Form JD-FM-164A "Addendum to Affidavit Concerning Children" - Connecticut

What Is Form JD-FM-164A?

This is a legal form that was released by the Connecticut Superior Court - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2014;
  • The latest edition provided by the Connecticut Superior Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form JD-FM-164A by clicking the link below or browse more documents and templates provided by the Connecticut Superior Court.

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Download Form JD-FM-164A "Addendum to Affidavit Concerning Children" - Connecticut

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ADDENDUM TO AFFIDAVIT
STATE OF CONNECTICUT
CONCERNING CHILDREN
SUPERIOR COURT
JD-FM-164A Rev. 11-14
Docket number
(Use this form to list additional children to form JD-FM-164)
C.G.S. § 46b-115S, P.B. § 25-57
Child's name (First, middle, last)
Date of birth (Month, day, year)
Residence information is same as for previous child
(If not same, provide information)
Location
Relationship
Name(s) and present address(es) of person(s)
Date(s) of residence
(Town or city, and state,
child lived with (unless confidential)
to child
unless confidential)
to the present
to
to
to
to
Child's name (First, middle, last)
Date of birth (Month, day, year)
Residence information is same as for previous child
(If not same, provide information)
Location
Relationship
Name(s) and present address(es) of person(s)
Date(s) of residence
(Town or city, and state,
child lived with (unless confidential)
to child
unless confidential)
to the present
to
to
to
to
Child's name (First, middle, last)
Date of birth (Month, day, year)
Residence information is same as for previous child
(If not same, provide information)
Location
Relationship
Name(s) and present address(es) of person(s)
Date(s) of residence
(Town or city, and state,
to child
child lived with (unless confidential)
unless confidential)
to the present
to
to
to
to
Print Form
Reset Form
(Page 1 of 2)
ADDENDUM TO AFFIDAVIT
STATE OF CONNECTICUT
CONCERNING CHILDREN
SUPERIOR COURT
JD-FM-164A Rev. 11-14
Docket number
(Use this form to list additional children to form JD-FM-164)
C.G.S. § 46b-115S, P.B. § 25-57
Child's name (First, middle, last)
Date of birth (Month, day, year)
Residence information is same as for previous child
(If not same, provide information)
Location
Relationship
Name(s) and present address(es) of person(s)
Date(s) of residence
(Town or city, and state,
child lived with (unless confidential)
to child
unless confidential)
to the present
to
to
to
to
Child's name (First, middle, last)
Date of birth (Month, day, year)
Residence information is same as for previous child
(If not same, provide information)
Location
Relationship
Name(s) and present address(es) of person(s)
Date(s) of residence
(Town or city, and state,
child lived with (unless confidential)
to child
unless confidential)
to the present
to
to
to
to
Child's name (First, middle, last)
Date of birth (Month, day, year)
Residence information is same as for previous child
(If not same, provide information)
Location
Relationship
Name(s) and present address(es) of person(s)
Date(s) of residence
(Town or city, and state,
to child
child lived with (unless confidential)
unless confidential)
to the present
to
to
to
to
Print Form
Reset Form
(Page 1 of 2)
Child's name (First, middle, last)
Date of birth (Month, day, year)
Residence information is same as for previous child
(If not same, provide information)
Location
Relationship
Name(s) and present address(es) of person(s)
Date(s) of residence
(Town or city, and state,
child lived with (unless confidential)
to child
unless confidential)
to the present
to
to
to
to
Child's name (First, middle, last)
Date of birth (Month, day, year)
Residence information is same as for previous child
(If not same, provide information)
Location
Relationship
Name(s) and present address(es) of person(s)
Date(s) of residence
(Town or city, and state,
child lived with (unless confidential)
to child
unless confidential)
to the present
to
to
to
to
Child's name (First, middle, last)
Date of birth (Month, day, year)
Residence information is same as for previous child
(If not same, provide information)
Location
Relationship
Name(s) and present address(es) of person(s)
Date(s) of residence
(Town or city, and state,
child lived with (unless confidential)
to child
unless confidential)
to the present
to
to
to
to
The Judicial Branch of the State of Connecticut complies with the Americans with Disabilities Act (ADA). If you need a reasonable
accommodation in accordance with the ADA, contact a court clerk or an ADA contact person listed at www.jud.ct.gov/ADA/
JD-FM-164A Rev. 11-14
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