Form JD-JM-60 "Affidavit/Consent to Termination of Parental Rights" - Connecticut

What Is Form JD-JM-60?

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 July 1, 2011;
  • 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-JM-60 by clicking the link below or browse more documents and templates provided by the Connecticut Superior Court.

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Download Form JD-JM-60 "Affidavit/Consent to Termination of Parental Rights" - Connecticut

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AFFIDAVIT/CONSENT TO TERMINATION
STATE OF CONNECTICUT
OF PARENTAL RIGHTS
SUPERIOR COURT
JD-JM-60 Rev. 7-11
COURT OF PROBATE
C.G.S. §§ 17a-112, 45a-707, 45a-715;
www.jud.ct.gov
Instructions
PA 11-240, Sec. 2
1. Print or type; this form must be filed with every consent termination.
2. Attach original to Superior Court form JD-JM-40 or Probate Court
Court use only
form PC-600 or PC-601.
Docket number
3. This affidavit may not be executed by a mother within 48 hours
immediately after the birth of her child.
4. If a minor parent is consenting to the termination of parental rights, a
Guardian Ad Litem appointed by the court shall assure that the minor
parent is giving an informed and voluntary consent.
Address of Superior Court
Superior Court
To
For Probate District of
Probate district number or juvenile venue number
Court of Probate
Name of parent who is consenting to termination of parental rights
Date and time of birth of child/youth
In the matter of
, a person under the age of eighteen.
I, the parent named above, voluntarily and knowingly consent to the
I have considered the following:
termination of my parental rights. Termination means "the complete
1. the child or youth will be legally free for adoption after the
severance by court order of the legal relationship, with all its rights
termination and I will have no right to notice of the adoption
and responsibilities, between the child and the child's parent or
proceedings nor any right to participate in the proceedings;
parents so that the child is free for adoption except it shall not affect
2. as an alternative to the termination of my parental rights, the
the right of inheritance of the child or the religious affiliation of the
nature and extent of family and counseling services which may be
child." Section 45a-707 of the Connecticut General Statutes
available through an agency which could improve the relationship
(Inheritance rights cease upon adoption.) I understand that no
between the child or youth and me or reunite the child or youth
action taken with respect to my consent to termination of my
with me;
parental rights affects the parental rights of the other parent.
3. the child's or youth's feelings and the emotional ties of the child or
youth toward me;
I understand the termination of my parental rights to mean that I will
no longer have the following legal rights and responsibilities on the
4. the extent to which I may have been prevented from maintaining a
effective date of termination:
meaningful relationship with the child or youth by actions of the
other parent of the child or youth or any other person, or by my
1. the legal right to custody, guardianship or control of the child or
economic circumstances.
youth; I will have no legal right to care for the child or youth or
5. My consent today in the Superior Court for Juvenile Matters
make any decisions on behalf of the child or youth;
may permit the Department of Children and Families to seek to
2. the legal right to obtain the child's or youth's birth certificate;
terminate my parental rights to another child of mine under the
age of seven. It may seek to do so without giving me more than
3. the legal right to any state or federal benefits I may have been
ninety (90) days to rehabilitate, if the child has been found
receiving for the child or youth;
neglected, uncared for or abused by the court.
4. the legal responsibility to support the child or youth and to pay for
I am aware that the court must conduct a hearing before approving
the child's or youth's maintenance, medical and other expenses,
the termination of parental rights even if both parents consent to the
but I may be responsible for support of the child or youth until the
termination.
effective date of the termination;
I am aware that the child or youth, upon reaching his or her 18th
5. the responsibility to care for the child or youth or make any
birthday, may have the right to information which may identify me or
decisions on his or her behalf.
other blood relatives.
Signed (Parent)
If parent is a minor, signature of guardian ad litem
This is to certify that the above document was signed in my presence after having been read by the subscriber, who
stated that she (he) understood its contents.
This is to certify that the above document was signed in my presence after it was read by me to the subscriber in the
language understood by her (him) and that she (he) further stated that she (he) understood the contents of this consent and
authorization for adoption.
Subscribed and sworn to before me on (Date)
At (Town)
Signed (Judge, Assistant Clerk, Notary Public, Comm. of Sup. Court)
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.
Print Form
Reset Form
AFFIDAVIT/CONSENT TO TERMINATION
STATE OF CONNECTICUT
OF PARENTAL RIGHTS
SUPERIOR COURT
JD-JM-60 Rev. 7-11
COURT OF PROBATE
C.G.S. §§ 17a-112, 45a-707, 45a-715;
www.jud.ct.gov
Instructions
PA 11-240, Sec. 2
1. Print or type; this form must be filed with every consent termination.
2. Attach original to Superior Court form JD-JM-40 or Probate Court
Court use only
form PC-600 or PC-601.
Docket number
3. This affidavit may not be executed by a mother within 48 hours
immediately after the birth of her child.
4. If a minor parent is consenting to the termination of parental rights, a
Guardian Ad Litem appointed by the court shall assure that the minor
parent is giving an informed and voluntary consent.
Address of Superior Court
Superior Court
To
For Probate District of
Probate district number or juvenile venue number
Court of Probate
Name of parent who is consenting to termination of parental rights
Date and time of birth of child/youth
In the matter of
, a person under the age of eighteen.
I, the parent named above, voluntarily and knowingly consent to the
I have considered the following:
termination of my parental rights. Termination means "the complete
1. the child or youth will be legally free for adoption after the
severance by court order of the legal relationship, with all its rights
termination and I will have no right to notice of the adoption
and responsibilities, between the child and the child's parent or
proceedings nor any right to participate in the proceedings;
parents so that the child is free for adoption except it shall not affect
2. as an alternative to the termination of my parental rights, the
the right of inheritance of the child or the religious affiliation of the
nature and extent of family and counseling services which may be
child." Section 45a-707 of the Connecticut General Statutes
available through an agency which could improve the relationship
(Inheritance rights cease upon adoption.) I understand that no
between the child or youth and me or reunite the child or youth
action taken with respect to my consent to termination of my
with me;
parental rights affects the parental rights of the other parent.
3. the child's or youth's feelings and the emotional ties of the child or
youth toward me;
I understand the termination of my parental rights to mean that I will
no longer have the following legal rights and responsibilities on the
4. the extent to which I may have been prevented from maintaining a
effective date of termination:
meaningful relationship with the child or youth by actions of the
other parent of the child or youth or any other person, or by my
1. the legal right to custody, guardianship or control of the child or
economic circumstances.
youth; I will have no legal right to care for the child or youth or
5. My consent today in the Superior Court for Juvenile Matters
make any decisions on behalf of the child or youth;
may permit the Department of Children and Families to seek to
2. the legal right to obtain the child's or youth's birth certificate;
terminate my parental rights to another child of mine under the
age of seven. It may seek to do so without giving me more than
3. the legal right to any state or federal benefits I may have been
ninety (90) days to rehabilitate, if the child has been found
receiving for the child or youth;
neglected, uncared for or abused by the court.
4. the legal responsibility to support the child or youth and to pay for
I am aware that the court must conduct a hearing before approving
the child's or youth's maintenance, medical and other expenses,
the termination of parental rights even if both parents consent to the
but I may be responsible for support of the child or youth until the
termination.
effective date of the termination;
I am aware that the child or youth, upon reaching his or her 18th
5. the responsibility to care for the child or youth or make any
birthday, may have the right to information which may identify me or
decisions on his or her behalf.
other blood relatives.
Signed (Parent)
If parent is a minor, signature of guardian ad litem
This is to certify that the above document was signed in my presence after having been read by the subscriber, who
stated that she (he) understood its contents.
This is to certify that the above document was signed in my presence after it was read by me to the subscriber in the
language understood by her (him) and that she (he) further stated that she (he) understood the contents of this consent and
authorization for adoption.
Subscribed and sworn to before me on (Date)
At (Town)
Signed (Judge, Assistant Clerk, Notary Public, Comm. of Sup. Court)
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.
Print Form
Reset Form