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Connecticut Divorce Complaint Form

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Connecticut Divorce Complaint Form Page 2
Connecticut Divorce Complaint Form
JD-FM-159 (Back) Rev. 8-13
any other documents filed with this Complaint to the City Clerk of the town providing assistance and file the Certification
of Notice (JD-FM-175) with the court clerk.
The other parent of this unborn child is the
State of Connecticut:
If yes, you must send a copy of the Summons, Complaint, Notice of Automatic Court Orders and any other documents
filed with this Complaint to the Assistant Attorney General, 55 Elm Street, Hartford, CT 06106, and file the Certification
of Notice (JD-FM-175) with the court clerk.
The Court is asked to order: ("X" all that apply)
Signature
If there is a court order regarding custody or support for any child listed above, name the child(ren) below and specify
the person or agency awarded custody or ordered to pay support:
And anything else the Court deems fair.
)
.
educational support of the child(ren).
• If this is a Complaint, attach a copy of the Automatic Court Orders before serving a copy on the Defendant.
• If this is an Amended Complaint or a Cross Complaint, you must mail or deliver a copy to anyone who has filed
an appearance and you must complete the certification below.
13.
11.
12. The ("X" all that apply)
14.
parental decisionmaking regarding the minor child(ren).
AND
The ("X" all that apply)
from a city or town in Connecticut. ("X" one)
Regarding Parental Decisionmaking Responsibility:
Regarding Physical Custody:
schedule of physical care of the minor child(ren).
Child's name Name of person or agency awarded custody Name of person ordered to pay support
Child's name Name of person or agency awarded custody Name of person ordered to pay support
Child's name Name of person or agency awarded custody Name of person ordered to pay support
plaintiff defendant or any of the child(ren) listed above have received from the
financial support ("X" one)
Yes No Do not know
HUSKY Health Insurance ("X" one)
Yes No Do not know
The ("X" all that apply)
plaintiff defendant is pregnant with a child due to be born on
(date)
plaintiff or defendant unknown
not the plaintiff not the defendant.
plaintiff defendant or any of the child(ren) listed above has received financial support
Yes (State city or town:
No Do not know. If yes, send a copy of the Summons, Complaint, Notice of Automatic Court Orders and
A divorce (dissolution of marriage).
A fair division of property and debts.
Alimony.
Child Support.
An order regarding the post-majority
Name change to:
Sole custody.
Joint legal custody.
A parenting responsibility plan which includes a plan for the
Primary residence with:
Visitation.
A parenting responsibility plan which includes a plan for the
Print name of person signing Date signed
Address
Juris number (If applicable) Telephone (Area code first)
and self-represented parties of record and that written consent for electronic delivery was received from all attorneys and self-represented
parties receiving electronic delivery.
Certification
I certify that a copy of this document was mailed or delivered electronically or non-electronically on (date)
to all attorneys
Name and address of each party and attorney that copy was mailed or delivered to*
Signed (Signature of filer)
u
*If necessary, attach additional sheet or sheets with name and address which the copy was mailed or delivered to.
Print or type name of person signing
Date signed
Telephone number
Mailing address (Number, street, town, state and zip code)
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Connecticut Divorce Complaint Form
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