Form Pc 600 – Fill Out and Use This PDF

Petition/Termination of
Parental Rights	C O N N E C T I C U T P R O B A T E C O U R T S
PC-600 REV. 10/19
	CONFIDENTIAL
RECEIVED:

Instructions: 1) A parent or guardian, or other authorized person or agency under C.G.S. section 45a-715, may use this form

to petition for termination of parental rights of a parent or parents of a minor child. For a child born out of wedlock, the petition shall list any putative father as defined in C.G.S. section 45a-716 (b).

2)The petition should be filed in the court for the probate district in which (1) the petitioner resides; (2) the minor child resides, is domiciled or is located at the time of the filing of the petition; or (3) in the case of a minor who is under the guardianship of any child care facility or child-placing agency, in the district in which the main or local office of the agency is located.

3)A statement of facts for each ground of termination, including consent, must be completed. See Page 4.

4)The following documents should be filed with the petition: a) A long-form birth certificate, b) JD-FM-164, Affidavit Concerning Children and c) Confidential Sheet, PC-600CI, with confidential social security numbers.

5)Contact the court regarding payment of service of process fees and, if applicable, payment of newspaper notice publication.

6)For more information, see C.G.S. sections 45a-715 et seq., 46b-115 et seq., and 52-231a, and Probate Court Rules of Procedure, rule 4o.

7) Type or print in ink. Use an additional sheet, or PC-180, if more space is needed.

	Probate Court Name			District Number
	In the Matter of		Place of Birth of Minor Child		Birth Date of Minor Child
	Hereinafter referred to as the minor child
	Address where minor child resides	Address where minor child is		Address where minor child is located
		domiciled (if different)		at time of filing petition (if different)

Tribe and Reservation of Minor Child, if an Indian Child as defined by 25 U.S.C. section 1903 (Name and address)

Petitioner (Name, address and telephone number, and the nature of the relationship to the minor child)

Parents of Minor Child (For each parent, list name, address, telephone number: date of birth, whether in the military service of the United States or Allied Nation (50 U.S.C. section 3931); Indian tribe and reservation, if a member as defined by 25 U.S.C. section 1903; and whether the parent is legally incompetent. Include any putative father of a child born out of wedlock. C.G.S. section 45a-716 (b)(2)).

		a. Relationship to minor child:
1.		b. If parent, date of birth:
		c. In military service of US or Allied Nation)					Yes		No
		d. Indian tribe and reservation:
		e. Legally incompetent:	Yes		No
2.		a. Relationship to minor child:
		b. If parent, date of birth:
		c. In military service of US or Allied Nation:					Yes		No
		d. Indian tribe and reservation:
		e. Legally incompetent:	Yes		No

Hereinafter referred to as the respondent(s)

Petition/Termination of Parental Rights	PC-600 Page 1 of 7

Petition/Termination of
Parental Rights	C O N N E C T I C U T P R O B A T E C O U R T S
PC-600 REV. 10/19
	CONFIDENTIAL

If a parent listed above is a minor or legally incompetent, list the parents or guardian/conservator for the parent (Include the name, address, telephone number and relationship.)

1.

2.

Name of parent whose parental rights were previously terminated. (Provide a copy of the court decree.)

The petitioner alleges that the whereabouts of the respondents is unknown. The last-known address of the respondents is:

The following efforts have been made to obtain the current address for the respondents:

Guardian of the person, if not a parent (For each guardian, list name, address, telephone number and date of appointment as guardian.)

Child-placing agency involved with the minor child, if not the petitioner (Name, address and telephone number)

The petitioner represents that:

The parental rights of the persons indicated below should be terminated for one or more of the following grounds as provided by statute and as more fully described in the attached statement of facts for each ground for termination:

__________________________________________________ consents to termination of his or her parental rights

with respect to minor child. (No further allegation is necessary against a consenting parent. However an Affidavit/ Consent to Termination of Parental Rights, JD-JM-60, must accompany this petition.)

OR The child was abandoned by __________________________________________in the sense that the parent has

failed to maintain a reasonable degree of interest, concern or responsibility as to the welfare of the child.

Petition/Termination of Parental Rights

PC-600 Page 2 of 7

Petition/Termination of
Parental Rights
PC-600 REV. 10/19	C O N N E C T I C U T P R O B A T E C O U R T S

CONFIDENTIAL

The petitioner further represents that the termination of parental rights of the parents, _______________________ and

_______________________, is in the best interests of the child.

The petitioner further represents that to the best of his or her knowledge and belief:

The minor child			has resided		has not resided in Connecticut continuously for the last six months.
There	is a proceeding			is no proceeding pending or contemplated in Connecticut or any other state affecting the
custody of the minor child.
There	has been a proceeding				has not been a proceeding	in the past in Connecticut or any other state
affecting the custody of the minor child.
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			is	is not	the subject of a pre-existing child support order.

WHEREFORE, the petitioner requests that the court terminate the parental rights of

________________________________________________________ , and petitions the court to:

Appoint a statutory parent for the minor child, adoption being contemplated. The proposed statutory parent is:______________________________________.

Appoint guardians of the person of the minor child.

The proposed guardians are:__________________________________________________________.

Affirm that the remaining parent shall be the sole parent and natural guardian of the minor child.

Affirm the appointment of __________________________________________as guardian of the minor child.

The representations made in this petition are made under penalty of false statement.

Signature of Petitioner

Type or Print Name

Date

Acceptance of Trust of Proposed Statutory Parent, if applicable. If appointed statutory parent, I will accept the position of trust:

Signature

Type or Print Name
Agency and Title
Address
Telephone Number
Date
Petition/Termination of Parental Rights	PC-600 Page 5 of 7

	Petition/Termination of
	Parental Rights	C O N N E C T I C U T	P R O B A T E C O U R T S
	PC-600 REV. 10/19

CONFIDENTIAL

Acceptance of Trust of Proposed Guardians, if applicable.

If appointed guardian, I will accept the position of trust:

Signature

Type or Print Name

Address

Telephone Number

Birth Date

Date

Signature

Type or Print Name

Address

Telephone Number

Birth Date

Date

Consent to Termination

I consent to the termination of my parental rights with respect to the minor child. (Any consent to termination of parental rights must be accompanied by an Affidavit/ Consent to Termination of Parental Rights, JD-JM-60. C.G.S. section 45a-715. A parent may waive personal service by filing a Waiver of Personal or Abode Service/Parental Rights Matter, PC-633.)

Signature of Parent/Guardian	Duly Acknowledged Before Me
Type or Print Name
Date	Judge, Clerk, Public Notary, Comm. Sup. Ct.
Signature of Parent/Guardian	Duly Acknowledged Before Me
Type or Print Name
Date	Judge, Clerk, Public Notary, Comm. Sup. Ct.

Joinder and Consent of Minor Child

I, the undersigned minor child, being at least 12 years of age, do join in the petition for termination of parental rights and consent to the appointment of the proposed guardian as my guardian. C.G.S. section 45a-715.

	Signature of Minor Child	Duly Acknowledged Before Me
	Type or Print Name
	Date	Judge, Clerk, Public Notary, Comm. Sup. Ct.
Petition/Termination of Parental Rights		PC-600 Page 6 of 7