(Continued...)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.)LEGAL SEPARATION COMPLAINT JD-FM-237 Rev. 10-18 C.G.S. 247247 46b-40, 46b-56c, 46b-84, P.A. 18-14; P.B. 247 25-2, et seq. Name of child (First, Middle Initial, Last) Date of birth (Month, day, year)5. ("X" all that apply)6. A legal separation 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 ONLYCRSCMP10.STATE OF CONNECTICUT SUPERIOR COURT www.jud.ct.govbefore the filing of this legal separation complaint or before the legal separation 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), Notice of Amended Complaint. Cross Complaint. The ("X" one) plaintiff defendant has lived in Connecticut for at least 12 months immediately The ("X" one) plaintiff defendant lived in Connecticut at the time of the marriage, moved away, and The marriage broke down after the ("X" one) plaintiff defendant moved to Connecticut. 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 and are not children of the other party to this marriage. 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) 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.Automatic Court Orders (JD-FM-158), and a blank Appearance (JD-CL-12) form. American LegalNet, Inc. www.FormsWorkFlow.com JD-FM-237 (Page 2) Rev. 10-18any 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 or any of the child(ren) listed above have received from the financial support ("X" one) Yes No Do not know HUSKY Health Insurance ("X" one) Yes No Do not know The ("X" all that apply) plaintiff defendant is pregnant with a child due to be born on (date) plaintiff or defendant unknown not the plaintiff not the defendant. plaintiff defendant or any of the child(ren) listed above has received financial support Yes (State city or town: No Do not know. If yes, send a copy of the Summons, Complaint, Notice of Automatic Court Orders and A legal separation. A fair division of property and debts. Alimony. Child Support. An order regarding the post-majority 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) and self-represented parties of record and that written consent for electronic delivery was received from all attorneys and self-represented parties receiving electronic delivery.CertificationI certify that a copy of this document was mailed or delivered electronically or non-electronically on (date) to all attorneys Name and address of each party and attorney that copy was mailed or delivered to* Signed (Signature of filer) u*If necessary, attach additional sheet or sheets with name and address which the copy was mailed or delivered to. Print or type name of person signing Date signed Telephone number Mailing address (Number, street, town, state and zip code) American LegalNet, Inc. www.FormsWorkFlow.com