Form Jd-Fm-183 - Custody/visitation Agreement - State Of Connecticut Superior Court
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1
2CUSTODY/VISITATION AGREEMENT
STATE OF CONNECTICUT
SUPERIOR COURT
JD-FM-183
Rev. 7-17
C.G.S. § 46b-66
Court Use Only
AGREMNT
*AGREMNT*
Instructions Complete form. Make copies for yourselves and give the original to the court clerk.
Judicial District of
At (Town )
Docket number
Plaintiff's name (Last, first, middle initial)
Defendant's name (Last, first, middle initial)
Name of child (Last, First, Middle Initial)
Date of birth
Name of child (Last, First, Middle Initial)
Date of birth
The parties agree that:
1. The custody of the child(ren) shall be as follows:
Legal Custody:
Primary Residence:
2. As to visitation with the child(ren):
Who will pick up/drop off for visits:
Holiday and school vacation visits:
3. As to income withholding, we understand that the support orders are by immediate income withholding unless for
cause or we both agree to it being contingent: We agree to a(n)
Immediate
Contingent
income withholding.
4. As to post-majority educational support ("X" one):
No post-majority educational support order is requested at this time; or
The parties ask the Court to reserve jurisdiction to determine whether a post-majority educational support order
should issue and the terms of the order; or
The parties ask the Court to find that it is more likely than not that the parents would have provided post-majority
educational support, and for the Court to reserve jurisdiction to determine whether to enter an educational support
order and the terms of the order; or
The parties ask the Court to enter post-majority education support as follows (Attach additional sheets if necessary):
Continued on Back/Page 2
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