CONNECTICUT PROBATE COURTSPetition/Appointment of Coguardian of the Person of a Minor Child PC-509 /1 RECEIVED: Instructions: 1) The sole parent or 2) persons to serve as coguardians of the 3) The petition should be filed in the probate district in which the minor resides 4) Probate Court Name District Number Date of Birth In the Matter of (ame and address of minor child) Hereinafter referred to as the minor Petitioner/Sole Parent or Guardian am Date of Birth of ole Parent/Guardian Petitioner/Commissioner of Department of Children and Families (List address and designee, if applicable.) Proposed Coguardian(s) (ame, address, telephone number and relationship to minor) ate(s) Other Persons to Whom Notice Should Be Given (ames, addresses and relationship to the minor, including a parent whose guardianship rights have been removed, if any) Petition/Appointment of Coguardian of Person of Minor PC-509 Page 1 of CONFIDENTIAL Address where minor resides Address where minor is domiciled (If different) Address where minor is located at time of filing petition (If different) American LegalNet, Inc. www.FormsWorkFlow.com CONNECTICUT PROBATE COURTSPetition/Appointment of Coguardian of the Person of a Minor Child PC-509 / THE PETITIONER REPRESENTS that: The minor resides within the probate district. is the sole parent / sole guardian of the person of the minor. There is no proceeding pending or contemplated in Connecticut or any other state affecting the custody of the minor. There is a proceeding pending, or there has been a past proceeding in Connecticut or other state affecting the custody of the minor. (If checked, complete and attach form JD-FM-164, Affidavit Concerning Children.) The minor is in the care of the Commissioner of Children and Families, and the sole parent or sole guardian consents to the petition. Each proposed coguardian listed above has the ability to meet, on a continuing daytoday basis, the physical, emotional, moral and educational needs of the minor and has established a relationship with the minor as indicated below: (Identify name of the proposed coguardian and describe relationship with minor.) The appointment of a coguardian of the person of the minor is in the best interests of the child. THEREFORE, the petitioner respectfully requests that: The court appoint the person(s) listed above as coguardian(s) of the person of the minor, effective immediately upon the occurrence of the following contingency: The representations made under penalty of false statement. Signature of Petitioner Type or print name Date If appointed, I/we will accept the position of trust as coguardian(s). Signature Signature Type or print name Type or print name Date Date Consent to Appointment of Coguardian of the Minor If the petitioner is the Commissioner of Children and Families, the sole parent or sole guardian must complete this section: I consent to the appointment of the above proposed coguardian(s) of the person of the minor. Sole Parent: Signature Acknowledged before me: Type or Print Name Date Judge/Clerk/Notary Public/Comm.Sup. Ct. Sole Guardian: Signature Acknowledged before me: Type or Print Name Date Judge/Clerk/Notary Public/Comm.Sup. Ct. Petition/Appointment of Coguardian of Person of Minor PC-509 Page 2 of CONFIDENTIAL American LegalNet, Inc. www.FormsWorkFlow.com Confidential Information/Petition/ A ppointment of Coguardian of the Person of a Minor Child PC-509C CONNECTICUT PROBATE COURTS CONFIDENTIAL INFORMATION/ Petition/Appointment of Coguardian of the Person o f a Minor Child PC-509C 10/1 FOR COURT USE ONLY The social security numbers of the following persons are required in connection with this proceeding. 1)Sole Parent: Name: Maiden Name: (If applicable) Social Security Number: 2)Sole Guardian: Name: Maiden Name: (If applicable) Social Security Number: 3)Proposed Coguardian(s): a. Name: Maiden Name (If applicable) Social Security Number: b. Name: Maiden Name (If applicable) Social Security Number: Probate Court Name District Number In the Matter of ,a minor child. American LegalNet, Inc. www.FormsWorkFlow.com