Form Pc 504 – Fill Out and Use This PDF

The PC-504 form is a crucial document in the State of Connecticut for the application and appointment of a temporary guardian of a minor child. It outlines specific information related to the child, the petitioner, the proposed temporary guardian, and any other guardians with legal rights concerning the minor. Understanding and accurately completing this form can ensure the minor's needs are met in situations where the usual guardians are unable to fulfill their responsibilities.

For those needing to secure a temporary guardian for a minor, filling out the PC-504 form accurately is the first step. Click the button below to get started with your application.

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Form Pc 504 PDF Details

The process of safeguarding a minor's well-being in Connecticut involves various legal instruments, among which the PC-504 form plays a crucial role. Designed to facilitate the application and appointment of a temporary guardian, this form serves as a vital resource for individuals seeking to ensure the welfare of a minor child in instances where the usual guardians are unable to fulfill their responsibilities. The comprehensive nature of the PC-504 form, revised as of July 2012, requires detailed information including the personal details of the petitioner, the proposed temporary guardian, and those initially entitled to guardianship over the minor. Furthermore, it mandates a clear exposition of the reasons necessitating temporary guardianship, ranging from absence due to illness to other significant impediments. This form encompasses a meticulous process, ensuring all legal criteria are met, including disclosures pertaining to the minor's residency, any existing legal proceedings affecting custody, and the absence or presence of a legal disability among respondents. Additionally, it covers military service considerations for respondents, previous custody proceedings, child support orders, existing agreements with the Department of Children and Families, and any protective or restraining orders. The appointment of a temporary guardian, as stipulated by the PC-504 form, is bounded by a one-year term unless decreed otherwise, emphasizing the provisional nature of this safeguarding measure. The importance of integrity in this process is underscored by the requirement for representations to be made under the penalties of false statement, ensuring that all parties provide information with the utmost honesty and accuracy.

Question	Answer
Form Name	Form Pc 504
Form Length	3 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	45 sec
Other names	pc 504ar temporary guardianship 45a 622 pc 504 form

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APPLICATION/APPOINTMENT	STATE OF CONNECTICUT
OF TEMPORARY GUARDIAN	RECORDED(CONFIDENTIAL VOLUME):
OF TEMPORARY GUARDIAN
PC-504 REV. 7/12 Page 1 of 2	COURT OF PROBATE
[Type or print in black ink. Complete Confidential Information Sheet for PC-504 on last page.

TO: COURT OF PROBATE,	DISTRICT NO.

IN THE MATTER OF	A MINOR CHILD BORN ON
	A MINOR CHILD BORN ON

Presently residing at

PETITIONER [Name, address, zip code, telephone number, and legal status of petitioner. C.G.S. § 45a-622.]

PROPOSED TEMPORARY GUARDIAN [Name, address, zip code, and birth date.]

PERSONS WHO HAVE GUARDIANSHIP RIGHTS WITH RESPECT TO SAID MINOR CHILD [If any is a minor, give date of birth;

if incompetent or in military service, so indicate. Give last known address and zip code. C.G.S. § 45a-621.]

MOTHER

FATHER [Including an unwed father, C.G.S. § 45a-604. If father is unknown, so state.]

GUARDIAN(S) OF THE PERSON OF THE MINOR

Explain why the parent(s) or guardian(s) is/are unable to care for the minor. [E.g., absence from jurisdiction, illness, etc.]

APPLICATION/APPOINTMENT OF TEMPORARY GUARDIAN

PC-504

Page 1 of 2

APPLICATION/APPOINTMENT						STATE OF CONNECTICUT
OF TEMPORARY GUARDIAN							RECORDED(CONFIDENTIAL VOLUME):
OF TEMPORARY GUARDIAN
PC-504 REV. 7/12				Page 2 of 2		COURT OF PROBATE
						[Type or print in black ink.]

THE PETITIONER FURTHER REPRESENTS that to the best of his or her knowledge and belief:
	The following respondent(s) is/are under a legal disability:
							No respondent(s) is under a legal disability.
	The following respondent(s) is/are in the military service of the United States or Allied Nation (Title 50 Appendix, U.S.C. 520).
							No respondent(s) is in the military service.

	There is	a		no proceeding pending or contemplated in Connecticut or any other state affecting the custody of the minor child.
	C.G.S. §§ 52-231a and 46b-115 et seq. [Complete and attach form JD-FM-164, Affidavit Concerning Children.]
There		has been		has not been a proceeding in the past in Connecticut or any other state affecting the custody of the minor child.
C.G.S. § 52-231a and 46b-115 et seq.
	The minor child			is	is not the subject of a pre-existing child support order.
	There	is	is not a current safety or service agreement between the Department of Children and Families and the parent/guardian of
	the minor child.
	There	is	is not a current protective order or restraining order involving any party. If so, please attach.
	The minor child			has	has not resided in Connecticut continuously for the last six months. C.G.S. § 46b-115 et seq.

WHEREFORE THE PETITIONER REQUESTS that this court appoint a temporary guardian(s) of the person of the minor to commence on

the date of the court decree and to terminate one year from the date of the decree OR	20
In no event shall such guardianship exceed the period of one year.

The representations contained herein are made under the penalties of false statement.

.....................................................................................	................................................................................
Petitioner:	Petitioner:
Date:	Date:

[If petitioner is requesting a waiver of fees, attach PC-184, Request/Order Waiver of Fees - Petitioner.]

PROPOSED TEMPORARY GUARDIAN(S)

IF APPOINTED, I/WE WILL ACCEPT THE POSITION OF TRUST.

Signature .......................................................................................................................................................................

Name [Type or print.]

Address and zip code:

Telephone Number(s):	Date of Birth:
	Date of Birth:
Signature
Signature
Name [Type or print.]
Address and zip code:
Address and zip code:

Telephone Number(s):		Date of Birth:
		Date of Birth:


APPLICATION/APPOINTMENT OF TEMPORARY GUARDIAN
PC-504	Page 2 of 2

CONFIDENTIAL	STATE OF CONNECTICUT	DO NOT RECORD
INFORMATION SHEET
FOR PC-504, Application/	COURT OF PROBATE
Appointment of Temporary Guardian
NEW 7/12	[Type or Print in Black Ink.]

_____________________________________________________________________________________

Court of Probate,
In the Matter of	, a minor child.

The social security numbers of the following persons are required in connection with this proceeding:

1)Petitioner:

Name:

Social Security Number:

2)Proposed Temporary Guardian(s): a. Name:

Social Security Number: b. Name:

Social Security Number:

3)Persons who have guardianship rights with respect to the minor child: a. Name:

Social Security Number: b. Name:

Social Security Number:

How to Edit Form Pc 504 Online for Free

Working with PDF forms online is surprisingly easy with our PDF tool. You can fill in Form Pc 504 here painlessly. The tool is consistently maintained by our staff, receiving useful features and turning out to be better. Here is what you would need to do to get started:

Step 1: Firstly, access the pdf editor by clicking the "Get Form Button" in the top section of this site.

Step 2: Once you open the online editor, there'll be the form all set to be filled out. In addition to filling in various blank fields, you can also perform some other actions with the PDF, that is writing custom textual content, changing the initial textual content, inserting illustrations or photos, affixing your signature to the PDF, and much more.

It will be an easy task to fill out the form using out practical tutorial! This is what you should do:

1. Complete the Form Pc 504 with a selection of necessary fields. Collect all the information you need and ensure nothing is missed!

2. Given that the last part is done, you need to include the necessary details in FATHER Including an unwed father, GUARDIANS OF THE PERSON OF THE, and Explain why the parents or allowing you to proceed further.

Form Pc 504 writing process described (portion 2)

It is easy to make an error when completing your GUARDIANS OF THE PERSON OF THE, so make sure to take a second look before you submit it.

3. Completing The following respondents isare, The following respondents isare in, No respondents is in the military, There is a no proceeding pending, No respondents is under a legal, There has been has not been a, The minor child is is not the, There is is not a current safety, There is is not a current, The minor child has has not, WHEREFORE THE PETITIONER REQUESTS, the date of the court decree and, In no event shall such, year, and The representations contained is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

Form Pc 504 writing process detailed (stage 3)

4. All set to complete the next section! Here you'll get all of these Petitioner, Date, Petitioner, Date, If petitioner is requesting a, IF APPOINTED IWE WILL ACCEPT THE, Signature, PROPOSED TEMPORARY GUARDIANS, Name Type or print, Address and zip code, Telephone Numbers, Date of Birth, Signature, Name Type or print, and Address and zip code blanks to do.

5. The form has to be wrapped up within this section. Further you'll find an extensive list of form fields that have to be filled out with specific information to allow your document submission to be accomplished: Court of Probate, In the Matter of, a minor child, The social security numbers of the, Petitioner, Name, Social Security Number, Proposed Temporary Guardians, a Name, Social Security Number, b Name, and Social Security Number.

Step 3: Once you have glanced through the information in the blanks, just click "Done" to finalize your form at FormsPal. Join FormsPal now and immediately get Form Pc 504, prepared for downloading. All alterations you make are preserved , making it possible to modify the file at a later stage as required. FormsPal ensures your data privacy with a secure method that in no way records or distributes any sort of private information used in the file. Be confident knowing your documents are kept safe whenever you work with our tools!

Form Pc 504 – Fill Out and Use This PDF

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