COURT COUNTY .OF. . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . INSTRUCTIONS MOTION. FOR . . . . . . . . . . SUSPENSION . . PROSECUTION AND ORDER OF TO DEFENDANT: Forward original to Clerk:of Court and Index No. TREATMENT - ALCOHOL OR DRUG send a copy to the state's attorney. DEPENDENCY TO CLERK: Send a copy of the final court order granting : Calendar or denying the motion to the Court Support Services Division and the DMHAS treatment facility JD-CR-90 Rev. 6-04 C.G.S. § 17a-696 : Plaintiff(s) TO: The Superior Court of the State of Connecticut FROM (Name of Defendant) -against- No. JUDICIAL SUBPOENA NO. SUPERIOR COURT DOCKET : ADDRESS OF DEFENDANT (Number, Street, Town) JUDICIAL DISTRICT OR G.A. ADDRESS OF COURT : : CRIME(S) CHARGED AGAINST DEFENDANT (Name and Statute No.) MOTION (To Be Completed by Defendant) Defendant(s) : I, the . . . . . . . . . .Defendant,. hereby . . . . . the .following statements: . . . . . . . . undersigned . . . . . . . . . . . . make . . . . . . . . . . . . . . . . . 1. I AM NOT CHARGED WITH SEEK WAIVER OF MY INELIGIBILITY BECAUSE OF 6. I agree that (a) prosecution may be suspended for a BEING CHARGED WITH period not exceeding two years, (b) during said period I shall be placed in the custody of the Court Support a THE PEOPLE OF THE STATE OF NEW YORK violation of Section 14-227a or Section 53a-60d of the Services Division for treatment of alcohol or drug General Statutes or with a class A, B or C felony. dependency, and (c) the court or the Court Support 2. I WAS NOT TWICE PREVIOUSLY ORDERED TREATED Services Division may require me to (1) comply with the TO SEEK WAIVER OF MY INELIGIBILITY BECAUSE I conditions specified in subsections (a) and (b) of Section WAS TWICE PREVIOUSLY ORDERED TREATED 53a-30 of the General Statutes and (2) be tested for use of alcohol or drugs during the period of suspension. under the provisions of Section 17a-696, subsection (i) of Section 17-155y, Section 19a-386 or Section 21a-284 of the General Statutes, revised to 1989, or any combination thereof. GREETINGS: 7. I agree, if this motion is granted, to pay to the court forthwith an administration fee of $25, unless such fee is waived. I understand that the court may waive the administration fee if it finds that I am indigent or unable to excuses being$25 administration fee.each of youthe following) laid aside, you and ("X" one of attend before pay the 3. I agree, with respect to the Crime(s) Charged above, to the tolling of theWE COMMAND YOU, thatperiod of statute of limitations during the all business and the Honorable at any suspension granted and waive the right to a speedy trial. the , Court I intend to claim indigency or inability to pay. located at County of 4. I was an alcohol-dependent or drug-dependent person at I intend to pay the $25 administrationat any recessed in room , Charged day , 20 , at o'clock in the noon, and fee. the time of the Crime(s)on the above. of or adjourned date, to testify and give evidence as a witness in this action on the part of the WHEREFORE, the undersigned moves that the prosecution of the above Crime(s) Charged be suspended and that I be ordered treated for alcohol or drug dependency. 5. I agree to give notice of this motion to the victim(s) of said crime(s) so that the victim(s) will have an opportunity to be heard in this matter. SIGNED (Defendant) DATE SIGNED I have read the above and understandwith this subpoena is punishable as a contempt of court and will make you liable to Your failure to comply it. I agree to the foregoing statements. subpoena was issued for a maximum penalty of $50 and all damages sustained as a the party on whose behalf this CONSENTED TO BY (Parent or guardian if minor) SIGNED (Attorney for Defendant) 2nd ORDER (if applicable) 1st ORDER result of your failure to comply. The foregoing motion is denied. Witness, Honorable The foregoing motion is continued to the following Court Court that County, Date, so in the defendant may notify the day of of the victim(s) COURT HEARING DATE AND TIME NOTICE DATE , opportunity to be heard on this matter. Notice to the Victim(s) must , one by Registered or Certified Mail on or be given on form JD-CR-89 of the Justices of the 20 before the Notice Date indicated below. SIGNED (Judge or Assistant Clerk) DATE SIGNED (Attorney must sign above and type name below) The foregoing motion is denied. Due notice to the victim(s) having been given, the court finds that the defendant was an alcohol-dependent or drug-dependent person at the time of the crime(s) charged, the defendant presently needs and is likely to benefit from treatment for the dependency, and suspension of prosecution will advance the interests of justice. The motion is granted; the prosecution is suspended and the case is continued to the below date; and the defendant is released to the custody of Attorney(s) for Services Division for treatment for the Court Support alcohol or drug dependency for the Period of Probation specified below, subject to the following conditions and payment of the administration fee and cost of treatment ordered unless waived below. The court, having found that the defendant has an estate insufficient to provide for the defendant's support and that there is no person legally liable or able to support the defendant, CASE CONTINUED TO (Date and Time) Waives the payment of the $25 administration fee. Waives the payment of the cost of treatment. Other (Specify): Office and P.O. Address PERIOD OF PROBATION (Not to exceed two years) CONDITIONS OF PROBATION: Telephone No.: 1. The defendant shall be tested, as the probation officer deems appropriate, for use of alcohol or drugs. 2. OTHER CONDITIONS SPECIFIED ON ATTACHED SHEET. Facsimile No.: BY THE COURT (Name of Judge) SIGNED (Assistant Clerk) E-Mail Address: Mobile Tel. No.: DATE SIGNED American LegalNet, Inc. www.USCourtForms.com