CLAIM OF EXEMPTION - ORDER
SUMMARY PROCESS (EVICTION)
JD-HM-3 Rev. 5-09 C.G.S. § 47a-26h
STATE OF CONNECTICUT SUPERIOR COURT OFFICE OF THE CLERK www.jud.ct.gov
Name and address of Plaintiff or Plaintiff's Attorney
Instructions to Occupant 1. Fill-out Section I of this form. 2. File the original and two (2) copies of this form with the clerk. 3. The clerk will schedule a hearing date and will give you back one (1) copy of this form so you can use it.
Name and address of Occupant or Occupant's Attorney
Section I - Claim Of Exemption
(To be filled-out by Occupant)
Name of case (Eviction (Summary Process) Action) Address of court Name of Occupant(s) Location of premises
Date of judgment (If applicable)
I am an occupant of the premises in the case named above. I am over the age of eighteen (18) and I believe in the obligation of an oath. I have not been named in this eviction (summary process) action. I have a right to continue to occupy the premises because: ("X" all that apply) a. my occupancy began before the service of the notice to quit; b. my occupancy began or continued with the consent of the plaintiff (landlord); c. I have a right to occupy the premises that is equal to or greater than the rights of the plaintiff (landlord). I claim an exemption from the eviction (summary process) action named above.
Subscribed and sworn to before me on:
Signed (Assistant Clerk/Commission of Superior Court)
Section II - Notice Of Court Hearing On Claim Of Exemption
(To be completed by court clerk)
The occupant(s) named above has/have filed a claim of exemption from the eviction (summary process) action named above. This is to notify you that the Superior Court will hold a hearing on this claim. If you wish to be heard about this claim, you must personally come to court on the date and time shown below. If the plaintiff (landlord) does not come to court, an order granting the claim and changing in some way this eviction (summary process) action may be entered. If the occupant(s) does/do not come to court, an order denying this claim may be entered.
Place of hearing (If different from address of court shown above) Date of hearing Time of hearing Date notice mailed
Section III - Order Of Court
The exemption claimed above is:
Original - kept by the Court
Copy 1 - mailed to the Plaintiff
Copy 2 - returned to the Occupant