Custodians Affidavit Immediate Temporary Custody
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Custodians Affidavit Immediate Temporary Custody Form. This is a Connecticut form and can be use in Probate Statewide.
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Tags: Custodians Affidavit Immediate Temporary Custody, PC-510, Connecticut Statewide, Probate
CUSTODIAN'S AFFIDAVIT/
IMMEDIATE TEMPORARY CUSTODY
PC-510 REV. 9/91
STATE OF CONNECTICUT
RECORDED(CONFIDENTIAL VOLUME):
COURT OF PROBATE
[Type or print in black ink.]
TO: COURT OF PROBATE, DISTRICT OF
DISTRICT NO.
IN THE MATTER OF [Name, address, and zip code.]
DATE OF BIRTH OF
MINOR CHILD
CUSTODIAN[Name, address, zip code, and telephone number]
LENGTH OF TIME AS
CUSTODIAN OF MINOR
CHILD
State circumstances under which you obtained custody of the minor child.
Give specific facts that would justify the conclusion that immediate temporary custody is necessary and that determination of the need for
temporary custody cannot await notice of hearing. Any false statement made herein is punishable under the law. C.G.S. ยง45a-607(b)(1).
...................................................................................
Custodian:
[To give further details, use PC-180, Second Sheet.]
SUBSCRIBED AND SWORN TO
BEFORE ME
DATE
...................................................................................
Judge, Ass't Clerk, Notary Public, Comm. Sup. Ct.
CUSTODIAN'S AFFIDAVIT/IMMEDIATE TEMPORARY CUSTODY
PC-510
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