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Instructions explain filing requirements by probate district, eligibility for adult relatives or attorneys, and required supporting documents such as custodian affidavit/physician certificate, birth certificate, and confidential information sheet for social security numbers. The form gathers parties’ addresses and dates of birth, lists respondents to be removed or whose parental rights are to be terminated, and records additional guardianship rights, current physical care, and related allegations.",{"@graph":63,"@context":111},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/petitionimmediate-temporary-custody-pc-501-rev-0723-connecticut-probate-courts/282913/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/petitionimmediate-temporary-custody-pc-501-rev-0723-connecticut-probate-courts/282913.png","ImageObject",442,249,{"name":88,"@type":89},"Nguyễn Văn Học","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-18","2026-09-16",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",8,{"@type":103,"mainEntity":104},"FAQPage",[105],{"name":106,"@type":107,"acceptedAnswer":108},"What documents must be filed with the PC-501 petition?","Question",{"text":109,"@type":110},"A Custodian’s Affidavit/Immediate Temporary Custody (PC-510) is required unless the child is in a parent’s custody and hospitalized with serious injury/illness and the parent refuses or cannot consent to treatment, in which case a Physician’s Certificate/Immediate Temporary Custody (PC-550) is filed instead. A long-form birth certificate, JD-FM-164 Affidavit Concerning Children, and PC-501CI confidential sheet for SSNs are also required.","Answer","https://schema.org",{"og:url":78,"og:type":113,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":115,"canonical":78},"index,follow",{"doc_id":117,"site_id":56},282913,1790184538,{"code":4,"msg":5,"data":120},{"doc_id":117,"user_id":121,"nickname":88,"user_avatar":122,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":123,"file_id":124,"file_url":125,"file_type":126,"file_size":127,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":47,"language":128,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":129,"faqs":130,"seo_title":131,"seo_description":61,"update_tm":132,"read_time":73},1374402739827,"https://ap-avatar.wpscdn.com/avatar/14000c97e7351f1a627?x-image-process=image/resize,m_fixed,w_180,h_180&k=1787885694763230660","Petition/Immediate Temporary Custody PC-501 REV. 07/23  \nRESET  \nCONN ECTICUT P ROBATE COURTS  \n\n| CONFIDENTIAL |  |\n| --- | --- |\n| RECEIVED: | |\n| Instructions: 1) An adult relative may use this form to petition for the appointment of an immediate temporary custodian of a minor child, if a petition for: a) removal of guardian, b) termination of parental rights, or c) appointment of a guardian of a minor child who has no guardian has been filed with the court. This form may also be used by an attorney for a minor child or by an adult who is not a relative, but who has actual physical custody of the minor child at the time the petition is filed.\u003Cbr>2)The petition should be filed in the court for the probate district in which the minor child resides, is domiciled, or is located at the time of filing the petition. If the petitioner is requesting immediate temporary custody pending termination of parental rights, the petition may also be filed where the petitioner resides.\u003Cbr>3)A Custodian’s Affidavit/Immediate Temporary Custody, PC-510, must be filed with the petition unless the minor child is in the custody of a parent and is hospitalized with a serious injury or illness, and the parent is refusing or unable to consent to treatment. In this case, a Physician’s Certificate/Immediate Temporary Custody, PC-550, must be filed instead of the PC-510. In addition, a birth certificate (long form) and JD-FM-164, Affidavit Concerning Children, should be filed with the petition. Also file Confidential Sheet, PC-501CI, with confidential social security numbers.\u003Cbr>4)Contact the court regarding payment of service of process and, if applicable, payment of newspaper notice publication.\u003Cbr>5)For more information, see C.G.S. sections 45a-607, 45a-603 et seq., 45a-706 et seq., 46b-115 et seq. and 52-231a.\u003Cbr>6)Type or print in ink. Use an additional sheet, or PC-180, if more space is needed. |  |\n\nProbate Court Name District Number  \n\n| In the Matter of (Name of minor child) ( Hereinafter referred to as the minor child) |  | Minor Child’s Date of Birth |\n| --- | --- | --- |\n| Address where minor child resides | Address where minor child is domiciled (If different) | Address where minor child is located at time of filing petition (if different) |\n\nTribe and Reservation of Minor Child, if an Indian Child as defined by 25 U.S.C. section 1903 or by Pub. Act 23-113  \n(Name and address)  \n\n| Petitioner(Name, address and telephone number) | Petitioner is: Adult relative(List relationship and date of birth. )\u003Cbr>Attorney for minor child (Also file Appearance of Attorney, PC-183 . )\u003Cbr>Adult with actual physical custody of minor child. (List birth date and describe circumstances under which the minor came to be in the petitioner’s custody): |\n| --- | --- |\n\nPersons to be Removed as Guardian/Parental Rights Terminated. (For each, list name, address, telephone number, relationship to the child; date of birth, if a parent; if in the military service of the United States or an Allied Nation (50 U.S. C. section 3931); Indian tribe and reservation, if a member as defined by 25 U.S.C. section 1903 or by Pub. Act 23-113; and if the  \nperson is legally incompetent. 1.  \na. Relationship to minor child:  \nb. If parent, date of birth:  \nc. In military service of US or Allied Nation:  \nd. Indian tribe and reservation:  \ne. Legally incompetent: Yes No  \nYes  \nNo  \n2.  \na. Relationship to minor child:  \nb. If parent, date of birth:  \nc. In military service of US or Allied Nation: Yes No  \nd. Indian tribe and reservation:  \ne. Legally incompetent: Yes No  \nHereinafter referred to as the respondents  \nPC-501 REV. 07/23 CONN ECTICUT PROBATE COURTS  \n\n| In the Matter of CONFIDENTIAL |  |\n| --- | --- |\n| If a parent listed above is a minor or legally incompetent, list the parents or guardian/conservator for the parent (Include the name, address, telephone number and relationship.)\u003Cbr>1. 2. |  |\n| Name of parent whose parental rights were previously terminated, if any |  |\n|","cbCais7lfRt6B5Lq","https://ap.wps.com/l/cbCais7lfRt6B5Lq","pdf",748561,"English","# Instructions\n## Petition and filing requirements\n## Required supporting documents\n## Probate court and minor child information\n# Parties and allegations\n## Petitioner information\n## Respondents to be removed / parental rights terminated\n## Additional guardianship rights\n## Current physical care of the minor","[{\"question\":\"What documents must be filed with the PC-501 petition?\",\"answer\":\"A Custodian’s Affidavit/Immediate Temporary Custody (PC-510) is required unless the child is in a parent’s custody and hospitalized with serious injury/illness and the parent refuses or cannot consent to treatment, in which case a Physician’s Certificate/Immediate Temporary Custody (PC-550) is filed instead. A long-form birth certificate, JD-FM-164 Affidavit Concerning Children, and PC-501CI confidential sheet for SSNs are also required.\"}]","Petition/Immediate Temporary Custody PC-501 REV. 07/23 - Connecticut Probate Courts | PDF",1789585018]