COMPLAINT - HOUSING CODE ENFORCEMENT
JD-HM-35 (Old JD-CV-28) Rev. 4-01 C.G.S. § 47a-14h
CONNECTICUT SUPERIOR COURT
1. Type or print legibly and firmly with a ball point pen. Sign original and conform copies. 2. File all copies with the clerk of the court accompanied by form JD-HM-19, "Notice of Suit - Housing Code Enforcement" and the entry fee, or a request for waiver of such fee. 3. A hearing will be scheduled not more than fourteen (14) days after the filing of the complaint, or the return of service (made by the clerk), whichever is later. If there is no return of service, the plaintiff will be responsible for service.
NAME OF CASE
COMPLAINT 1. The plaintiff is a tenant in the building at 2. The defendant is the landlord of that building. 4. The rent for the apartment is $ Rent of $
(Street address, apt. # or floor, town)
3. The parties entered into an oral/written lease for the term of one month/week/year. per month/week, and it is due on the for the current month/week has been paid to my landlord. day of each month/week.
5. On (date) , the tenant made a complaint about the premises to (Name of municipal agency/Comm. of Consumer Protection) This was at least 21 days before filing this action. 6. The plaintiff has not been served with a notice to quit based on nonpayment of rent prior to institution of this action, and has not been served with a notice to quit based on any other ground prior to making the complaint to the appropriate municipal agency or to the Commissioner of Consumer Protection. 7. The landlord has failed to perform his/her legal duty to maintain the premises under § 47a-7 (Landlord's Responsibilities) of the General Statutes. The violations are the following:
CONTINUATION OF COMPLAINT ATTACHED AND MADE A PART HEREOF.
THE TENANT REQUESTS: 1. An order requiring the landlord promptly to make repairs and to perform his/her other legal duties under local, state and federal law. 2. An order appointing a receiver to collect rents and to use the money to correct conditions in the property which violate local, state, or federal law. 3. An order staying other proceedings concerning the same property. 4. An award of money damages, which may include a retroactive abatement of rent payable into court pursuant to 47a-14h(h) of the General Statutes. 5. Such other relief in law or equity as the court may deem proper. The undersigned, being duly sworn, deposes and says that the above claims are true.
SIGNED (Plaintiff) SUBSCRIBED AND SWORN TO BEFORE ME ON (Date) TYPE IN NAME OF PERSON SIGNING AT LEFT SIGNED (Asst. Clerk, Notary, Comm. of Sup. Ct ) TITLE OF PERSON SIGNING
MILITARY SERVICE AFFIDAVIT
The undersigned deposes and says:
that the defendant(s) is(are) in the military or naval service of the United States. that the undersigned is unable to determine whether or not the defendant(s) in this action are in the military or naval service of the United States. that no defendant in this action is in the military or naval service of the United States, and that, to the personal knowledge of the undersigned (state facts showing defendant is not in such service):
SIGNATURE AND TITLE
SUBSCRIBED AND SWORN TO BEFORE ME ON (Date)
SIGNED (Asst. Clerk, Notary, Comm. of Sup. Ct )
ORIGINAL - Court File
COPY 1 - Defendant
COPY 2 - Housing code enforcement agency
COPY 3 - Plaintiff