PROPERTY EXECUTION PROCEEDINGS CLAIM FOR DETERMINATION OF INTERESTS IN DISPUTED PROPERTY JD-CV-5c Rev. 3-02. C.G.S. 52-356c STATE OF CONNECTICUT SUPERIOR COURT www.jud.ct.gov * C L M * INSTRUCTIONS JUDGMENT CREDITOR OR ATTORNEY, OR PERSON CLAIMING INTEREST IN PROPERTY 1. Complete application in triplicate. 2. Present original and one copy to the clerk of court. 3. Retain copy for your file. CLERK 1. Upon filing of claim set down for hearing on date certain. 2. Complete and sign order of notice. 3. Retain copy for file. (NOTE: A claim concerning an interest in personal property sought to be levied on or a claim that the execution will prejudice the superior interest of a third person may be made by the third person or the judgment creditor within 20 days of the service of execution or upon application by the judgment creditor for a turnover order.) HOUSING JUDICIAL SESSION DISTRICT ADDRESS OF COURT DOCKET NO. DATE OF JUDGMENT SMALL CLAIMS AREA AT G.A. ORIGINAL CASE CAPTION DATE OF SERVICE OF EXECUTION OR APPLICATION FOR TURNOVER ORDER NAME(S) AND ADDRESS(ES) OF JUDGMENT CREDITOR(S) NAME(S) AND ADDRESS(ES) OF JUDGMENT DEBTOR(S) NAME(S) AND ADDRESS(ES) OF PERSON(S) CLAIMING INTEREST IN PROPERTY DESCRIPTION OF PROPERTY IN WHICH INTEREST IS CLAIMED STATEMENT OF BASIS OF CLAIM, SUPERIOR INTEREST OR NATURE OF DISPUTE (Attach additional sheets if more room is needed) DATE SIGNED SIGNED (Note: Signing this document constitutes the appearance of any third person claimant) TYPE IN NAME OF PERSON SIGNING AT LEFT X FOR THE JUDGMENT CREDITOR OR PERSON CLAIMING INTEREST: (Name and address of Attorney or Pro Se Movant) TEL. NO. JURIS NO. (If attorney or firm) ORDER FOR HEARING AND NOTICE DATE OF HEARING TIME OF HEARING (am/pm) COURTROOM ADDRESS OF COURT (If different from above) The foregoing claim having been presented to the court, it is hereby ordered that a hearing be held thereon at a session of this court to be held within and for the above-named Court Location shown above on the Date and Time shown above, and that the applicant give notice to all persons known to claim an interest in the disputed property of the pendency of such claim and of the time and place where it will be heard, by having a true and attested copy of the claim and of this order served upon the interested persons in the manner prescribed by law, at least six days before the date of the hearing. DATED AT (Town) ON (Date) BY THE COURT SIGNED (Assistant Clerk) FOR COURT USE ONLY TO ANY PROPER OFFICER By authority of the State of Connecticut you are hereby commanded to serve a true and attested copy of the above claim upon the judgment creditor(s), judgment debtor(s) and person(s) claiming an interest in property named above by leaving in their hands or at their usual place of abode on or before six days before the hearing date shown above. Hereof fail not but due service and return make. DATED AT (Town) SIGNED (Assistant Clerk) PROPERTY EXECUTION PROCEEDINGS American LegalNet, Inc. www.FormsWorkflow.com