JD-JM-65 Rev. 8-06 C.G.S. §§ 46b-120, 121, 129j, 17a-93(i) Pr. Bk. Sec. 33-8, 33-9 Public Act 06-102 ADDRESS OF COURT NAME OF PETITIONER NAME OF FATHER NAME OF MOTHER NAME OF GUARDIAN (If applicable) NAME OF CHILD/YOUTH ADDRESS OF FATHER ADDRESS OF MOTHER
STATE OF CONNECTICUT SUPERIOR COURT JUVENILE MATTERS
DOCKET NO. DATE OF BIRTH
ADDRESS OF GUARDIAN (If applicable)
At a session of the Superior Court and in accordance with the provisions of the applicable statutes in such case, the court makes the following findings and enters the following orders in the best interest of the above named child/youth: ADJUDICATION The court finds said child/youth: The court has found said child/youth: NEGLECTED NEGLECTED UNCARED FOR UNCARED FOR DEPENDENT DEPENDENT on OR .
REASONABLE EFFORTS FINDING (If necessary) Continuation in the home is contrary to the welfare of said child/youth and Voluntary placement Such out-of-home placement is in the best interests of the child/youth. Reasonable efforts to prevent removal finding: Reasonable efforts to prevent or eliminate the need for removal of said child/youth were made by the state. Reasonable efforts to prevent or eliminate the need for removal of said child/youth from the home were not possible. Reasonable efforts were not made. DISPOSITION 1. 2. The court hereby finds that the following disposition is in the best interest of the child/youth: OR
The court hereby grants the motion to reopen and modify the prior disposition in this case, and finds the following modified disposition to be in the best interest of the child/youth: A. COMMITMENT Said child/youth is committed until further order of the court to the Commissioner of Children and Families who shall be the guardian of said child/youth according to the statutes in such cases. Commitment is effective . B. PROTECTIVE SUPERVISION Continuation in the home is not contrary to the best interest of the child/youth. The Commissioner of Children and Families shall provide Protective Supervision for said child/youth effective until . Child's place of abode is with (name)
who is a suitable and worthy person. Page 1 of 2
C. CUSTODY/GUARDIANSHIP The (name)
guardianship of said child/youth is vested in who is/are found to be suitable and worthy caretaker(s).
Subject to an order of Protective Supervision for said child/youth . effective until D. EXTENSION OF PROTECTIVE SUPERVISION The Commissioner of Children and Families shall provide until Protective Supervision for said child/youth for an additional period effective FURTHER ORDER OF THE COURT
The above order incorporates the services and steps enumerated in the attached Specific Steps. The Commissioner of Children and Families shall file: A Status Report on or about . . .
A Motion for Review of Permanency Plan on or before A hearing to review the permanency plan shall be held on A Motion for: Revocation/Transfer of Guardianship no later than (date): MODIFICATION OF DISPOSITION no later than (date): A hearing to review said motion shall be held on (date):
A Petition for Termination of Parental Rights no later than (date): An In Court Judicial Review shall be held on (date): .
NAME OF JUDGE
The above and foregoing is a true copy of the order and was mailed to the Commissioner of Children and Families.
SIGNED (Judge, Clerk) AT (Town) ON (Date)
JD-JM-65 Rev. 8-06 (Page 2)