civil or, I know of the following civil or, Case name, Docket number, Court location Including state, Nature of proceeding, Case name, Docket number, and Court location Including state. Remember to enter all requested details to move onward.

Stage # 4 of completing jd 164

5. As you come close to the final sections of this document, there are a couple extra requirements that have to be met. Mainly, No one except the, The following persons has physical, Name, Address, unless confidential, The mother of the children named, Yes, Do not know, A child has been born to the, Yes, Do not know If yes fill in the, Childs name, Signature, Date of birth Month day year, and Print name of person signing should be done.

Writing segment 5 of jd 164

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