Free JD-JM-40 - Connecticut

NOTICE/SUMMONS AND ORDER FOR HEARING - TERMINATION OF PARENTAL RIGHTS
JD-JM-40 Rev. 1-09 C.G.S. §§ 45a-716, 46b-123d Pr. Bk. Secs. 32a-1(g) 33a-2(b), (c), 33a-4 and 33a-5

STATE OF CONNECTICUT

SUPERIOR COURT
JUVENILE MATTERS www.jud.ct.gov

INSTRUCTIONS TO CLERK 1. Set matter down for hearing not more than 30 days after petition is filed, except not more than 20 days after a consent petition is filed. 2. Fill in name and telephone number of clerk in "Notice to Person(s)..."

Superior Court For Juvenile Matters At (Address of Court)

In The Interest Of (Name of child/youth)

Summons/Order For Hearing And Notice
The attached petition for termination of parental rights in the interest of the minor child or youth named above has been presented to the court. It is ordered: A hearing on this matter is scheduled for: 1. that the following persons are summoned Date Time (A.M./P.M ) to appear before the court at the above address on 2. that any proper officer make due and legal service of the order and summons and the foregoing petition at least ten (10) days before the above hearing date as follows: By personal service, having a true and attested copy of the petition and this order left with and in the hands of:
Name and Address

1. 2. 3. By certified mail, restricted delivery, return receipt requested, addressed to:
Name and Address

1. 2. 3.
By Publication In (Name(s) and location(s) of newspaper(s)) To Give Notice To (Name and last known address)

1. 2.
Dated At (Town) On (Date) By Order Of The Court (Name of Judge) Signed (Clerk)

Notice To Person(s) Whose Parental Rights Are Sought To Be Terminated
1. Failure to appear: If you do not come to court, the court may take action against you including entering orders affecting your parental rights. 2. Right to counsel: You have a right to be represented by an attorney. If you want an attorney but cannot pay for one and if you give proof that you cannot pay, the court will ensure that the Chief Child Protection Attorney's Office will assign an attorney to you. Your request should be made immediately at the court office where your hearing is to be held. 3. Effects of a termination decree: The effects of a termination decree will be the complete end of the legal relationship between the child or youth and the person(s) whose parental rights have been terminated so that the child or youth is free for adoption except it shall not affect the right of inheritance of the child or youth or the religious affiliation of the child or youth. The parent will have no legal right or responsibility to care for the child or youth or make any decisions on behalf of the child or youth, to obtain the child's or youth's birth certificate or any state or federal benefit. The parent will have no legal responsibility to support or to pay for the child's or youth's expenses after the effective date of termination. The child or youth will be legally free for adoption after the termination and the parent will have no right to notice of the adoption proceedings nor any right to participate in the proceedings. 4. Right to remain silent: You have the right to refuse to make any statements; any statements you make may be introduced in evidence and used against you.
Name of Clerk Telephone Number

The Judicial Branch of the State of Connecticut complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation under the ADA, contact the court clerk at the number listed above.
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Return of Service - To Be Completed By Any Proper Officer
STATE OF CONNECTICUT
County of SS. Name of Person Served Date of Service

Fees
Copy

Then and there, by virtue of the original petition, and by order and summons of the court, I left with and in the hands of the above-named respondent a true and attested copy of the original petition, order and summons. The within and foregoing is the original order and summons with my doings thereon endorsed.

Endorsement Service Travel

Attest (Signature and title of proper officer)

Total

STATE OF CONNECTICUT
County of SS. Name of Person Served Date of Service

Fees
Copy

Then and there, by virtue of the original petition, and by order and summons of the court, I left with and in the hands of the above-named respondent a true and attested copy of the original petition, order and summons. The within and foregoing is the original order and summons with my doings thereon endorsed.

Endorsement Service Travel

Attest (Signature and title of proper officer)

Total

STATE OF CONNECTICUT
County of SS. Name of Person Served Date of Service

Fees
Copy

Then and there, by virtue of the original petition, and by order and summons of the court, I left with and in the hands of the above-named respondent a true and attested copy of the original petition, order and summons. The within and foregoing is the original order and summons with my doings thereon endorsed.

Endorsement Service Travel

Attest (Signature and title of proper officer)

Total

STATE OF CONNECTICUT
County of SS. Certified Letter Addressed To (Name and address)

For Certified Mail
United States Post Office At (Town) Date of Service

Fees
Copy

Then and there, by virtue hereof, I made service of the within petition, order and summons by depositing a true and attested copy at the above post office, postage prepaid and letter certified, addressed to the person named above, restricted delivery, return receipt demanded. The within and foregoing is the original order and summons with my doings thereon endorsed.
Attest (Signature and title of proper officer)

Endorsement Service Travel

Total

JD-JM-40 (Page 2 of 4) Rev. 1-09

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PETITION FOR TERMINATION OF PARENTAL RIGHTS
C.G.S. §§ 17a-111b, 17a-112, 45a-715, 45a-717 Pr. Bk. Sec. 33a-1 P.A. 06-102

STATE OF CONNECTICUT

SUPERIOR COURT
JUVENILE MATTERS www jud.ct.gov

TO: The Superior Court For Juvenile Matters:
Address of Court Jurisdiction Based On Docket Number

Child or youth in the custody of the Commissioner of the Department of Children and Families (DCF). Neglect Petition (Coterminous Petitions).
Name of Minor Child/Youth In the Interest of: (a person under the age of eighteen Present Address (Tribe and reservation, if child is American Indian) years) Name of Petitioner Petitioner Relationship To Child/Youth (if any) Place of Birth Date of Birth Sex Address of Petitioner

Guardian
(1) Name Address (2) Name Parents/ Address Respondents (Include putative father, if applicable) (3) Name Address

Other (Specify)
Tribe and Reservation if American Indian Date of Birth

Tribe and Reservation if American Indian

Date of Birth

Tribe and Reservation if American Indian

Date of Birth

If Parent(s) is/are Minor(s), Give Name(s) and Address(es) of Parent(s) or Guardian(s) of the Person of the Minor Parents

Name and Address of Current Guardian of the Person of the Child/Youth Guardianship/ Custody

Commissioner of DCF

Other (Specify):

Name of Persons or Agencies Which Have Agreed to Accept Custody or Guardianship of Child/Youth upon Disposition Name(s) and Address(es) of Guardian(s) Ad Litem Appointed in Prior Proceedings

Court Appointed Guardian(s) Ad Litem Placement Agency

Commissioner of DCF

Other (Specify):

The petitioner represents: Parental rights of the parent named below should be terminated in the best interests of the child or youth, for the following reasons under Connecticut General Statutes Sec. 17a-112: father of said child or youth voluntarily and knowingly consent(s) to the termination of any parental rights I. The mother with respect to said child/youth; (No further allegation against a consenting parent is required. Attach completed form JD-JM-60 for any consenting parent.) OR

II.

DCF has made reasonable efforts to locate the

mother

father (if applicable). mother father, OR

DCF has made reasonable efforts to reunify said child/youth with the Mother

Father is/are unable or unwilling to benefit from reunification efforts. mother father as the court determined at a hearing

Reasonable efforts to reunify are not required for the under Sec. 17a-111b that such efforts are not required.
JD-JM-40 (Page 3 of 4) Rev. 1-09

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III. The petitioner alleges the following ground(s) for termination of parental rights: A. The child or youth has been abandoned by the mother father in the sense that the parent(s) failed to maintain a reasonable degree of interest, concern, or responsibility as to the welfare of the child or youth. father mother B1.The child or youth has been found in a prior proceeding to have been neglected or uncared for and the has/have failed to achieve the degree of personal rehabilitation that would encourage the belief that within a reasonable time, considering the age and needs of the child or youth, he/she/they could assume a responsible position in the life of the child or youth, or B2.The child or youth is neglected or uncared for and has been in the custody of the Commissioner for at least 15 (fifteen) months and the parent has been given specific steps to take to facilitate the return of the child or youth and the mother father has/have failed to achieve the degree of personal rehabilitation that would encourage the belief that within a reasonable time, considering the age and needs of the child or youth, he/she/they could assume a responsible position in the life of the child or youth. C. The child or youth has been denied, by reason of an act or acts by the of commission or mother father omission; including but not limited to, sexual molestation or exploitation, severe physical abuse or a pattern of abuse, the care, guidance or control necessary for his/her physical, educational, moral or emotional well being. father that ordinarily develops as a mother D. There is no ongoing parent-child or youth relationship with the result of a parent having met on a day-to-day basis the physical, emotional, moral, and educational needs of the child or youth and to allow further time for the establishment or reestablishment of the parent-child or youth relationship would be detrimental to the best interests of the child or youth. E. The mother father of the child, under the age of 7 (seven) years who is neglected or uncared for, has/have failed, is/are unable or is/are unwilling to achieve such degree of personal rehabilitation as would encourage the belief that within a reasonable period of time, considering the age and needs of the child, such parent(s) could assume a responsible position in the life of the child and the parent's/parents' parental rights of another child were previously terminated pursuant to a petition filed by the Commissioner of the Department of Children and Families. father has killed through a deliberate, non-accidental act another child or youth of the parent or has F. The mother requested, commanded, importuned, attempted, conspired, or solicited such killing or has committed an assault, through a deliberate non-accidental act that resulted in serious bodily injury of another child or youth of the parent. father was convicted as an adult or a delinquent by a court of competent jurisdiction of a sexual G. The mother assault resulting in the conception of the child/youth, except a conviction for a violation of section 53a-71 or 53a-73a.

IV. The summary of facts, the particular facts upon which termination is sought, is attached hereto and made a part hereof. For these reasons, the petitioner requests that the court terminate the parental rights of:
Name(s) of Parent(s) whose rights are sought to be terminated

And appoint a:
Signed By (Petitioner)

Statutory parent for said child/youth.

Guardian of the person of said child/youth.
Date Signed (Judge, Notary, Commissioner of the Superior Court)

Subscribed and sworn to before me on:
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JD-JM-40 (Page 4 of 4) Rev. 1-09

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