DOCKET NO: ______________                  :                  SUPERIOR COURT

__________________________                  :                  JUDICIAL DISTRICT OF

(Name of Plaintiff)                                                :                  _____________________

  1.                                                            :                 AT__________________

    ___________________________     :              Date: ________________

    (Name of Defendant)

     

     

    Petition for Appeal of Decision of Family Support Magistrate

    To the Superior Court, Judicial District of ________________________ at ______________ comes the defendant, ______________________________, who, pursuant to C.G.S. ' 46b-231(n) and Connecticut Practice Book ' 25-66, hereby appeals from the decision of Family Support Magistrate, _______________________, which was entered on ________________, ordering child support. Defendant respectfully represents that:

    1. On ___________________________, the Court ordered him/her to pay child support in the amount of $____________/per week in current support and

    $__________ per week as a weekly payment toward the arrearage.

    2. At trial, the defendant offered the following evidence about his/her ability to pay child support: (Circle all the choices that apply)

        ( )    a.  Pay stub(s) from employment showing gross earnings of:  $_________ per week.

        ( )    b.  Proof of receipt of SSI

        ( )    c.  Proof of receipt of Temporary Family Assistance (TFA), State Administered General Assistance (SAGA), or other public assistance.

        ( )    d.  Appellant's financial affidavit dated ________, showiwng gross weekly earnings of $__________ per week

        ( )    e.  Testimony from the appellant concerning  his/her ability to pay child support

        ( )    f.  Other evidence ___________________________________________________________

    3. The decision violates Conn. Gen . Stat. 46b-215b. It deviates from the presumptive guideline amount without adequate findings or evidence to justify a deviation.

    4. Substantial rights of the appellant have been prejudiced because the decision of the family support magistrate is:

      1. In violation of constitutional or statutory provisions
      2. In excess of the statutory authority of the family support magistrate
      3. Made upon unlawful procedure
      4. Affected by other error of law
      5. Clearly erroneous in view of the reliable, probative and substantial evidence on the whole record;
      6. Arbitrary or capricious or characterized by abuse of discretion or clearly unwarranted exercise of discretion.

     

     

                                                                                                    RESPONDENT

     

                                                                                                    _________________________________

                                                                                                    Name:

                                                                                                    Address:

     

                                                                                                    Telephone Number:

     

     

     

     

    CERTIFICATION

    I hereby certify that a copy of the above was mailed/delivered to the following parties of record on_____________________________

    Office of Attorney General

    Child Support Department

    55 Elm Street.

    Hartford, CT 06106

    Other parties:

     

     

     

    _____________________________________