Dissolution Of Marriage Page 2

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Based on these facts, the Court hereby dissolves the marriage of the parties and
Docket number
declares each party to be single and unmarried. The Court further orders:
The written agreement between the parties dated
is attached and its terms are incorporated by reference.
Joint legal custody to
and
Primary residence with:
A parenting responsibility plan in the best interest(s) of the minor child(ren)
incorporated by reference herein
as follows:
Visitation as follows:
Sole custody to
Alimony payable to:
Amount: $
to terminate at
Child support as follows:
Payable through the State of Connecticut.
Medical insurance coverage as follows:
Immediate income withholding (See Notice to Nonappearing Obligor of Income Withholding Order, JD-FM-70,
if defendant has not filed an appearance)
Contingent income withholding
Regarding post-majority educational support orders (Select one):
The Court finds that both of the parties have made a knowing and intelligent waiver of their right to request a
post-majority educational support order; or
The Court reserves jurisdiction to determine whether a post-majority educational support order should issue and
the terms thereof; or
The Court having found that it is more likely than not that the parents would have provided post-majority
educational support, reserves jurisdiction to determine whether to enter an educational support order and the
terms thereof; or
The Court enters a post-majority educational support as follows (Attach additional sheets if necessary):
The name of the
Plaintiff
Defendant
is restored to:
Other:
Notice as directed by the judicial authority must be given to parties who have not filed an appearance, of any
order for support or alimony. No such order shall be effective until the order of notice has been complied with or
the nonappearing party has actually received notice of such order. (Practice Book section 25-29)
By the Court (Full name of Judge)
Signed (Judge/Assistant Clerk)
Print name of person signing at left
Date of judgment
,J.
Attorney Certification:
(Completed by attorneys only if both the plaintiff and defendant were represented by attorneys)
I certify that the foregoing judgment file conforms to the judgment entered by the court.
Plaintiff's attorney
Print name
Date signed
Defendant's attorney
Print name
Date signed
JD-FM-177 (Back) Rev. 11-09
(Page 2 of 2)
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