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Dissolution Of Marriage Report JD-FM-181 - Connecticut
| Dissolution Of Marriage Report Form. This is a Connecticut form and can be used in Family Statewide . |
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DISSOLUTION OF MARRIAGE REPORT JD-FM-181 Rev. 11-09 P.B. ยง 25-58 Instructions 1. To be completed by the Attorney for the Plaintiff or, if a Self-Represented Person, by the Plaintiff. 2. Clerk to complete section 2. STATE OF CONNECTICUT SUPERIOR COURT www.jud.ct.gov PART 1 (To be completed by the Attorney for the Plaintiff or if a Self-Represented Person, by the Plaintiff) Plaintiff Name (First, middle, last) Usual Residence (Number and street) State City or Town Zip code Birthplace (State or Foreign Country) Attorney For Plaintiff (If Applicable) (Name) Attorney's Address (If Applicable) (Number street, city, state, zip code) Defendant Name (First, middle, last) Usual Residence (Number and street) State City or town Zip code Birthplace (State or Foreign Country) Marital History Place of This Marriage (City) Date of Marriage (Month, Day, Year) State Zip code Date of civil union that merged into marriage by subsequent ceremony or by operation of law (Month, Day, Year) Number of Children Born Alive of This Marriage Number of Children Still Living Approximate Date Couple Separated (Month, Year) Number of Children Under 18 Years of Age Conflict Resolution Conference Number of Children Under 23 Years of Age Issue Focused Evaluation CSSD Family Services Evaluation CSSD Family Services Mediation Yes Yes No No Yes Yes No No Yes Attorney For minor Child(ren) No Yes No Public Assistance Recipient -- Cash Recipient Public Assistance Recipient -- HUSKY Recipient (Medical) Guardian Ad Litem For Minor Child(ren) Yes No Yes No Information For Statistical Purposes Only: (To be completed by the Attorney for the Plaintiff or, if a Self-Represented Person, by the Plaintiff) Number of This Marriage (First, Second, etc. specify) For Plaintiff If Previously Married, How Many Ended By Divorce or Death Annulment For Plaintiff For Plaintiff For Defendant For Defendant Education - Specify Highest Grade Completed Elementary (0,1,2,3, thru 8) Plaintiff Defendant High School (1,2,3, or 4) Plaintiff Defendant College (1,2,3, 4 or 5+) Plaintiff Defendant For Defendant PART 2 (To be completed by the Clerk of Superior Court) Decree Date of Decree (Month, Day, Year) Docket Number Type of Decree Date Writ Returnable (Month, Year) Divorce FA Case Contested Custody of Minor Children To Annulment Legal Grounds for Dissolution (Specify) Yes Decree Granted To No Defendant Plaintiff Title of Official Defendant Joint Not Applicable Signed (Clerk or Assistant Clerk) Plaintiff American LegalNet, Inc. www.FormsWorkFlow.com
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