AFFIDAVIT OF SERVICE PETITION FOR ORDER RE: COMMISSION ON HUMAN RIGHTS AND OPPORTUNITIES AND NOTICE OF HEARING
JD-CV-69 New 6-98 Public Act 98-245, Sec. 8
STATE OF CONNECTICUT SUPERIOR COURT
COURT USE ONLY
PETIT
INSTRUCTIONS TO PETITIONER Complete the Affidavit (the Docket Number is the number assigned by the clerk to your original petition), attach your return receipts and file the Affidavit with the clerk of court within five days of service being made.
AFFIDAVIT OF SERVICE PETITION FOR ORDER RE: COMMISSION ON HUMAN RIGHTS AND OPPORTUNITIES AND NOTICE OF HEARING
TO: Superior Court for the Judicial District of Hartford-New Britain at Hartford, 95 Washington St. Hartford CT 06106
NAME OF PETITIONER NAME OF RESPONDENT NAME(S) OF RESPONDENT(S) (Person(s) named in CHRO complaint)
DOCKET NUMBER
ADDRESS OF PETITIONER (No., street, town, zip code) ADDRESS OF RESPONDENT (No., street, town, zip code) ADDRESS(ES) OF RESPONDENT(S) (No., street, town, zip code)
If additional respondents are to be named, attach a separate sheet of paper.
CHRO CASE NAME CHRO CASE NUMBER
PETITION FOR ORDER
I, the undersigned Petitioner in the above referenced Petition for Order RE: Commission on Human Rights and Opportunities and Notice of Hearing, hereby certify that a copy of the Petition and Notice of Hearing in the above referenced matter was served on the date and in the manner noted below for each of the defendants, and that I have attached the return receipts that I have received indicating the delivery of the Petition and Notice of Hearing:
METHOD OF SERVICE CERTIFIED/REGISTERED DATE OF SERVICE RETURN RECEIPT NO.
NAME OF RESPONDENT
1. 2. 3. 4.
(If additional Respondents were served, complete a second affidavit)
Dated at
INSERT TOWN WHERE SIGNED
, Connecticut on
INSERT DATE YOU SIGN THE AFFIDAVIT OF SERVICE
SIGNED
PETITIONER/ATTORNEY
Subscribed and sworn to before me at _________________________ this _______ day of__________________, _______.
COMMISSIONER OF THE SUPERIOR COURT/NOTARY PUBLIC
My Commission Expires
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