How to Fill Out Addendum to Affidavit Concerning Children (JD-FM-164A)

The Addendum to Affidavit Concerning Children (JD-FM-164A) is a supplemental form used in Connecticut family law cases, including divorce, legal separation, and custody matters. This form is not used on its own; it is an attachment to the primary Affidavit Concerning Children (JD-FM-164). You must file this addendum if you and your spouse have more than two minor children together, as the main form only has space to list two.

This form's purpose is to provide the Connecticut Superior Court with detailed information about the residency of your additional children for the past five years. This information is legally required under the Uniform Child Custody Jurisdiction and Enforcement Act (UCCJEA), as codified in Connecticut General Statutes (C.G.S.) § 46b-115s. The court uses this five-year history to determine if it has the authority, or 'jurisdiction,' to make decisions about custody and parenting for your children. Providing a complete and accurate history is crucial for your case to proceed smoothly and helps prevent future legal challenges regarding jurisdiction.

Completing this form accurately ensures the court has a full picture of your family situation, which is essential for making orders that are in the best interests of all your children. This addendum provides space for up to six additional children. If you have more than eight children in total, you will also need to use form JD-FM-164B.

Requirements

Before you begin filling out this form, gather the following documents and information to ensure accuracy and save time:

• Completed JD-FM-164 Form: You should have the main Affidavit Concerning Children (JD-FM-164) filled out for your first two children. This addendum attaches directly to it.
• Court Docket Number: This number is assigned to your case when it is first filed. It should be written on all subsequent documents, including this one.
• Children's Birth Certificates: You will need the full legal name and exact date of birth for each child you are listing on this form.
• Five-Year Residence History for Each Child: For each child, you must list every place they have lived for the past five years. For each residence, you will need:
  • The start and end dates of their stay.
  • The town, city, and state of the residence.
  • The full name and current address of every adult person the child lived with at that location.
  • The relationship of each of those adults to the child (e.g., Mother, Father, Aunt, Grandfather).
• Supporting Records: To reconstruct the 5-year history accurately, it is helpful to have documents like school records, medical records, old lease agreements, utility bills, or tax returns.

Step-by-Step Instructions

Case Information

This information identifies your case within the court system. It must be filled out at the top of the first page.

Docket number: Enter the docket number assigned to your divorce or custody case by the court clerk. This number appears on all your court documents, such as the Summons (JD-FM-1) or your original Divorce Complaint (JD-FM-3). It ensures this addendum is correctly filed with your case. Example: NBD-FA24-XXXXXXX-S ⚠️ Leaving the docket number blank can cause significant delays, as the court clerk may not know which case file this form belongs to. Double-check it for accuracy.

Information for Additional Child (Child 3)

This section is for the third minor child of the marriage. You will provide their personal details and a complete five-year residency history. Repeat these steps for each additional child, using a new block for each one.

Child's name (First, middle, last): Enter the child's full legal name as it appears on their birth certificate. Example: Jane Marie Doe

Date of birth (Month, day, year): Enter the child's date of birth in MM/DD/YYYY format. Example: 07/15/2015

Residence information is same as for previous child (If not same, provide information): Check this box ONLY if this child has lived in the exact same locations, for the exact same time periods, and with the exact same people as the child listed immediately above them on the forms (this could be Child 2 on form JD-FM-164). If you check this box, you can skip the residency table below for this child. If there is any difference at all, leave this box unchecked and fill out the table completely. ⚠️ Only use this checkbox if the residency history is identical. This is common for siblings who have always lived together, but if one child ever lived with a different relative or attended a boarding school, you must fill out the table separately.

Date(s) of residence (to the present): This table documents the child's living situations for the last five years, starting with the most recent. In the first row, the end date is pre-filled as 'to the present'. You only need to enter the start date for their current residence. Work backward in time from there. Example: 08/01/2021 to the present

Location (Town or city, and state, unless confidential): Enter the town/city and state where the child currently lives. Do not list the full street address unless specifically required by the court. Example: Hartford, CT ⚠️ If you have a protective order or fear for your or your child's safety, you can request to keep this information confidential. You may need to file a separate motion to seal the address.

Name(s) and present address(es) of person(s) child lived with (unless confidential): List the full name of every person the child lives with at this location. You must also provide the current address for each of those people, even if it's the same as the child's. Example: John Doe, 123 Main St, Hartford, CT 06106; Jane Doe, 123 Main St, Hartford, CT 06106

Relationship to child: State the relationship of each person listed in the previous column to the child. Example: Father, Mother

Date(s) of residence (to): For the second row, list the residence immediately prior to the current one. The 'to' date should be the day before the start date of the residence above it. Then enter the start date for this prior residence. Example: 06/15/2019 to 07/31/2021

Location (Town or city, and state, unless confidential): Enter the town/city and state for this prior residence. Example: Stamford, CT

Name(s) and present address(es) of person(s) child lived with (unless confidential): List the full name and current address of every person the child lived with at this prior residence. Example: John Doe, 123 Main St, Hartford, CT 06106; Jane Doe, 123 Main St, Hartford, CT 06106

Relationship to child: State the relationship of each person to the child for this prior residence. Example: Father, Mother

Common Mistakes to Avoid

1. Using as a Standalone Form: This form is an addendum. It must be filed with the main Affidavit Concerning Children (JD-FM-164), not by itself.
2. Incomplete 5-Year History: Failing to provide a continuous residency history for the last five years is a common error. The court needs a complete timeline with no gaps to establish jurisdiction.
3. Forgetting the Docket Number: Submitting the form without the case docket number will cause confusion and delays at the clerk's office.
4. Incorrectly Using the 'Same Residence' Checkbox: Ticking this box when there are minor differences in where siblings lived can lead to inaccurate court records. Only use it if the history is 100% identical.
5. Vague Information: Simply writing 'parents' is not sufficient. You must list the full legal name of each person the child lived with, their current address, and their specific relationship to the child.
6. Not Listing All Adults: You must list every adult who resided with the child at each location, not just the parents. This could include grandparents, stepparents, or other relatives.

Frequently Asked Questions

What if I don't know the exact dates my child lived at a certain address? Do your best to reconstruct the timeline using records like school enrollment dates, lease agreements, or utility bills. If you must estimate, be as accurate as possible (e.g., 'Approximately June 2020 to August 2021'). The court prefers precise dates but understands that estimates are sometimes necessary. The key is to provide a continuous history.

What does 'unless confidential' mean and how do I make an address confidential? This clause is for situations involving domestic violence or where revealing an address could endanger you or your child. To keep an address confidential, you cannot simply write 'confidential' on the form. You must file a separate motion with the court, such as a Motion to Seal Financial Affidavit or a request for a protective order, explaining why the information needs to be protected. The court must approve this request.

Who signs this form? The JD-FM-164A addendum itself does not have a signature line. It is considered part of the main Affidavit Concerning Children (JD-FM-164), which you must sign under oath in front of a notary or court clerk. Your signature on the main form certifies that all information, including that on any attached addenda, is true and accurate.

What if my spouse and I lived separately with the children at different times? You must document this accurately. For any period the child lived with only one parent, you would list that parent's name, their current address, and their relationship to the child for that specific time frame. The form is designed to capture these exact scenarios.

What if we have more than eight children? If you have more than eight minor children, you will use the main form (JD-FM-164) for the first two, this addendum (JD-FM-164A) for children three through eight, and an additional form, JD-FM-164B, for the ninth child and any subsequent children.

Next Steps

After you have completely filled out the JD-FM-164A form:

1. Review for Accuracy: Carefully proofread the entire form. Check all names, dates, and addresses for correctness. Ensure the five-year residency history for each child is complete and without gaps.
2. Attach to Main Form: Securely attach this addendum (JD-FM-164A) to your main Affidavit Concerning Children (JD-FM-164). The addendum goes behind the main form.
3. Make Copies: Make at least two copies of the complete packet (JD-FM-164 and JD-FM-164A). You will need one copy for your records and one copy to be served on your spouse.
4. File with the Court: File the original, signed packet with the Superior Court clerk's office where you initiated your case.
5. Serve Your Spouse: A copy of the complete packet must be formally delivered ('served') to your spouse along with the other initial divorce papers, such as the Summons and Complaint. This is a critical legal step that must be done correctly, usually by a state marshal.