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PC 600 (State of Connecticut, Office of the Probate Court Administrator)

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BROWSE STATE OF CONNECTICUT, OFFICE OF THE PROBATE COURT ADMINISTRATOR (CT) FORMS

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CONN
EC TI CUT PROBATE COURTS
Petition/Termination of
Parental Rights
PC-600 REV. 10/19
CONFIDENTIAL
Petition/Termination of Parental Rights
PC-600 Page 1 of 7
RECEIVED:
Instructions: 1) A parent or guardian, or other authorized person or agency under C.G.S. section 45a-715, may use this form
to petition for termination of parental rights of a parent or parents of a minor child.
For a child born out of
wedlock,
the petition shall list any putative father as defined in C.G.S. section 45a-716 (b).
2)
The petition should be filed in the court for the probate district in which (1) the petitioner resides; (2) the
minor child resides, is domiciled or is located at the time of the filing of the petition; or (3) in the case of a
minor who is under the guardianship of any child care facility or child-placing agency, in the district in
which the main or local office of the agency is located.
3)
A statement of facts for each ground of termination, including consent, must be completed. See Page 4.
4)
The following documents should be filed with the petition: a) A long-form birth certificate, b) JD-FM-164,
Affidavit Concerning Children and c) Confidential Sheet, PC-600CI, with confidential social security numbers.
5)
For more information, see C.G.S. sections 45a-715 et seq., 46b-115 et seq., and 52-231a, and Probate Court Rules
of Procedure, rule 4o.
6)
Type or print in ink. Use an additional sheet, or PC-180, if more space is needed.
Probate Court Name
District Number
In the Matter of
Hereinafter referred to as the minor child
Place of Birth of Minor Child
Birth Date of Minor Child
Address where minor child resides
Address where minor child is
domiciled (if different)
Address where minor child is located
at time of filing petition (if different)
Tribe and Reservation of Minor Child, if an Indian Child as defined by 25 U.S.C. section 1903 (Name and address)
Petitioner (Name, address and telephone number, and the nature of the relationship to the minor child)
Parents of Minor Child (For each parent, list name, address, telephone number: date of birth, whether in the military service
of the United States or Allied Nation (50 U.S.C. section 3931); Indian tribe and reservation, if a member as defined by 25
U.S.C. section 1903; and whether the parent is legally incompetent. Include any putative father of a child born out of wedlock.
C.G.S. section 45a-716 (b)(2)).
1.
a. Relationship to minor child:
b. If parent, dat
e of birth:
c. In military service of US or Allied Nation) Yes No
d.
Indian tribe and reservation:
e. Legally incompetent
: Yes No
2.
a. Relationship to minor child:
b. If parent, date of birth:
c. In military service of US or Allied Nation: Yes No
d.
Indian tribe and reservation:
e. Legally incompetent
:
Yes No
Hereinafter referred to as the respondent(s)
7)
Contact the court regarding payment of service of process fees and, if applicable, payment of newspaper notice
publication.
RESET
Petition/Termination of
Parental Rights
PC-600 REV. 10/19
CONFIDENTIAL
Petition/Termination of Parental Rights PC-600 Page 2 of 7
If a parent listed above is a minor or legally incompetent, list the parents or guardian/conservator fo
r the parent
(Include the name, address, telephone number and relationship.)
1.
2.
Name of parent whose parental rights were previously terminated. (Provide a copy of the court decree.)
The petitioner alleges that the whereabouts of the respondents is unknown. The last-known addres
s of the respondents is:
The following efforts have been made to obtain the current address for the respondents:
Guardian of the person, if not a parent (For each guardian, list name, address, telephone number and date of
appointment as guardian.)
Child-placing agency involved with the minor child, if not the petitioner (Name, address and telephone number)
The petitioner represents that:
The parental rights of the persons indicated below should be terminated for one or more of the following grounds as
provided by statute and as more fully described in the attached statement of facts for each ground for termination:
__________________________________________________ c
onsents to termination of his or her parental rights
with respect to minor child. (No further allegation is necessary
against a consenting parent. However an Affidavit/
Consent to Termination of Parental Rights, JD-JM-60, must accompany this petition.)
OR
The child was 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.
CONN
EC TI CUT PR OBATE COURTS
Petition/Termination of
Parental Rights
PC-600 REV. 10/19
CONFIDENTIAL
Petition/Termination of Parental Rights PC-600 Page 3 of 7
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.
Other acts of parental commission or omission as follows:______________________________________
________________________________________________________________________________________
OR
There is no ongoing parent/child relationship, as defined in C.G.S. section 45a-717(g), between the child and
_____________________________ 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, abused or uncared for as those terms are defined under C.G.S. section 46b-120
AND has been in the custody of the Commissioner of the Department of Children and Families for at least 15
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.S. section 46b-129, AND the parent has failed to
achieve such degree of personal rehabilitation as would encourage the belief that, within a reasonable time and
considering the age and needs of the child, such parent could assume a responsible position in the life of the child.
OR
The child has been found in a prior proceeding by the Probate Court for the District of ________________________
or the Superior Court _______________________________ to have been neglected, abused or uncared for as
those terms are defined under C.G.S. section 46b-120, AND the parent has failed to achieve such degree of
personal rehabilitation as would encourage the belief that, within a reasonable time and considering the age and
needs of the child, such parent could assume a responsible position in the life of the child.
OR
The child is under seven years of age AND is neglected, abused or uncared for as those terms are defined in C.G.S.
section 46b-120, AND the parent, ______________________, has failed, is unable or is unwilling to achieve such
degree of personal rehabilitation as would encourage the belief that, within a reasonable time and considering the age
and needs of the child, such parent could assume a responsible position in the life of the child, AND such parent’s
parental rights of another child were previously terminated pursuant to a petition filed by the Commissioner of Children
and Families.
OR
The parent, _______________________, has killed through deliberate, nonaccidental act another child of the
parent OR has requested, commanded, importuned, attempted, conspired or solicited such killing OR has
committed an assault through deliberate and nonaccidental act that has resulted in serious bodily injury of
another child of the parent.
OR
The parent, ____________________________, committed an act or acts that constitute sexual assault as
described in sections 53a-70, 53a-70a, 53a-70b, 53a-70c, 53a-71, 53a-72a, 53a-72b or 53a-73a, and the assault
resulted in the conception of the child.
The parent,
, was adjudged guilty of sexual assault under section 53a-70, 53a-70a, 53a-
70b, 53a-70c, 53a-71, 53a-72a, 53a-72b or 53a-73a, and the assault resulted in the conception of the child.
CONN
EC TI CUT PR OBATE COURTS
Petition/Termination
of Parental Rights
PC-600 REV. 10/19
CONFIDENTIAL
Petition/Termination of Parental Rights PC-600 Page 4 of 7
Statement
of facts in support of each ground for termination of parental rights alleged, including consent
termination:
CONN E C TI CUT PR OBA TE COURTS
Petition/Termination of
Parental Rights
PC-600 REV. 10/19
CONFIDENTIAL
Petition/Termination of Parental Rights PC-600 Page 5 of 7
The petitioner further represents that the termination of parental rights of the parents, _______________________
_______________________, is in the best interests of the child.
The petitione
r further represents that to the best of his or her knowledge and belief:
The minor child has resided has not resided in Connecticut continuously for the last six months.
There is a proceeding is no proceeding pending or contemplated in Connecticut or any other state affecting the
custody of the minor child.
There has been a proceeding has not been a proceeding in the past in Connecticut or any other state
affecting the custody of the minor child.
There is is not a current safety or service agreement between the Department of Children and Families and
the parent/guardian of the minor child.
There is is not a current protective order or restraining order involving any party. If so, please attach.
The minor child is is not the subject of a pre-existing child support order.
WHEREFORE, the petitioner requests that the court terminate the parental rights of
________________________________________________________ , and petitions the court to:
Appoint a statutory parent for the minor child, adoption being contemplated.
The proposed statutory parent is:______________________________________.
Appoint
guardians of the person of the minor child.
The proposed guardians are:__________________________________________________________.
Affirm that the remaining parent shall be the sole parent and natural guardian of the minor child.
Affirm the appointment of __________________________________________as guardian of the minor child.
The representations made in this petition are made under penalty of false statement.
Signature of Petitioner
Type or Print Name
Date
Acceptance of Trust of Proposed Statutory Parent, if applicable.
If appointed statutory parent, I will accept the position of trust:
Signature
Type or Print Name
Agency and Title
Address
Telephone Number
Date
CONN
E CT I CUT PR O B A T E COUR T S
and
Petition/Termination of
Parental Rights
PC-600 REV. 10/19
CONFIDENTIAL
Petition/Termination of Parental Rights PC-600 Page 6 of 7
Acceptance of Trust of Proposed Guardians, if applicable.
If appointed guardian, I will accept the position of trust:
S
ignature
Type or Print Name
Address
Telephone Number
Birth Date
Date
Signature
Type or Print Name
Address
Telephone Number
Birth Date
Date
Consent to Termination
I consent to the termination of my parental rights with respect to the minor child. (Any consent to termination of
parental rights must be accompanied by an Affidavit/ Consent to Termination of Parental Rights, JD-JM-60. C.G.S.
section 45a-715. A parent may waive personal service by filing a Waiver of Personal or Abode Service/Parental Rights
Matter, PC-633.)
Signature of
Parent/Guardian Duly Acknowledged Before Me
Type or Print Name
Date Judge, Clerk, Public Notary, Comm. Sup. Ct.
Signature of Parent/Guardian Duly Acknowledged Before Me
Type or Print Name
Date Judge, Clerk, Public Notary, Comm. Sup. Ct.
Joinder and Consent of Minor Child
I, the undersigned minor child, being at least 12 years of age, do join in the petition for termination of parental
rights and consent to the appointment of the proposed guardian as my guardian. C.G.S. section 45a-715.
Signature of Minor Child Duly Acknowledged Before Me
Type or Print Name
Date Judge, Clerk, Public Notary, Comm. Sup. Ct.
CONN EC TI CUT PR OBATE COURTS
Petition/Termination of
Parental Rights
PC-600 REV. 10/19
CONFIDENTIAL
Petition/Termination of Parental Rights PC-600 Page 7 of 7
Legal Effe
cts of a Termination of Parental Rights Decree
Termination of parental rights means “the complete severance by court order of the legal relationship, with all of its rights
and responsibilities between the child and his parent or parents so that the child is free for adoption except it shall not
affect the right of inheritance of the child or the religious affiliation of the child.” C.G.S. section 45a-707(8). (Inheritance
rights cease upon adoption.) No action taken with respect to the termination of parental rights of one parent affects the
parental rights of the other parent.
Upon a decree of termination of parental rights, the parent will NO LONGER have the following rights and responsibilities
with respect to the minor child who is the subject of the decree:
• The legal right to custody, guardianship or control of the minor child. The parent will have no legal right to
care for the minor child or to make any decisions on behalf of the minor child.
• The legal right to the minor child's birth certificate.
• The legal right to any state and federal benefits the parent may have been receiving for the minor child.
• The legal responsibility to support the minor child and to pay for the minor child's maintenance, medical and
other expenses, but the parent MAY be responsible for support of the minor child until the effective date of the
termination.
• The legal responsibility to care for the minor child or make any decisions on his or her behalf.
Furthermore, upon a decree of termination, the minor child will be legally free for adoption, and the parent will have no
right to notice of the adoption proceedings nor any right to participate in the proceedings.
CONN EC TI CUT PR OBATE COURTS
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PC 600 (State of Connecticut, Office of the Probate Court Administrator)

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Completed 20 July 2020

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