Form JD-JM-76 "Revocation of Order of Commitment/Guardianship Custody/Temporary Custody and Subsequent Orderof Custody/Temporary Custody Guardianship/Protective Supervision" - Connecticut

What Is Form JD-JM-76?

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 April 1, 2012;
  • 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-76 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-76 "Revocation of Order of Commitment/Guardianship Custody/Temporary Custody and Subsequent Orderof Custody/Temporary Custody Guardianship/Protective Supervision" - Connecticut

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STATE OF CONNECTICUT
REVOCATION OF ORDER OF COMMITMENT/GUARDIANSHIP
SUPERIOR COURT
CUSTODY/TEMPORARY CUSTODY AND SUBSEQUENT
JUVENILE MATTERS
ORDER OF CUSTODY/TEMPORARY CUSTODY
www.jud.ct.gov
GUARDIANSHIP/PROTECTIVE SUPERVISION
JD-JM-76 Rev. 4-12
C.G.S. § 46b-129(m)
ADA NOTICE
P.B. §§ 26-1(q), 35a-12, 35a-14a, 35a-16
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.
Juvenile Matters At (Address of court)
Docket Number
Name of Minor Child or Youth
Date of Birth
Place of Birth
Name of Mother
Address of Mother
Name of Father
Address of Father
Name of Guardian (If applicable)
Address of Guardian (If applicable)
Order of Custody/Guardianship
The court enters the following orders in the best interest of the child or youth named above at a session of the Superior
Court and in accordance with the statutes that apply to the case:
1. Temporary custody is vested in:
Name (Other than Commissioner of DCF)
Relationship to Child or Youth (if any)
Address
2. The order of
Commitment and/or
Custody
Temporary Custody
Guardianship
to
entered on
with respect to the minor child or youth named above is revoked or modified and the child's or youth's:
Custody
Guardianship
Temporary Custody
Reverts To:
Is Transferred To:
Is vacated
Name (Other than Commissioner of DCF)
Relationship to Child or Youth (If any)
Address
3.
Protective Supervision is ordered, beginning
until
The child or youth is to reside with the custodian and/or guardian named above subject to the
services and steps set out in the Specific Steps.
Dated At (Town)
On (Date)
By (Type name of Judge)
Signed (Judge/Clerk)
Distribution:
Original - File
Copy 1 - Parent or Guardian
Copy 2 - Commissioner of D.C.F.
Print Form
Reset Form
STATE OF CONNECTICUT
REVOCATION OF ORDER OF COMMITMENT/GUARDIANSHIP
SUPERIOR COURT
CUSTODY/TEMPORARY CUSTODY AND SUBSEQUENT
JUVENILE MATTERS
ORDER OF CUSTODY/TEMPORARY CUSTODY
www.jud.ct.gov
GUARDIANSHIP/PROTECTIVE SUPERVISION
JD-JM-76 Rev. 4-12
C.G.S. § 46b-129(m)
ADA NOTICE
P.B. §§ 26-1(q), 35a-12, 35a-14a, 35a-16
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.
Juvenile Matters At (Address of court)
Docket Number
Name of Minor Child or Youth
Date of Birth
Place of Birth
Name of Mother
Address of Mother
Name of Father
Address of Father
Name of Guardian (If applicable)
Address of Guardian (If applicable)
Order of Custody/Guardianship
The court enters the following orders in the best interest of the child or youth named above at a session of the Superior
Court and in accordance with the statutes that apply to the case:
1. Temporary custody is vested in:
Name (Other than Commissioner of DCF)
Relationship to Child or Youth (if any)
Address
2. The order of
Commitment and/or
Custody
Temporary Custody
Guardianship
to
entered on
with respect to the minor child or youth named above is revoked or modified and the child's or youth's:
Custody
Guardianship
Temporary Custody
Reverts To:
Is Transferred To:
Is vacated
Name (Other than Commissioner of DCF)
Relationship to Child or Youth (If any)
Address
3.
Protective Supervision is ordered, beginning
until
The child or youth is to reside with the custodian and/or guardian named above subject to the
services and steps set out in the Specific Steps.
Dated At (Town)
On (Date)
By (Type name of Judge)
Signed (Judge/Clerk)
Distribution:
Original - File
Copy 1 - Parent or Guardian
Copy 2 - Commissioner of D.C.F.
Print Form
Reset Form