Form Jd Fm 164 – Fill Out and Use This PDF

Form Jd Fm 164 is a legally binding document, approved and regulated by the United States District Court. The form protects the interests of both parties involved in the agreement. It can be used to create many different types of agreements, ranging from residential tenancy contracts to civil partnership dissolution documents. In addition to protecting each party's rights and addressing potential liabilities, Form Jd Fm 164 also defines matters of enforcement for every agreement created using it as a baseline document. It sets out specified penalties for chosen cases that may result in consequential damages or sanctions if oversight should occur. When correctly utilized, this form serves to provide safety and assurance to individuals engaged in the contract.

Form Jd Fm 164 PDF Details

On July 1, 2014, a new form will be available for Massachusetts employers to use when filing their unemployment insurance tax returns. The new form, Jd Fm 164, replaces the old Form UC-1. While the overall process remains the same, there are a few changes that employers should be aware of. This blog post will outline those changes and provide some helpful tips on how to complete the new form. Stay tuned for future posts in which we will go into more detail on specific sections of Jd Fm 164. Thanks for reading!

Question	Answer
Form Name	Form Jd Fm 164
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	child 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	Relationship
	Date(s) of residence			(Town or city, and state, unless	person(s) child lived with	to child
				confidential by court order)	(unless confidential)	to child
				confidential by court order)	(unless confidential)

From		To The present
From		To The present
	(date)
	(date)


From		To
From		To
	(date)		(date)
	(date)		(date)


From		To
From		To
	(date)		(date)
	(date)		(date)


From		To
From		To
	(date)		(date)
	(date)		(date)


From		To
From		To
	(date)		(date)
	(date)		(date)

Child's name (First, middle, last)

Date of birth (Month, day, year)			Residence information is same as for child above.
			Residence information is same as for child above.
			(If not same, provide information)
			(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	Relationship
		Date(s) of residence			(Town or city, and state, unless	person(s) child lived with	to child
					confidential by court order)	(unless confidential)	to child
					confidential by court order)	(unless confidential)

From			To The present
From			To The present
		(date)
		(date)


From			To
From			To
		(date)		(date)
		(date)		(date)


From			To
From			To
		(date)		(date)
		(date)		(date)


From			To
From			To
		(date)		(date)
		(date)		(date)


From			To
From			To
		(date)		(date)
		(date)		(date)



	Check here if additional children are listed on JD-FM-164A.						Page 1 of 2
	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)

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.

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

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

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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To be able to finalize this form, ensure you type in the necessary information in every area:

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.

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.

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.

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.

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Form Jd Fm 164 – Fill Out and Use This PDF

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