MOTION FOR EXTENSION OF CIVIL PROTECTION ORDER STATE OF CONNECTICUT JD-CV-146 Rev. 10-16 C.G.S. §§ 6-32, 46b-16a, 51-5c(a), 6-32(b), 53a-223c, 53a-107 SUPERIOR COURT www.jud.ct.gov Instructions to Person Filing Motion (Applicant): 1. Fill out on-line, or print clearly in ink, or use a typewriter. 2. If the applicant is under 18 years of age, the Motion for Extension must be signed and filed by an adult representative, also known as a "next friend." The next friend may be a parent, guardian or other responsible adult. 3. Give to clerk to set a hearing date; the clerk will return to you an original and a copy for service on the respondent. 4. Give to State Marshal or proper officer for service. Be sure original is returned to court after service. Instructions to Clerk: Assign a hearing date prior to the expiration date of the original Civil Protection Order. Judicial District of Name of applicant (Last, first, middle initial) Address to which mail is to be sent (Number, street)* (See NOTE below) Home/residence address* (See NOTE below) Work address* (See NOTE below) Name of next friend (Last, first, middle initial) (If applicant is a minor) Same as mailing address Court location (number, street, town, zip code) Date of birth (mm/dd/yyyy) (Town) (Town) (Town) 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. Docket number Sex (M/F) Race (State) (State) (State) (Zip Code) (Zip Code) (Zip Code) ADA NOTICE Next friend address (town, state, Zip)* (See NOTE below) *NOTE: All addresses provided in this motion will be included on papers that are in the court file and will be provided to the respondent. The applicant/protected party's address or addresses will determine which law enforcement agencies are notified if the motion to extend the Civil Protection Order is granted. Information About The Respondent Name of respondent (Person the application is filed against) (Last, first, middle initial) Address of respondent (Number, street) Respondent's telephone number Do you know the respondent? (Town) Other identifiers (Examples include height, weight and approximate age) Date of birth (mm/dd/yyyy) Sex (M/F) (State) Race (Zip Code) If yes, how do you know the respondent Yes No Yes No Is the respondent a member of your family or household? A member of · Your spouse or a person you have a civil union with your family or · Your former spouse or a person you had a civil union with household is · The parent of your child defined as: · Your parent · Your child · Someone you have cohabited with as an intimate partner (romantic, spousal, or sexual relationship while living together) · A person related to you by blood or marriage · A person you reside or resided with · A person you have (or recently had) a dating relationship with *NOTE: If the respondent in your case is a family or household member, you do not qualify for a Civil Protection Order and you should NOT continue to fill out this form. However, if the respondent is a family or household member you may qualify for an Order of Relief from Abuse under section 46b-15 of the Connecticut General Statutes. For more information, see Civil Protection Order Information Form (form JD-CV-148), and Restraining Orders: How to Apply for Relief from Abuse (form JDP-FM-142). "X" here if a Criminal Protective Order or Family Restraining Order exists affecting any party to this Application. (Enter docket number and court location) Docket number Court location Optional to applicant (If you choose to answer, "X" the appropriate boxes below) 1. Does the respondent hold a permit to carry a pistol or revolver? ........................ Yes No Unknown 2. Does the respondent hold an eligibility certificate for a pistol or revolver, a long gun eligibility certificate, or an ammunition certificate? ............................................. Yes No Unknown 3. Does the respondent possess one or more firearms? ....................................... Yes No Unknown 4. Does the respondent possess ammunition? ................................................... Yes No Unknown If you think you need more security when you are in court for your Civil Protection Order hearing, contact the Clerk's Office or the Court Service Center in the court where your hearing is scheduled. Page 1 of 2 (continued on page 2) American LegalNet, Inc. www.FormsWorkFlow.com Name of applicant Name of respondent Docket number MOTION FOR EXTENSION OF CIVIL PROTECTION ORDER Date (mm/dd/yyyy) 1. A Civil Protection Order was entered on against the respondent. 2. The facts and circumstances that were the basis for that order still exist. 3. I continue to need the protection of this order because: 4. There is no Criminal Protective Order or Family Restraining Order currently in effect against the respondent arising from those facts and circumstances. 5. The respondent is not a member of my family or household as defined in the Instructions and lnformation About the respondent sections of this form. See sections 46b-15 and 46b-38 of the Connecticut General Statutes or the Civil Protection Order Information Form (form JD-CV-148), for more information. Therefore, I move for an extension of the Civil Protection Order. Signed (Applicant or next friend, if applicant is a minor) Subscribed and sworn to before me Signed (Clerk, Notary, Commissioner of the Superior Court) Date signed For Court Use Only Hearing date Time of hearing Court location (Number, street, town, zip code and courtroom, if applicable) .m. To Any Proper Officer: By authority of the State of Connecticut you are hereby commanded to serve a true and attested copy of the Motion for Extension of Civil Protection Order upon the respondent according to law not less than five (5) days before the Hearing Date Shown above. The cost of such service upon the respondent shall be paid for by the Judicial Branch of the State of Connecticut in accordance with section 6-32, 46b-16a, and 52-261(a) of the Connecticut General Statutes. By Order of the Court Signed (Assistant Clerk) Date signed Return Of Service To Officer Executing Service: Type or print legibly in the spaces below, then promptly return this and all accompanying papers to the clerk of the court at the court location above before the date of the hearing. Date of service Time of service Service exec