SUSPENSION OF PROSECUTION/ ORDER OF COMMUNITY SERVICE APPLICATION, ORDER, REPORT STATE OF CONNECTICUT SUPERIOR COURT www.jud.ct.gov JD-CR-81 Rev. 9-11 C.G.S. §§ 21a-279, 53a-39c Instructions to Defendant 1. Send the first three copies to clerk of court. 2. Send the last copy to the state's attorney(s). 3. A $205 program fee is required if your application is granted unless you file an affidavit of indigency or inablility to pay and the court finds you indigent. Instructions to Clerk 1. Unless denied, upon the first order of the court, forward a copy to C.S.S.D. Adult Supervision. 2. Unless denied, upon the second order of the court, forward a copy to C.S.S.D. Adult Supervision. 3. Retain original in court file. Docket number To: The Superior Court of the State of Connecticut Year of birth From (Name of defendant) Other name(s) known as (Alias) Address of court Sex Address (Number, street and town) Judicial District or Geographical Area Place of birth Telephone Name of attorney (Include juris number) Crime(s) charged against the defendant In violation of General Statutes section 21a-267 21a-279 Application and Motion I am applying for the community service labor program and say: 1. I am charged with a violation of the section of Connecticut General Statutes specified above. 2. I have not been convicted of violating Connecticut General Statutes sections 21a-267, 21a-277, 21a-278 or 21a-279 before. 3. I have not been placed in the community service labor program before. 4. If prosecution is suspended and I am placed in the community service labor program, I agree to give the state more time to prosecute me for this charge or charges (the tolling of any statute of limitations and to waive the right to a speedy trial). 5. I agree, if this application is granted, to pay the court a participation fee of $205, unless the court decides that I do not have to pay the fee. I understand that the court may decide that I do not have to pay the participation fee if (1) I file with the court an affidavit of indigency or inability to pay, (2) my inability to pay or indigency is confirmed by the Court Support Services Division, and (3) the court decides that I cannot pay or that I am indigent. ("X" one of the following): I intend to claim indigency or inability to pay. An affidavit of indigency or inability to pay is attached. I intend to pay the $205 participation fee. I request that the prosecution be suspended and that my application to take part in the community service labor program be granted in accordance with section 53a-39c of the Connecticut General Statutes. Date signed Signed (Defendant) I have read/had read to me the above and I understand it. I agree with the statements above. Consented to by (Parent or guardian) Date signed Signed (Attorney for defendant) First Order of the Court The application is denied. The application is continued to the following Court Hearing Date so that the Defendant's prior criminal record and record of prior participation in the community service labor program may be verified. Court hearing date and time Date signed Signed (Judge or Assistant Clerk) CSLP Eligibility and Indigency Confirmation Report Defendant is eligible Defendant is eligible but has similar charges pending (See attached record) Defendant is ineligible for the following reasons: Prior CSLP participation Once before Twice before Prior criminal record for violation of C.G.S. 21a-267, 21a-277, 21a-278, 21a-279, For Court Use Only File date (See attached criminal record) Other (Specify): Affidavit of indigency or inability to pay - The Defendant's affidavit of indigency or inability to pay was: Confirmed Not Confirmed Eligibility and indigency report provided by Date of report Page 1 of 2 Client number State identification number American LegalNet, Inc. www.FormsWorkFlow.com Second Order of the Court The Application is denied. Having found that the Defendant was charged with a violation of Connecticut General Statutes section 21a-267, or 21a-279 and the Defendant was not previously convicted of a violation of Connecticut General Statutes 21a-267, 21a-277, 21a-278 or 21a-279, and the Defendant has not previously been placed in the community service labor program, the application is granted; the prosecution is suspended and the case is continued to the below court hearing date; and the Defendant is referred to the Court Support Services Division for placement in a program of community service labor that shall include a drug education component, for the period specified below. Period of Participation:________________________ (a minimum of 14 days for a first violation) and payment of the participation fee unless waived below. The court, having found that the defendant is indigent or has an inability to pay, waives the payment of the $205 participation fee. Other (specify): ________________________________________________________________ Court hearing (Date and time) By the court (Name of Judge) Signed (Assistant Clerk) Date signed __.M. Final Progress Report Drug education provider Community service provider Drug Education Community Service Has satisfactorily completed the assigned program. Has satisfactorily completed community service. Has not satisfactorily completed the assigned program. Has not satisfactorily completed community service. Reasons for non-compliance: Reasons for non-compliance: Signed (C.S.S.D. Officer/duly authorized personnel) Date signed Signed (C.S.S.D. Officer/duly authorized personnel) Date signed Disposition Program successfully completed and charges dismissed. Program not satisfactorily completed, a plea of not guilty entered and this case immediately placed on the trial list. Other disposition: By the court (Name of Judge) Signed (Judge/Assistant Clerk) Date signed JD-CR-81 Rev. 9-11 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com