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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.
5. 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. 4-23
C.G.S. §§ 46b-56, 46b-61;
P.B. §§ 25-3, 25-4, 25-5
1. I am the child's or children's parent.
4. I want: (Select one)
Child's name (First, middle, last)
Date of birth
3. The respondent(s) is/are the:
Instructions
1. Select the “Custody” or “Visitation” box above, and complete pages 1 and 2 of this form. Attach the Order to Show Cause and Notice to the
Respondent (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 scheduled court date for this case, you must file the accompanying document(s) listed in number 2 below that prove the existing legal
relationship between the parents 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 the accompanying document(s). If you plan to file a copy of an acknowledgment of parentage, make
sure the original is completed and filed with the Department of Public Health before filing this Application. (Contact the Department of Social
Services or the Department of Public Health Vital Records Office for assistance with acknowledgments of parentage.)
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)
Parent 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
2. I understand that by the first scheduled date for this case, I must file the applicable accompanying document(s) from this
list that prove the existing legal relationship between the parents 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) or
the case may be dismissed. I plan to file the following document(s) to prove parentage: (Select all that apply)
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
A copy of the birth certificate of the child or children naming the parents;
A copy of a properly executed (finalized) acknowledgement of parentage;
A court order or decree naming the legally responsible parents (including an adoptive parent);
A surrogacy agreement naming the parents (see General Statutes Section 7-36);
Document(s) showing that the child or children was/were born during my marriage to the respondent; or
Any other evidence sufficient (enough) to prove legal parentage of the child or children.