Page 1 of 2 ADA NOTICE 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.born to one of the parties on or after the date of the marriage and are claimed to be children of the marriage. (List only children who have not yet reached the age of 23.)(List only children who have not yet reached the age of 23.) Name of child (First, Middle Initial, Last) Date of birth (Month, day, year)5. ("X" all that apply)6. A divorce is being sought because: ("X" all that apply)"X" and complete all that apply for items 6-13. Attach additional sheets if needed. Name of child (First, Middle Initial, Last) Date of birth (Month, day, year)7.8. 9. CROSS COMPLAINT CODE ONLY CRSCMP10.STATE OF CONNECTICUT SUPERIOR COURT www.jud.ct.govbefore the filing of this divorce complaint or before the divorce will become final.then returned to Connecticut, planning to live here permanently. 3. b. Date of civil union that merged into marriage by subsequent ceremony or by operation of law Complaint: Complete this form. Attach a completed Summons (JD-FM-3), a Notice of Automatic Court Orders (JD-FM-158) and a blank Appearance (JD-CL-12). Amended Complaint Cross Complaint: Complete this form and attach to the Answer (JD-FM-160) unless it is already filed. plaintiff defendant plaintiff defendant The marriage broke down after plaintiff defendant This marriage has broken down irretrievably. Other (must be reason(s) listed in section 46b-40(c) of the Connecticut General Statutes): No children were born to either the plaintiff or defendant after the date of this marriage. There are no children of this marriage under the age of 23. The following children are either: (a) the biological and/or adoptive children of both of the parties, or (b) have been The following children were born on or after the date of the marriage to the ("X" all that apply) plaintiff defendant 4. Town and State, or Country where marriage took place 3. a. Date of marriage Judicial District of At (Town) Return date (Month, day, year) Docket number Plaintiff's name (Last, First, Middle Initial) Defendant's name (Last, First, Middle Initial) 1. Plaintiff's birth name (If different from above) 2. Defendant's birth name (If different from above) The ("X" one)has lived in Connecticut for at least 12 months immediatelyThe ("X" one)lived in Connecticut at the time of the marriage, moved away, andthe ("X" one)moved to Connecticut.and are not children of the other party to this marriage.DIVORCE COMPLAINT (DISSOLUTION OF MARRIAGE) JD-FM-159 Rev. 10-18 C.G.S. 247247 46b-40, 46b-56c, 46b-84, P.A. 18-14 P.B. 247 25-2, et seq. American LegalNet, Inc. www.FormsWorkFlow.com JD-FM-159 Rev. 10-18 Page 2 of 2any other documents filed with this Complaint to the City Clerk of the town providing assistance and file the Certification of Notice (JD-FM-175) with the court clerk.The other parent of this unborn child is theState of Connecticut:If yes, you must send a copy of the Summons, Complaint, Notice of Automatic Court Orders and any other documents filed with this Complaint to the Assistant Attorney General, 55 Elm Street, Hartford, CT 06106, and file the Certification of Notice (JD-FM-175) with the court clerk.The Court is asked to order: ("X" all that apply) SignatureIf there is a court order regarding custody or support for any child listed above, name the child(ren) below and specify the person or agency awarded custody or ordered to pay support:And anything else the Court deems fair.).educational support of the child(ren). If this is an Amended Complaint or a Cross Complaint, you must mail or deliver a copy to anyone who has filed an appearance and you must complete the certification below.13.11.12. The ("X" all that apply)14.parental decision-making regarding the minor child(ren).ANDThe ("X" all that apply) from a city or town in Connecticut. ("X" one)Regarding Parental Decision-making Responsibility:Regarding Physical Custody:schedule of physical care of the minor child(ren). Child's name Name of person or agency awarded custody Name of person ordered to pay support Child's name Name of person or agency awarded custody Name of person ordered to pay support Child's name Name of person or agency awarded custody Name of person ordered to pay support plaintiff defendant financial support Yes No Do not know HUSKY Health Insurance Yes No Do not know plaintiff defendant (date) plaintiff or defendant unknown not the plaintiff not the defendant. plaintiff defendant Yes No Do not know. A divorce (dissolution of marriage). A fair division of property and debts. Alimony. Child Support. An order regarding the post-majority Name change to: Sole custody. Joint legal custody. A parenting responsibility plan which includes a plan for the Primary residence with: Visitation. A parenting responsibility plan which includes a plan for the Print name of person signing Date signed Address Juris number (If applicable) Telephone (Area code first) or any of the child(ren) listed above have received from the("X" one)("X" one)The ("X" all that apply)is pregnant with a child due to be born onor any of the child(ren) listed above has received financial support If yes, send a copy of the Summons, Complaint, Notice of Automatic Court Orders and(City or town: Mailing address (Number, street, town, state and zip code) Signed (Signature of filer) uCertification Print or type name of person signing Telephone number Date signed(date) to all attorneys and self-represented parties of record and that written consent for electronic delivery was received from all attorneys and self-represented parties of record who received or will immediately be receiving electronic delivery.I certify that a copy of this document was or will immediately be mailed or delivered electronically or non-electronically on *If necessary, attach additional sheet or sheets with name and address which the copy was or will be mailed or delivered to. Name and address of each party and attorney that copy was or will be mailed or delivered to* American LegalNet, Inc. www.FormsWorkFlow.com