Form Jd Fm 172 PDF Details

When filling out the Form JD-FM-172, you may find that there are some questions which do not apply to your situation. In this case, you should leave the question blank. If a question does not pertain to you because you are not subject to income tax withholding, then write 'N/A' in the space provided on the form. Remember, it is important to complete all sections of this form so that your employer can properly calculate your tax withholding. Otherwise, you may end up with a larger-than-expected tax bill come April!

QuestionAnswer
Form NameForm Jd Fm 172
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesDISSOLUTION, 46b-38oo, gov, AGREMNT

Form Preview Example

DISSOLUTION AGREEMENT

 

JD-FM-172 Rev. 7-10

STATE OF CONNECTICUT

C.G.S. §§ 46b-51, 46b-38oo

SUPERIOR COURT

 

Court Use Only

AGREMNT

www.jud.ct.gov

*AGREMNT*

 

Instructions: The instructions for filling out this form are on form JD-FM-172A.

 

Judicial District of

At (Town)

Docket number

Plaintiff's name (Last, first middle initial)

Defendant's name (Last, first, middle initial)

The plaintiff and defendant agree that:

1. Our ("X" one)

marriage

civil union

has broken down irretrievably.

2. The custody of the child(ren) shall be as follows:

Joint legal custody to

 

and

Primary residence with:

A parenting responsibility plan in the best interest(s) of the minor child(ren)

shall be incorporated by reference or

as follows:

Sole custody to:

3. As to visitation with the child(ren):

Who will pick up/drop off for visits or parenting time transition:

Holiday and school vacation schedule:

The amounts/percentages indicated below for Child Support, Health Care Insurance Coverage and Unreimbursed Health Care Costs, and Child Care Costs must follow the Child Support and Arrearage Guidelines (the Guidelines), which are available at Clerk's Offices and on the Judicial Branch website at www.jud.ct.gov/publications, unless you ask for one of the deviation criteria to apply (reasons for an amount different than the Guidelines).

4. As to current and/or past due Child Support:

This amount follows the Guidelines.

This amount is different from the Guidelines (deviation). Give reason for deviation from the Guidelines (see Guidelines for reason that applies):

5.As to the child's or children's required Health Care Insurance Coverage and Unreimbursed Health Care Costs:

This amount follows the Guidelines.

This amount is different from the Guidelines (deviation). Give reason for deviation from the Guidelines (see Guidelines for reason that applies):

(Continued on back/next page)

6. As to Child Care Costs that qualify under the Guidelines:

This amount follows the Guidelines.

This amount is different from the Guidelines (deviation). Give reason for deviation from the Guidelines (see Guidelines for reason that applies):

7. As to post-majority educational support ("x" one):

Both of the parties have made a knowing and intelligent waiver of their right to request a post-majority educational support order; or

The parties ask the Court to reserve jurisdiction to determine whether a post-majority educational support order should issue and the terms of the order; or

The parties ask the Court to find that it is more likely than not that the parents would have provided post-majority educational support, and for the Court to reserve jurisdiction to determine whether to enter an educational support order and the terms of the order; or

The parties ask the Court to enter a post-majority education support as follows (Attach additional sheets if necessary):

8.As to alimony:

9.As to income withholding, we understand that the support orders are by immediate income withholding unless for cause or we both agree to it being contingent: We agree to a(n)

Immediate

Contingent

income withholding.

10.As to division of property: As to real property

As to personal property

11.As to division of debts:

12.As to the change of name:

Plaintiff's name is restored to the

birthname of

 

or

former name of

 

 

.

Defendant's name is restored to the

birthname of

 

or

former name of

 

 

.

13. Other:

We certify that the above statements are our agreement.

Plaintiff (Print name)

Plaintiff's signature

Date signed

Defendant (Print name)

Defendant's signature

Date signed

JD-FM-172 (Back) Rev. 7-10

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This PDF form will involve specific details; to guarantee correctness, you should heed the next guidelines:

1. Whenever filling in the Arrearage, be sure to complete all needed fields in its corresponding part. This will help facilitate the process, allowing your information to be processed swiftly and correctly.

Filling in part 1 of 46b-51

2. Once your current task is complete, take the next step – fill out all of these fields - Who will pick updrop off for, Holiday and school vacation, The amountspercentages indicated, As to current andor past due, This amount follows the Guidelines, This amount is different from the, and As to the childs or childrens with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

46b-51 completion process clarified (part 2)

As to This amount follows the Guidelines and This amount is different from the, be sure that you do everything properly here. Both these are certainly the most important fields in this form.

3. Completing This amount follows the Guidelines, This amount is different from the, and Continued on backnext page is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

46b-51 conclusion process shown (stage 3)

4. This fourth part comes with all of the following form blanks to complete: As to Child Care Costs that, This amount follows the Guidelines, This amount is different from the, As to postmajority educational, Both of the parties have made a, As to alimony, As to income withholding we, and or we both agree to it being.

46b-51 completion process clarified (part 4)

5. This very last notch to complete this form is critical. Ensure you fill in the necessary form fields, like or we both agree to it being, Immediate, Contingent, income withholding, As to division of property As to, As to personal property, As to division of debts, As to the change of name, Plaintiffs name is restored to the, birthname of, former name of, Defendants name is restored to the, and birthname of, prior to using the pdf. Otherwise, it might contribute to a flawed and probably incorrect document!

birthname of, As to personal property, and Immediate of 46b-51

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