MOTION FOR CONTEMPT/ CONTEMPT CITATION JD-FM-173 Rev. 2-15 C.G.S. § 46b-87; 46b-220 P.B. § 25-27 STATE OF CONNECTICUT COURT USE ONLY MFCONTP SUPERIOR COURT www.jud.ct.gov ADA NOTICE The Judicial Branch of the State of Connecticut complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation in accordance with the ADA, contact a court clerk or an ADA contact person listed at www.jud.ct.gov/ADA. *MFCONTP* CONTCPL Use this docket legend when the Certification has been filled out, but there is no Order to Attend Hearing and Notice. Use this docket legend when the Order to Attend Hearing and Notice has been filled out and the "Before Judgment" box is checked. Use this docket legend when the Order to Attend Hearing and Notice has been filled out and the "After Judgment" box is checked. *CONTCPL* CONTCIT (Check one) Judicial District of Before Judgment (pendente lite) At (Town ) After Judgment *CONTCIT* Docket number Plaintiff's name (Last, first, middle initial) Defendant's name (Last, first, middle initial) Plaintiff's address (Number,street, city, state, zip code) Defendant's address (Number,street, city, state, zip code) I, the Plaintiff Defendant, respectfully represent that this Court issued an order on (month, day, year) directing the plaintiff defendant to (fill out only the box (or boxes) below for the order (or orders) you are claiming was (or were) disobeyed): Pay alimony in the amount of Pay arrearages in the amount of Total balance owed As of (Date) Pay child support in the amount of per per per Have visitation or parenting time as follows: (Attach a copy of the visitation schedule if available) Pay medical bills or provide health insurance as follows: Other: The plaintiff or defendant has disobeyed the court order in the following ways: (Please be specific. Include the amount of any past due amount you claim is due as of the date of this motion or another specific date.) I ask the Court to find the Signature* plaintiff defendant in contempt. I certify that the above information is true to the best of my knowledge. Date Telephone (Area code first) Name of attorney or self-represented litigant Address of attorney or self-represented litigant Certification (Complete if motion is filed before judgment (pendente lite)) I certify that a copy of this document was or will immediately be mailed or delivered electronically or non-electronically on (date) to all attorneys and self-represented parties of record and that written consent for electronic delivery was received from all attorneys and self-represented parties of record who were or will immediately be electronically served. Name and address of each party and attorney that copy was mailed or delivered to* *If necessary, attach additional sheet or sheets with name and address which the copy was mailed or delivered to. Signed (Signature of filer) Print or type name of person signing Date signed Telephone number X Mailing address (Number, street, town, state and zip code) Order To Attend Hearing and Notice (To be completed by the Court) The court orders the plaintiff the defendant to attend a hearing at the time and place shown below to show why you are not in contempt. The Court also orders the plaintiff the defendant to give notice to the opposing party of the Motion and of the time and place where the Court will hear it, by having a true and attested copy of the Motion and this Order mailed or delivered to the opposing party by any proper officer at least 12 days before the date of the hearing. Proof of mailing or delivery must be made to this Court at least 6 days before the hearing. By the Court (Judge/Assistant Clerk) Date signed Court Use Only Superior Court, Judicial District of Date Time Hearing To Be Held At Court address Room number (If known) Telephone (Area code first) If you do not come to the court hearing, a civil arrest order (capias) may be issued against you. (Continued on page 2) *Check appropriate court: Superior Court Family Support Magistrate Division American LegalNet, Inc. www.FormsWorkFlow.com Summons TO ANY PROPER OFFICER: By the Authority of the State of Connecticut, you must serve a true and attested copy of the above Motion and Order to Attend Hearing on the below named person in one of the ways required by law at least 12 days before the date of the hearing, and file proof of service with this Court at least six days before the hearing. Person to be served Address Assistant Clerk Date signed Order The Court has heard the above Motion and finds that the is not in contempt. plaintiff defendant: is in contempt in the following way(s): in the amount of . owes past due amount (arrears) as of other (specify) : It is ordered: payment in the amount of income withholding in the amount of incarceration attorney's fees marshal's fees this matter is continued to other (specify): (date) for current support and . on past due by (date) . at (time) . By the Court (Judge/Family Support Magistrate) Signed (Assistant Clerk) Date of order Return of Service I left a true and attested copy of the Motion for Contempt at the current home of the The original Motion is attached. Name and title County Date of service in the hands of the defendant in the hands of the plaintiff defendant or plaintiff at (Number, street, town or city) For Use By Any Proper Officer As Defined by C.G.S. § 52-50(a) Only Fee information: Copy Endorsement Service Travel Total JD-FM-173 Rev. 2-15 Page 2 American LegalNet, Inc. www.FormsWorkFlow.com