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Use for visitation
applications
Use for custody
applications
a.
b.
c.
Connecticut is the home state of the child (or children) at the time of the filing of this case.
The child (or children) has (or have) lived in Connecticut for the past 6 months, or from birth if the child (or children)
is (or are) younger than 6 months old.
The child (or children) lived in Connecticut for at least 6 months but was (or were) taken from Connecticut less than
6 months ago by a person claiming custody, and a parent or guardian continues to live here.
The child (or children) and at least one parent have a significant connection to Connecticut, and there is substantial
evidence in Connecticut concerning the child's (or children's) present or future care, protection, training, and
personal relationships.
The child (or children) is (or are) in Connecticut now and has (or have) been abandoned, or there is an emergency
affecting the child's (or children's) well-being.
No other state has an interest in hearing this case, and it is in the best interest of the child (or children) for a
Connecticut court to hear the case.
4. Connecticut has the authority to decide this case and should decide this case because: (Select all that apply)
CUSTODY/VISITATION
APPLICATION — PARENT
JD-FM-161 Rev. 1-20
C.G.S. §§ 46b-56, 46b-61;
P.B. §§ 25-3, 25-4, 25-5
1. I am the child or children's
3. I want: (Select one)
Child's name (First, middle, last)
Date of birth
2. The respondent(s) is/are the:
Instructions
1. Check the “Custody” or “Visitation” box above, and complete pages 1 and 2 of this form. Attach the Order to Attend Hearing (form JD-FM-162),
Notice of Automatic Court Orders (form JD-FM-158), and Affidavit Concerning Children (form JD-FM-164).
2. By the first date that this case appears on a court docket (the first scheduled date for this case), you must file the accompanying document(s)
listed in number 1 below that apply to you and that prove an existing legal relationship between the parent(s) and the child or children. You must
redact (remove) any personal identifying information, as defined by Section 4-7 of the Connecticut Practice Book, from these documents.
3. If you are a grandparent or a third party (not a legal parent), and you want to file for visitation with the child or children, use the Verified Petition
for Visitation — Grandparents & Third Parties (form JD-FM-221).
(Attach additional sheets if necessary)
Name(s) of parent(s) or guardian(s) (First, middle initial, last)
STATE OF CONNECTICUT
SUPERIOR COURT
www.jud.ct.gov
d.
e.
f.
Docket numberJudicial District of
At (Town)
Applicant's name (Last, first, middle initial) Respondent's name (Last, first, middle initial)
Additional respondent's name (If applicable) (Last, first, middle initial)
Mother Father
Mother Father Grandparent
Other: (Specify)
custody of the child (or children) listed below
visitation rights with the child (or children) listed below
Court use only
*APPLCUS* *APPLVIS*
APPLCUS APPLVIS
By the first scheduled date for this case, I will file the applicable accompanying document(s) from this list that prove an
existing legal relationship between the parent(s) and the child or children named in this application with any personal
identifying information, as defined by Section 4-7 of the Connecticut Practice Book, redacted (removed):
• A copy of a birth certificate naming me as one of the parents;
• A copy of a properly executed (finalized) acknowledgement of paternity;
• A court order or decree naming me as a legally responsible parent (including an adoptive parent);
• A gestational agreement giving me parental rights (see Section 7-36 of the Connecticut General Statutes);
• Document(s) showing that the child or children was/were born during my marriage; or
• Any other evidence that I think is sufficient (enough) to convince the court that I am a legal parent of the child or
children.
Other parent's name (If other parent is not the respondent)(Last, first, middle initial) Other parent's address (If other parent is not the respondent)
VisitationCustody
