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Application Termination Of Parental Rights PC-600 - Connecticut
|Application Termination Of Parental Rights Form. This is a Connecticut form and can be used in Probate Statewide .||
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APPLICATION/TERMINATION OF PARENTAL RIGHTS PC-600 REV. 7/12 Page 1 STATE OF CONNECTICUT COURT OF PROBATE RECORDED (CONFIDENTIAL VOLUME): [Type or print in black ink. Indicate if any information is unknown. Attach: 1) certified copy of birth certificate and 2) statement of facts under oath relating to grounds for termination. (See page 2.) Complete Confidential Information Sheet for PC-600 on last page. File this form in duplicate.] TO: COURT OF PROBATE, IN THE INTEREST OF [Name, present address, zip code, sex] DISTRICT NO. PLACE OF BIRTH OF MINOR CHILD DATE OF BIRTH OF MINOR CHILD a person under 18 years of age, hereinafter referred to as the minor child. TRIBE AND RESERVATION of minor child, if an Indian child as defined by P.L. 95-608, 25 U.S.C. 1901, et seq. [Name and address] The minor child is presently or was formerly the recipient of state assistance. Jurisdiction based on: Party whose parental rights are to be terminated is under a court order to pay child support. Petitioner or minor child resides in the probate district. Minor child is under the guardianship of a duly-licensed child care or child-placing agency, which has an office in the probate district. PETITIONER [Name, address, zip code, telephone number, the nature of the relationship to minor child and legal status of petitioner. C.G.S. §45a-715.] PARENT(S) OF MINOR CHILD [Name(s),address(es), and Indian tribe and reservation, if a member as defined by P.L. 95-608, 25 U.S.C.1901, et. seq.] MOTHER: MOTHER'S DATE OF BIRTH FATHER: [Include putative father named by the mother.] FATHER'S DATE OF BIRTH The petitioner represents that the whereabouts of the parent(s) or putative father are unknown. [If this box is checked, complete affidavit section at bottom of Page 3.] IF PARENT(S) TO BE TERMINATED IS A MINOR, LIST THE PARENT OR GUARDIAN OF THE MINOR PARENT. [Name(s), address(es), zip code(s), telephone number(s), and relationship] APPLICATION/TERMINATION OF PARENTAL RIGHTS PC-600 Page 1 of 5 Continued American LegalNet, Inc. www.FormsWorkFlow.com APPLICATION/ TERMINATION OF PARENTAL RIGHTS PC-600 REV. 7/12 Page 2 STATE OF CONNECTICUT COURT OF PROBATE RECORDED (CONFIDENTIAL VOLUME): [For the legal effects of a Termination of Parental Rights Decree, see page 5.] GUARDIAN OF PERSON OF MINOR CHILD, if other than parent, and GUARDIAN AD LITEM APPOINTED IN PRIOR . PROCEEDING(S), if any. [ Name(s), address(es), zip code(s), and telephone number(s)] AGENCY THAT PLACED THE CHILD IN CURRENT PLACEMENT. [Name, address, and zip code] THE PETITIONER REPRESENTS that the MINOR CHILD presently resides in the town named above, was born on the date written above, and the persons who may have parental rights are as stated above, AND THAT the parental rights of the person(s) indicated below should be terminated for the following reasons, as provided by statute. Attached hereto and made a part hereof is a statement of facts made under oath relating to each ground for termination. C.G.S. § 45a-717. See notice below. NOTICE -- IN ORDER TO GRANT THE PETITION, THE COURT MUST MAKE FINDINGS IN REGARD TO: (1) The timeliness, nature, and extent of services offered, provided, and made available to the parent and the child by an agency to facilitate the reunion of the child with the parent. (2) The terms of any applicable court order entered into and agreed upon by any individual or agency and the parent and the extent to which all parties have fulfilled their obligations under such order. (3) The feelings and emotional ties of the child with respect to his parents, any guardian of his person, and any person who has exercised physical care, custody, or control of the child for at least one year and with whom the child has developed significant emotional ties. (4) The age of the child. (5) The efforts the parent has made to adjust his circumstances, conduct, or conditions to make it in the best interest of the child to return him to his home in the foreseeable future, including, but not limited to, (A) the extent to which the parent has maintained contact with the child as part of an effort to reunite the child with the parent, provided the court may give weight to incidental visitations, communications, or contributions and (B) the maintenance of regular contact or communication with the guardian or other custodian of the child. (6) The extent to which a parent has been prevented from maintaining a meaningful relationship with the child by the unreasonable act or conduct of the other parent of the child, or the unreasonable act of any other person, or by the economic circumstances of the parent. THE PETITIONER REPRESENTS that the termination of the parental rights of is in the best interests of the child, AND THAT consent(s) to termination of their parental rights with respect to the minor child. [No further allegation is necessary against a consenting parent. However, an Affidavit of Consent to Termination of Parental Rights, JD-JM-60, and a statement of facts related to this ground for termination must accompany this application.] OR Continued APPLICATION/TERMINATION OF PARENTAL RIGHTS PC-600 Page 2 of 5 American LegalNet, Inc. www.FormsWorkFlow.com APPLICATION/ STATE OF CONNECTICUT RECORDED (CONFIDENTIAL TERMINATION OF COURT OF PROBATE PARENTAL RIGHTS PC-600 REV. 7/12 Page 3 [For legal effects of a Termination of Parental Rights Decree, see page 5. ] VOLUME): The child has been 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. OR The child has been denied the care, guidance, or control necessary for the child's physical, educational, moral, or emotional well-being, by reason of acts of parental commission or omission by There has been a nonaccidental or inadequately explained serious physical injury to the child. There has been sexual molestation and exploitation, severe physical abuse, or a pattern of abuse. OR There is no ongoing parent/child relationship as defined in C.G.S. § 45a-717(g), and to allow further time for the establishment or reestablishment of the parent/child relationship would be detrimental to the best interests of the child. OR The child is found to be neglected or uncared for AND has been in the custody of the Commissioner of the Department of Children and Families for at least fifteen months, AND the parent has been provided specific steps to take to facilitate the return of the child to the parent pursuant to C.G.