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PROPOSED PARENTAL
RESPONSIBILITY PLAN

STATE OF CONNECTICUT
SUPERIOR COURT
www.jud.ct.gov

JD-FM-199 Rev. 3-14
C.G.S. Sec. 46b-56a

ADA NOTICE

Instructions
If there is a dispute in Superior Court between the parents about the child
(ren)'s custody, care, education and upbringing, this form must be completed
and filed with the court on or before the case management date, if applicable,
or, as otherwise ordered by the court. Attach additional sheets if necessary.
Judicial District of

The Judicial Branch of the State of Connecticut complies with the

Americans with Disabilities Act (ADA). If you need a reasonable
accommodation in accordance with the ADA, contact a court clerk
or an ADA contact person listed at www.jud.ct.gov/ADA.

At (Town)

Docket number

Plaintiff's name (Last, First, Middle Initial)

Defendant's name (Last, First, Middle Initial)

It is proposed that:
1) The physical residence of the child(ren) will be according to the following schedule:

2) Decision-making about th