Free PC-610 - Connecticut

STATE OF CONNECTICUT AFFIDAVIT/TEMPORARY CUSTODY, REMOVAL, TERMINATION, OR ADOPTION RECORDED (CONFIDENTIAL VOLUME): COURT OF PROBATE PC-610 REV. 9/96 [To be submitted as of hearing date. C.G.S. §52-231a.] [Type or print in black ink.] TO: COURT OF PROBATE, DISTRICT OF IN THE MATTER OF Hereinafter referred to as the 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 any other court affecting the custody of said minor child. There is a proceeding in another court affecting the custody of said minor child, and a statement in detail of the nature of such proceeding is attached hereto [Use Second Sheet, PC-180], but the proceedings in this court on the pending matter concerning said minor child will not conflict with or interfere with such other proceedings. Name [Type or print] Signature ...................................................................................................... Address: Tel. No. SUBSCRIBED AND SWORN TO BEFORE ME DATE ..................................................................................... Judge, Ass't Clerk, Notary Public, Comm. Sup. Ct. Date: DISTRICT NO.
DATE OF BIRTH OF MINOR CHILD

AFFIDAVIT/TEMPORARY CUSTODY, REMOVAL, TERMINATION, OR ADOPTION PC-610

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