"Change of Information Form" - Connecticut

Change of Information Form is a legal document that was released by the Connecticut Judicial Branch - a government authority operating within Connecticut.

Form Details:

  • Released on July 5, 2012;
  • The latest edition currently provided by the Connecticut Judicial Branch;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Connecticut Judicial Branch.

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Download "Change of Information Form" - Connecticut

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Family Matters
Guardian Ad Litem (GAL)
Attorney for Minor Child (AMC)
CHANGE OF INFORMATION FORM
Step 1: Choose the type of change requested, date, and sign;
Step 2: Complete the appropriate areas below with the updated information;
Step 3: Review your updated information for accuracy;
Step 4: Submit original signed form via U.S. Mail or Email signed form in PDF version to:
U.S. Mail: Judicial Branch
Court Operations
nd
225 Spring Street – 2
Floor
Wethersfield, CT 06109
Attn: Family Matters GAL/AMC Information Change
Email:
GALAMCFA@jud.ct.gov
: GAL/AMC Information Change
Subject Line
*
= Required Field
*
Do you currently have a contract with the Division of Public Defender Services (DPDS) to accept state rate appointments?
Yes
No
TYPE OF CHANGE REQUESTED
Please make the following change(s) to my GAL/AMC information previously provided:
Note: All information provided is publicly disclosable.
Professional Contact Information
Professional Qualifications Information
Judicial District Information
*
*
Today’s date
:
Original Signature
:
______________________________________________________
PROFESSIONAL CONTACT INFORMATION
*
*
Middle Initial:
Last Name
:
First Name
:
Street Address:
P.O. Box:
City:
State:
Zip Code:
Business Tel:
Business Fax:
Cell Tel:
Email Address:
PROFESSIONAL QUALIFICATIONS INFORMATION
Have your professional qualifications changed? If so, please explain:
LANGUAGES
Creole
French
Italian
Polish
Portuguese
Spanish
:
OTHER LANGUAGE (
not listed)
P lease continue to P age 2
Page 1 of 2
Family Matters
Guardian Ad Litem (GAL)
Attorney for Minor Child (AMC)
CHANGE OF INFORMATION FORM
Step 1: Choose the type of change requested, date, and sign;
Step 2: Complete the appropriate areas below with the updated information;
Step 3: Review your updated information for accuracy;
Step 4: Submit original signed form via U.S. Mail or Email signed form in PDF version to:
U.S. Mail: Judicial Branch
Court Operations
nd
225 Spring Street – 2
Floor
Wethersfield, CT 06109
Attn: Family Matters GAL/AMC Information Change
Email:
GALAMCFA@jud.ct.gov
: GAL/AMC Information Change
Subject Line
*
= Required Field
*
Do you currently have a contract with the Division of Public Defender Services (DPDS) to accept state rate appointments?
Yes
No
TYPE OF CHANGE REQUESTED
Please make the following change(s) to my GAL/AMC information previously provided:
Note: All information provided is publicly disclosable.
Professional Contact Information
Professional Qualifications Information
Judicial District Information
*
*
Today’s date
:
Original Signature
:
______________________________________________________
PROFESSIONAL CONTACT INFORMATION
*
*
Middle Initial:
Last Name
:
First Name
:
Street Address:
P.O. Box:
City:
State:
Zip Code:
Business Tel:
Business Fax:
Cell Tel:
Email Address:
PROFESSIONAL QUALIFICATIONS INFORMATION
Have your professional qualifications changed? If so, please explain:
LANGUAGES
Creole
French
Italian
Polish
Portuguese
Spanish
:
OTHER LANGUAGE (
not listed)
P lease continue to P age 2
Page 1 of 2
Family Matters
Guardian Ad Litem (GAL)
Attorney for Minor Child (AMC)
CHANGE OF INFORMATION FORM
*
*
Middle Initial
Last Name
First Name
JUDICIAL DISTRICT INFORMATION
If applicable, please indicate the Judicial District location(s) that you are requesting to have added or removed for which
you will accept GAL/AMC appointments:
ADD
REMOVE
Ansonia/Milford (AAN)
Danbury (DBD)
Fairfield (FBT)
Hartford (HHD)
Litchfield (LLI)
Meriden (NNI)
Middlesex (MMX)
New Britain (HHB)
New Haven (NNH)
Norwich/New London (KNO)
Stamford (FST)
Tolland (TTD)
Waterbury (WWY)
Windham (WWM)
IMPORTANT: If you have a contract with the Division of Public Defender Services (DPDS) and you want to request a
change in the Judicial District location(s) for which you will accept state rate payments, you must contact the DPDS.
*
*
Initials
:
Date
:
_________________________
Top Pg. 1
FOR INTERNAL USE ONLY
Date Change Form Received:
Method of Receipt:
Further info requested:
Date info requested:
Type info requested:
Date info received:
Date Updated:
Entered By Staff:
(Rev. 7-5-12)
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