Form JD-FM-279 "Affidavit in Support of Request to Enter Final Custody/Visitation Judgment" - Connecticut

This version of the form is not currently in use and is provided for reference only.
Download this version of Form JD-FM-279 for the current year.

What Is Form JD-FM-279?

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 May 1, 2020;
  • 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-279 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-279 "Affidavit in Support of Request to Enter Final Custody/Visitation Judgment" - Connecticut

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AFFIDAVIT IN SUPPORT OF
For information on ADA
STATE OF CONNECTICUT
REQUEST TO ENTER FINAL
accommodations,
SUPERIOR COURT
CUSTODY/VISITATION JUDGMENT
contact a court clerk or go to:
www.jud.ct.gov
www.jud.ct.gov/ADA.
JD-FM-279 New 5-20
C.G.S. § 46b-66; E.O. 7CC
COURT USE ONLY
AFFFCJ
Note:
Each party must complete and file his or her own affidavit. If the facts stated in the two affidavits
*AFFFCJ*
conflict, the court may not be able to act without scheduling a hearing to be attended by the parties.
Name of case
Docket number
Judicial district
Address of court
I, (name)
, state under oath that:
1. This affidavit is made based on my own personal knowledge, and I understand the obligation of an oath.
2. I am over 18 years of age and competent to testify to the matters stated in this affidavit.
3. I am the
in the above case. The other party and I are the parents of a child or children
Applicant
Respondent
in common. The other party and I either have never been married to each other or we currently reside separately
from each other.
4. Neither a restraining order, issued pursuant to section 46b-15 of the Connecticut General Statutes, nor a protective
order, issued pursuant to section 46b-38c of the Connecticut General Statutes, between the other party to this case
and me is in effect, and no application for either order is pending before any court.
5. The following names and birth dates of the minor child(ren) that the other party to this case and I have in common:
Name
Birth date
Name
Birth date
6. The court has jurisdiction of this case because the above named child(ren) resided in Connecticut for a period of six
months immediately preceding the filing of this action, or since birth, whichever period is shorter; or if that is not the
case, then the court has jurisdiction of this case because: (State other grounds for jurisdiction)
7. There is no order of child support by any court currently in effect as to any of the above minor children except for the
following: (enter “None”, if applicable, otherwise briefly describe the order and the case in which the order was entered)
8. Neither the State of Connecticut, nor any town or city in Connecticut, is providing any financial assistance (such as
cash assistance or HUSKY insurance) to either party or the minor child(ren) except as follows:
9. The other party to this case and I have entered into a written Agreement dated
which we have
submitted to the court and which represents our full agreement on all issues relating to custody, visitation, parenting
time, and child support with respect to our minor child(ren).
10. I have read the entire Agreement carefully and I understand it completely. I have signed it voluntarily, and no one
pressured or forced me to do so. The other party and I have no side agreements about the custody, visitation,
parenting time, or support of our child(ren). I have reviewed any financial affidavit filed with the court by the other party.
I have no unanswered questions about the Agreement.
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AFFIDAVIT IN SUPPORT OF
For information on ADA
STATE OF CONNECTICUT
REQUEST TO ENTER FINAL
accommodations,
SUPERIOR COURT
CUSTODY/VISITATION JUDGMENT
contact a court clerk or go to:
www.jud.ct.gov
www.jud.ct.gov/ADA.
JD-FM-279 New 5-20
C.G.S. § 46b-66; E.O. 7CC
COURT USE ONLY
AFFFCJ
Note:
Each party must complete and file his or her own affidavit. If the facts stated in the two affidavits
*AFFFCJ*
conflict, the court may not be able to act without scheduling a hearing to be attended by the parties.
Name of case
Docket number
Judicial district
Address of court
I, (name)
, state under oath that:
1. This affidavit is made based on my own personal knowledge, and I understand the obligation of an oath.
2. I am over 18 years of age and competent to testify to the matters stated in this affidavit.
3. I am the
in the above case. The other party and I are the parents of a child or children
Applicant
Respondent
in common. The other party and I either have never been married to each other or we currently reside separately
from each other.
4. Neither a restraining order, issued pursuant to section 46b-15 of the Connecticut General Statutes, nor a protective
order, issued pursuant to section 46b-38c of the Connecticut General Statutes, between the other party to this case
and me is in effect, and no application for either order is pending before any court.
5. The following names and birth dates of the minor child(ren) that the other party to this case and I have in common:
Name
Birth date
Name
Birth date
6. The court has jurisdiction of this case because the above named child(ren) resided in Connecticut for a period of six
months immediately preceding the filing of this action, or since birth, whichever period is shorter; or if that is not the
case, then the court has jurisdiction of this case because: (State other grounds for jurisdiction)
7. There is no order of child support by any court currently in effect as to any of the above minor children except for the
following: (enter “None”, if applicable, otherwise briefly describe the order and the case in which the order was entered)
8. Neither the State of Connecticut, nor any town or city in Connecticut, is providing any financial assistance (such as
cash assistance or HUSKY insurance) to either party or the minor child(ren) except as follows:
9. The other party to this case and I have entered into a written Agreement dated
which we have
submitted to the court and which represents our full agreement on all issues relating to custody, visitation, parenting
time, and child support with respect to our minor child(ren).
10. I have read the entire Agreement carefully and I understand it completely. I have signed it voluntarily, and no one
pressured or forced me to do so. The other party and I have no side agreements about the custody, visitation,
parenting time, or support of our child(ren). I have reviewed any financial affidavit filed with the court by the other party.
I have no unanswered questions about the Agreement.
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11. Under all the facts and circumstances of my case, I believe that the Agreement is fair and equitable and in the best
interests of our minor child(ren).
12. If the Agreement includes a provision regarding child support which deviates from the Child Support Guidelines, I
believe that it would be inappropriate or inequitable to apply the Guidelines for the following reason(s):
13. I am asking the court to approve the Agreement as the final judgment in this matter, without necessity for either party
to appear in court at a hearing for that purpose.
I certify under the penalties of perjury that the statements above and on any attached document are true, complete, and
accurate to the best of my knowledge and belief. I understand that willful misrepresentation of any of the information provided
will subject me to sanctions and may result in criminal charges being filed against me.
Date signed
Signed (Affiant)
Signed (Notary, Commissioner of Superior Court, Assistant Clerk, Other
Print name and title of person signing at left
Date signed
Proper Officer under Section 1-24 of the Connecticut General Statutes)
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