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Get Ct Jd Fm 164 2015-2024

R visitation rights regarding any child listed here: Name: Address: (unless confidential) 5. The mother of the child(ren) named in the Complaint or Application is pregnant. Yes No Do not know 6. A child has been born to the mother named in the Complaint or Application after the filing of the Complaint or Application. Yes No Do not know If yes, fill in the following: Child's name Date of birth (Month, day, year) Print name of person signing Signature Date signed Sworn to before me (A.

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