APPLICATION FOR ISSUANCE OF SUBPOENA JD-CV-62 Rev. 7-08 Pr. Bk. Sec. 7-19, C.G.S. § 52-161b Judicial District Housing Session Docket Number COURT USE ONLY INSTRUCTIONS TO CLERK If a self-represented (pro se) applicant has been convicted of a family violence crime or of any of the other statutes listed below and is seeking to subpoena the victim of such crime, schedule a hearing and give the applicant notice of the date, time and location of the hearing. Geographical Area AISBPPP A I S B P P P At Name of Case Type of Court Case Civil Housing Family Family Support Magistrate Application To Applicant: State whether you have been convicted of a family violence crime (C.G.S. § 46b-38a) or Risk of Injury to Children (C.G.S. § 53-21), Sexual Assault (C.G.S. §§ 53a-70, 53a-70a, 53a-70b, 53a-71, 53a-72a, 53a-72b or 53a-73a), or Stalking (C.G.S. §§ 53a-181c, 53a-181d or 53a-181e.) YES NO If yes, are you asking to subpoena the victim of your crime? YES NO I am a self-represented party in the case named above and I want to require the person or people listed below to testify in this case. I think that the testimony is necessary and ask that the judge or family support magistrate in this case review this application without notice to the other parties in this case. If this case has not been assigned to a specific judge or family support magistrate, I ask that the administrative judge or any judge or family support magistrate designated by the administrative judge review my application without notice to the other parties in this case. If the judge or family support magistrate decides that the subpoena(s) should be issued, I ask the judge or family support magistrate to have the clerk of the court issue the subpoena(s). I understand that I have to give any subpoena(s) issued to a state marshal (an individual authorized to serve the person(s) being subpoenaed) or other authorized person and I must pay the state marshal or other authorized person a fee for serving the subpoena(s). Name(s) and Address(es) of Person or People I am Asking to Subpoena 1. Name of person Address (Number, street, and town) I believe testimony from this person is necessary because (Fill in this box) I want this person ordered to bring the following item(s) to Court 2. Name of person Address (Number, street, and town) I believe testimony from this person is necessary because (Fill in this box) I want this person ordered to bring the following item(s) to Court Type of Proceeding(s) I am Requesting Subpoena(s) For Trial scheduled for (Date) Before Judge (If known) Short Calendar matter scheduled for (Date) Pre-judgment remedy hearing scheduled for (Date) Before Judge/Magistrate/Hearing Officer (If known) Family Support Magistrate hearing scheduled for (Date) Signed (Self-represented Applicant) ("X" appropriate box) Print name Other (Specify) Telephone Number (Area code first) Date signed X Order Having conducted a review of this application pursuant to Practice Book Section 7-19, and having considered the nature of the scheduled hearing and future opportunities for examination of witnesses, the application is granted denied. Having granted the application, the clerk of this court is directed to issue the subpoena(s): As requested above. As requested above, except: As to the following individuals only: By the Court Signed (Judge or Family Support Magistrate) Date of Order American LegalNet, Inc. www.FormsWorkflow.com