Dissolution Agreement

Download a blank fillable Dissolution Agreement in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Dissolution Agreement with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

ADVERTISEMENT

DISSOLUTION AGREEMENT
Court Use Only
JD-FM-172 Rev. 7-10
STATE OF CONNECTICUT
AGREMNT
C.G.S. §§ 46b-51, 46b-38oo
SUPERIOR COURT
*AGREMNT*
Instructions: The instructions for filling out this form are on form JD-FM-172A.
Judicial District of
At (Town)
Docket number
Plaintiff's name (Last, first middle initial)
Defendant's name (Last, first, middle initial)
The plaintiff and defendant agree that:
1. Our
marriage
civil union
has broken down irretrievably.
("X" one)
2. The custody of the child(ren) shall be as follows:
Joint legal custody to
and
Primary residence with:
A parenting responsibility plan in the best interest(s) of the minor child(ren)
shall be incorporated by reference or
as follows:
Sole custody to:
3. As to visitation with the child(ren):
Who will pick up/drop off for visits or parenting time transition:
Holiday and school vacation schedule:
The amounts/percentages indicated below for Child Support, Health Care Insurance Coverage and Unreimbursed
Health Care Costs, and Child Care Costs must follow the Child Support and Arrearage Guidelines (the Guidelines), which
are available at Clerk's Offices and on the Judicial Branch website at /publications, unless you ask for one of
the deviation criteria to apply (reasons for an amount different than the Guidelines).
4. As to current and/or past due Child Support:
This amount follows the Guidelines.
This amount is different from the Guidelines (deviation). Give reason for deviation from the Guidelines (see
Guidelines for reason that applies):
5. As to the child's or children's required Health Care Insurance Coverage and Unreimbursed Health Care Costs:
This amount follows the Guidelines.
This amount is different from the Guidelines (deviation). Give reason for deviation from the Guidelines (see
Guidelines for reason that applies):
(Continued on back/next page)
Print Form
Reset Form

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go
Page of 2