CONNECTICUT PROBATE COURTS
Affidavit/Custody of Minor Child
PC-610 REV. 4/18
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Affidavit/Custody of Minor Child PC-610
Instructions: 1) A petitioner must file this form at each hearing on a matter affecting the custody of a minor child,
including a proceeding for temporary custody, removal of parent or guardian, termination of parental
rights, adoption and temporary guardian.
2) If there is a proceeding in another court affecting the custody of the minor child, attach a copy of the
JD-FM-164, Affidavit Concerning Children.
3) For more information, see C.G.S. section 52-231a.
4) Type or print the form in ink.
Probate Court Name District Number
In the Matter of (Name and present address)
Hereinafter referred to as the minor child.
Date of Birth of Minor Child
The subscriber hereby swears, affirms, or avers that:
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 the minor child.
There is a proceeding in another court affecting the custody of the minor child, but the proceedings in this court
on the pending matter concerning the minor child will not conflict with or interfere with the proceedings in the
other court.
Provide a copy of the JD-FM-164, Affidavit Concerning Children, and a detailed statement of the nature of the
other proceeding below:
The representations made in this affidavit are made under the penalty of false statement.
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Type or Print Name
Address
Date
