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Affidavit Temporary Custody Removal Termination Or Adoption PC-610 - Connecticut
| Affidavit Temporary Custody Removal Termination Or Adoption Form. This is a Connecticut form and can be used in Probate Statewide . |
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STATE OF CONNECTICUT AFFIDAVIT/TEMPORARY CUSTODY, REMOVAL, TERMINATION, OR ADOPTION RECORDED (CONFIDENTIAL COURT OF PROBATE PC-610 REV. 10/12 [To be submitted as of hearing date. C.G.S. ยง52-231a.] [Type or print in black ink.] TO: COURT OF PROBATE, IN THE MATTER OF Hereinafter referred to as the minor child. The subscriber hereby swears, affirms, or avers that: DISTRICT NO. VOLUME): DATE OF BIRTH OF MINOR CHILD To the best of my knowledge and belief, there is no proceeding pending or contemplated in another court in Connecticut or any other state affecting the custody of said minor child. There is a proceeding in another court affecting the custody of said minor child, and a statement in detail of the nature of such proceeding is attached hereto [Use JD-FM-164, Affidavit Concerning Children], but the proceedings in this court on the pending matter concerning said minor child will not conflict with or interfere with such other proceedings. Name [Type or print] Signature ...................................................................................................... Address: Tel. No. SUBSCRIBED AND SWORN TO BEFORE ME DATE ..................................................................................... Judge, Ass't Clerk, Notary Public, Comm. Sup. Ct. Date: AFFIDAVIT/TEMPORARY CUSTODY, REMOVAL, TERMINATION, OR ADOPTION PC-610 American LegalNet, Inc. www.FormsWorkFlow.com
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