Affidavit Re: Occurrence of Contingency for Appointment of Coguardian(s) of the Person of a Minor Child PC-511 NEW 7/15 RECEIVED: CONNECTICUT PROBATE COURTS RECORDED (CONFIDENTIAL): Instructions: 1) A coguardian whose appointment is effective upon the occurrence of a contingency may use this form to notify the court that the contingency has occurred. 2) Attach documentation of occurrence of contingency, e.g. physician's report, death certificate, etc. 3) Type or print the form in ink. District Number Minor's Birth Date Probate Court Name In the Matter of (Name of minor child and address and telephone number where minor child is currently living.) Hereinafter referred to as the minor. Coguardian(s) whose appointment is subject to contingency (List name, address and telephone number.) The undersigned represents that: · By decree dated , the court appointed the person(s) named above as coguardian(s) of the person of minor child, effective upon the occurrence of a specific contingency, namely: · · · · The specific contingency occurred on or about , evidence of which is attached. This affidavit constitutes the written affidavit and notice to the court required under C.G.S. section 45a-616 (b). I reaffirm that I accept the position of coguardian of the person of the minor. I understand that I may assume my duties and responsibilities as coguardian upon an order of the court affirming my appointment and that the court may act without notice and hearing. Signature Signature Type or print name Date Type or print name Date SUBSCRIBED AND SWORN TO BEFORE ME DATE ................................................................................................ Judge, Clerk, Notary Public, Comm. Sup. Ct. PC-511 American LegalNet, Inc. www.FormsWorkFlow.com Affidavit Re Occurrence of Contingency for Appointment of Coguardian(s) of the Person of a Minor Child