CONNECTICUT CONFIDENTIAL RECEIVED: (List name of minor child.) Hereinafter referred to as the minor child. (List name and address.) (List name, address and telephone number.) Adult relative (List relationship and date of birth.) Attorney for minor child (Attach Appearance of Attorney, PC(For each person, list name, address, telephone number, relationship to the minor child, date of birth, if a parent; whether in military service of United States or Allied Nation (50 U.S.C. App . 520); Indian tribe . . Relationship to minor Hereinafter referred to as the respondent(s) . Petition/Removal of Guardian PC-500 Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com CONFIDENTIAL (Include the name, address, telephone number and relationship.) The last-known address of the respondent (s) is: The following efforts have been made to obtain the current address for the respondent (s): (For each person, list name, address, telephone number, relationship to the child, date of birth if a parent; whether parent is in the military service of United States or Allied Nation; Indian tribe and reservation, if a member as defined by 25 U.S.C. section 1903; and whether the person is legally incompetent.) (For each person, list name, address, telephone number, relationship to the child, date of birth; whether the parent is in military service of United States or Allied Nation; Indian tribe and reservation, if a member as defined by 25 U.S.C. section 1903; and whether the person is legally incompetent.) The respondent(s) named above should be removed as guardian(s) of the person of the minor child for the following reasons as provided by law, C.G.S. sections 45a-610 and 45a-613: The respondent(s) consent(s) to removal as guardian(s) of the minor child. (No further allegation against a consenting respondent is necessary.) The minor child has been abandoned by the parent(s) or guardian(s) in the sense than the parent(s) or guardian(s) has failed to maintain a reasonable decree of interest, concern or responsibility for the child222s welfare. The minor child has been denied the care, guidance, or control necessary for the physical, educational, moral or emotional well-being as a result of acts of parental commission or omission as defined by law. The minor child has had physical injury or injuries inflicted upon him or her, other than by accidental means, as defined by law. The minor child has been neglected or uncared for, as defined in C.G.S. section 46b-120. Petition/Removal of Guardian PC-500 Page 2 of 4 CONNECTICUT American LegalNet, Inc. www.FormsWorkFlow.com Appoint a guardian(s) of the person of the person of the minor child. Affirm (Name) is the sole guardian. The minor child has resided has not resided in Connecticut continuously for the last six months. There is a proceeding is not a proceeding pending or contemplated in Connecticut or any other state affecting the custody of the minor child. There has been a proceeding has not been a proceeding in the past in Connecticut or any other state affecting the custody of the minor child. There is is not a current safety or service agreement between the Department of Children and Families and the parent/guardian of the minor child. There is is not a current protective order or restraining order involving any party. If so, please attach. The minor child is is not the subject of a pre-existing child support order. that the court remove the respondent(s) as guardian(s) of the person of the minor child and: Signature of Petitioner Type or Print Name Date Petition/Removal of Guardian PC-500 Page 3 of 4 CONFIDENTIAL CONNECTICUT American LegalNet, Inc. www.FormsWorkFlow.com (A parent may waive personal service by filing a Waiver of Personal or Abode Service/Parental Rights Matter, PC-633.) Signature of Parent/Guardian Duly Acknowledged Before Me Type or Print Name Date Judge, Clerk, Notary Public, Comm. Sup. Ct. Signature of Parent/Guardian Duly Acknowledged Before Me Type or Print Name Date Judge, Clerk, Notary Public, Comm. Sup. Ct. C.G.S. section 45a-617. Signature of Minor Child Duly Acknowledged Before Me Type or Print Name Date Judge, Clerk, Notary Public, Comm. Sup. Ct. Petition/Removal of Guardian PC-500 Page 4 of 4 CONFIDENTIAL Signature of Proposed Guardian Type or Print Name (Include all prior names.) Date Address Phone Number Date of Birth Signature of Proposed Guardian Type or Print Name (Include all prior names.) Date Address Phone Number Date of Birth CONNECTICUT American LegalNet, Inc. www.FormsWorkFlow.com CONNECTICUT PROBATE COURTS 1)Petitioner who is an adult relative of the minor child: a.Name Social Security Number 2)Person(s) to be removed as guardian(s) a.Name Social Security Number b.Name Social Security Number 3 Proposed Guardian(s) a.Name Social Security Number b.Name Social Security Number Confidential Information/Petition/Removal of Guardian PC-500C RECEIVED : American LegalNet, Inc. www.FormsWorkFlow.com