Free APPEAL FROM FAMILY SUPPORT MAGISTRATE - Connecticut

APPEAL FROM FAMILY SUPPORT MAGISTRATE
JD-FM-111 Rev. 12-05 C.G.S. 46b-231(n), P.B. § 25-66

STATE OF CONNECTICUT SUPERIOR COURT www jud.ct.gov

COURT USE ONLY

APFFSM

INSTRUCTIONS TO APPELLANT 1. Type or print legibly; sign the certification section. 2. Prepare a separate petition which includes the reasons for the appeal and attach the petition to this form. 3. Serve a copy of this form with the petition attached, to each party of record, and mail one copy, by certified mail, to the following address: OFFICE OF ATTORNEY GENERAL, CHILD SUPPORT DEPARTMENT, 55 ELM ST., HARTFORD, CT 06106 4. File this form, with the petition attached, with the clerk of the court for the Judicial District where the magistrate's decision was rendered WITHIN FOURTEEN DAYS OF EITHER a. the date the final decision of the magistrate was filed with the clerk, OR b. if a rehearing was requested, the date of filing the notice of the decision thereon, WHICHEVER IS LATER.

INSTRUCTIONS TO CLERK 1. Provide a copy of the filed appeal form and attached petition to the Family Support Magistrate whose decision is being appealed. 2. Provide a copy of the Superior Court Judge's verbal or written decision to the Family Support Magistrate.

NAME OF CASE NAME AND ADDRESS OF COURT FILING DATE OF MAGISTRATE'S DECISION

DOCKET NO. NAME OF MAGISTRATE FILING DATE OF DECISION ON REQUEST FOR REHEARING (If applicable) FOR PLAINTIFF (Include Juris No. if applicable) FOR RESPONDENT (Include Juris No. if applicable)

ATTORNEYS OR PRO SE PARTY(IES) AT MAGISTRATE HEARING
TRANSCRIPT

ADDITIONAL EVIDENCE REQUESTED

NOT NECESSARY

HAS BEEN ORDERED

NO

YES - If yes, attach statement pursuant to C.G.S. 46b-231(n)(5)

NOTICE
The filing of an appeal from a decision of a Family Support Magistrate does not affect the order of support of a Family Support Magistrate, but it shall continue in effect until the appeal is decided, and thereafter, unless denied, until changed by further order of a Family Support Magistrate or the Superior Court. Further, any order entered by the court pursuant to an appeal under C.G.S. 46b-231(n) may be retroactive to the date of the original order entered by the Family Support Magistrate.
(Signature of attorney or pro se party) TELEPHONE NO. JURIS NO. (If applicable)

APPEAL BY:

CERTIFICATION
I hereby certify that a copy of the above was mailed/delivered to:
NAME OF EACH PARTY SERVED* ADDRESS AT WHICH SERVICE WAS MADE*

* If necessary, attach additional sheet with name of each party served and the address at which service was made.

COURT USE ONLY
FILE DATE

I further certify that a copy was mailed, by certified mail, to the Office of the Attorney General, Child Support Department, 55 Elm Street, Hartford, CT 06106 in accordance with C.G.S. § 46(b)-231(n)(2).
SIGNED (Individual attorney or pro se party) DATE COPY(IES) MAILED OR DELIVERED

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