Free MOTION FOR INTERVENTION IN JUVENILE MATTERS - Connecticut

MOTION FOR INTERVENTION IN JUVENILE MATTERS
JD-JM-141 Rev. 4-2001 C.G.S. §§ 46b-129c; 46b-57

INSTRUCTIONS
1. Complete the form below to intervene in an existing case and file with the Court Clerk. 2. You must also file an Appearance form (JD-JM-13).

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

NOTICE:

Upon the granting of this motion, you may appear by counsel or pro se. Be advised that you are not entitled to court appointed counsel at state expense. If you retain your own counsel, it must be at your own expense.

DOCKET NO. COURT DATE AND TIME

ADDRESS OF COURT CHILD'S NAME (First, middle, last) DATE OF BIRTH

NAME(S) OF PARENT(S) OR GUARDIAN(S) (First, middle initial, last)

"X" here if additional children are listed on a separate sheet.
INTERVENOR'S NAME (Last, first, middle initial) INTERVENOR'S ADDRESS (No., street, town, state, zip code) INTERVENOR'S PHONE NO.

1. I am the (State relationship to child(ren)): 2. I want to be made a party to this case. 3. I request the Court's permission to intervene in this case pursuant to C.G.S. § 46b-129(c) or § 46b-57.

X

SIGNED

PRINT NAME OF PERSON SIGNING AT LEFT DATE MAILED OR DELIVERED

I certify that a copy of the above was mailed/delivered to all counsel and pro se parties of record on:

X

SIGNED

PRINT NAME OF PERSON SIGNING AT LEFT

NAME OF EACH PARTY SERVED AND 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.

ORDER (To be completed by the court) The motion having been heard by/presented to the court, it is ordered:
BY THE COURT (Name of Judge) SIGNED (Judge/Asst. Clerk)

GRANTED

DENIED
DATE SIGNED

, J.
PRINT

PRINT NAME OF PERSON SIGNING AT LEFT

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