Free PETITION - Connecticut

PETITION: NEGLECTED, UNCARED-FOR, DEPENDENT CHILD/YOUTH
JD-JM-98 Rev. 12-08 C.G.S. 46b-120, 121, 129 Pr. Bk. Sec. 32a-1(g), 33a-1, 33a-2

STATE OF CONNECTICUT SUPERIOR COURT JUVENILE MATTERS
www jud.ct.gov

TO: The Superior Court For Juvenile Matters
Address of Court Name and Address of Child/Youth Name and Address of Petitioner Relationship to Child or Youth Place and Date of Birth Telephone Number Sex

Commissioner D.C.F.

Probation Officer

Other (Specify)
Date of Birth Date of Birth Date of Birth Date of Birth Indian Tribe/Reservation Indian Tribe/Reservation Indian Tribe/Reservation Indian Tribe/Reservation

Respondents
Name and Address of Mother (If applicable) Name and Address of Father (If applicable) Name and Address of Guardian (If applicable) Name and Address of Putative Father

If Parent(s) is/are Minor(s), Name(s) and Address(es) of Grandparent(s) or Guardian(s):

The Petitioner Represents That the Child or Youth Is:
Neglected in that the child or youth has been abandoned: the child or youth is being denied proper care and attention, physically, educationally, emotionally or morally; the child or youth is being permitted to live under conditions, circumstances or associations injurious to well-being; or the child or youth has been abused and has: physical injury or injuries inflicted by other than accidental means; injuries which are at variance with the history given of them or; a condition which is the result of maltreatment such as, but not limited to, malnutrition, sexual molestation or exploitation, deprivation of necessities, emotional maltreatment or cruel punishment. Uncared for in that the child or youth is homeless, or the child's or youth's home cannot provide the specialized care which the physical, emotional or mental condition of the child or youth requires. Dependent in that the child's or youth's home is suitable except for the financial inability of the parents, parent, or guardian or other person maintaining such home to provide the specialized care the condition of the child or youth requires.
State Jurisdictional Facts (Use additional sheet if necessary)

The Petitioner requests that process issue to bring the parents, or legal custodian of the child or youth before the court to be dealt with according to law.
Signed (Petitioner) Subscribed and Sworn To Before Me On (Date) Date Signed (Judge, Assistant Clerk, Notary, Comm. Superior Court)

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Order For Hearing And Summons
Upon the foregoing petition, it is hereby ordered, that said petition be heard and determined at the Court Location shown below on the Hearing Date and time indicated,and further ordered, that the petitioner shall serve a copy of the foregoing petition on each parent/guardian named in this petition and they hereby are summoned to appear before the court on the Hearing Date and at the Court Location shown below by having a proper officer leave a true and attested copy of this order and summons with said respondent(s) or at the usual place of abode, or, if so ordered, by publication or mail on or before the date for service shown below and return same to the court.
Date Time of Hearing

Hearing Date
Number, Street and Town

.m.

Court Location
Publication For: Service to be Made on or Before (Date) By Order of the Court (Signed - Judge/Clerk of Superior Court) Date Signed Certified Mail For:

1. Failure to Appear: If you do not come to court, the court may find that your child is neglected, uncared for or dependent. 2. Right to Counsel: You have the right to be represented by an attorney and if you want an attorney but cannot pay for one, and if you give proof that you cannot pay, the court will make sure that an attorney is provided for you by the Chief Child Protection Attorney. Your request should be made immediately at the court office where your hearing is to be held. 3. Right to Remain Silent. You have the right to refuse to make statements; any statements you make may be introduced in evidence and used against you.

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.

JD-JM-98 Rev. 12-08

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STATE OF CONNECTICUT
County of SS.

Return of Service
Name of Person(s) Served

Docket Number

Date of Service

Fees

Then and there, I duly served the foregoing petition, order and summons on the above-named respondent(s), by either (check one): leaving with (for in hand); or leaving at the usual place of abode (for abode) at__________________________________________ The within and foregoing is a true and attested copy of the original petition, order, and summons.
Attest (Signature and title of proper officer)

Copy Endorsement Service Travel

Total

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

Fees

Then and there, I duly served the foregoing petition, order and summons on the above-named respondent(s), by either (check one): leaving with (for in hand); or leaving at the usual place of abode (for abode) at__________________________________________ The within and foregoing is a true and attested copy of the original petition, order, and summons.
Attest (Signature and title of proper officer)

Copy Endorsement Service Travel

Total

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

Fees

Then and there, I duly served the foregoing petition, order and summons on the above-named respondent(s), by either (check one): leaving with (for in hand); or leaving at the usual place of abode (for abode) at__________________________________________ The within and foregoing is a true and attested copy of the original petition, order, and summons.
Attest (Signature and title of proper officer)

Copy Endorsement Service Travel

Total

STATE OF CONNECTICUT
County of SS.

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

Then and there, by virtue hereof, I made service of the within petition, order and summons by depositing a true and attested copy by United States Post mail, postage prepaid, addressed to __________________________________________________________________, by (check one): restricted delivery, return receipt requested; or first class mail; or certified mail, return receipt requested. The within and foregoing is the original petition, order and summons with my doings thereon endorsed.
Attest (Signature and title of proper officer)

Fees
Copy Endorsement Service Travel

Total

JD-JM-98 Rev. 12-08

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