Certification of Public Assistance Form
If you are applying for a divorce in the State of Connecticut and wish to inform the state of this divorce application, you have to use the following form. Complete the form and send it along with any required filing fees.
DownloadExtracted Text for Proper Search
If any party or any child received public assistance from the State of Connecticut:The Office of the Attorney General 55 Elm Street Hartford, CT 06106 If any party or any child received public assistance from any town or city in the State of Connecticut: The City Clerk for the town providing public assistance: JUDICIAL DISTRICT OF AT (Town) DOCKET NO. (If known) CERTIFICATION OF NOTICE IN FAMILY CASES (PUBLIC ASSISTANCE) JD-FM-175 Rev. 1-2001 P.B. §§ 10-12 through 10-17, 25-2 C.G.S. § 46b-55 SIGNATURE And State Marshal's return was mailed/delivered on (month, day, year) NAME OF CASE RETURN DATE (Mo., day, year) (if applicable) (No., street, town) ADDRESS (No., street, town, state, zip code) CERTPA COURT USE ONLY TELEPHONE NO. (Area code first) INSTRUCTIONS (CHECK ALL THAT APPLY) This is to certify that a true copy of the: Summons Complaint Custody Application (only if seeking child support) Notice of Automatic Court Orders Order to Attend Hearing (for custody actions seeking support) Affidavit Concerning Children (for proceedings seeking custody) Financial Affidavit to: If you, your spouse, or your children have ever received public assistance (state aid, city aid, or welfare) follow the instructions below (visitation actions are exempt from these requirements): 1. Mail or deliver a copy of the Summons and Complaint or Custody Application, Notice of Automatic Court Orders, Order to Attend Hearing (if applicable), and a copy of the State Marshal's return (proof that the court papers were served) to the Attorney General or Town Clerk's office. 2. Complete the form below. 3. Keep a copy for your records. 4. File this Certification form with the court clerk when you file your Summons and Complaint or Custody Application. www.jud.ct.gov STATE OF CONNECTICUT SUPERIOR COURT PRINT NAME
If you want to remove Certification of Public Assistance Form from this website please contact us providing the reasons together with this url: https://formsarchive.com/certification-of-public-assistance-form/