REQUEST FOR NONDISCLOSURE OF INFORMATION IN PROTECTION ORDER REGISTRY
JD-CL-80 Rev. 8-06 C.G.S. § 51-5c(c)
INSTRUCTIONS TO PROTECTED PARTY Complete this form and file it with the clerk's office where the protection order issued. Retain a copy for your records. INSTRUCTIONS TO CLERK Ensure that the name and address of the protected party are NOT disclosed from the Protection Order Registry except to the law enforcement agencies that are referenced by the protected party. Retain original for court file.
STATE OF CONNECTICUT SUPERIOR COURT www.jud.ct.gov
NOTICE TO PROTECTED PARTY If you believe that disclosure of location information contained in this matter would jeopardize you and/or your child(ren)'s health, safety or liberty, you may be able to file a "Request for Nondisclosure of Location Information", form JD-FM-188, with the clerk.
NAME OF CASE PROTECTED PARTY'S NAME (First, middle initial, last)
DOCKET NO. RESPONDENT'S/DEFENDANT'S NAME (First, middle initial, last)
I, the above-named protected party, request that the Protection Order Registry NOT disclose my name and address except to the law enforcement agency for the town(s) in which I reside, I am employed, and in which the Respondent/Defendant resides.
SIGNED (Protected Party)
ORIGINAL - Clerk
COPY - Protected Party