AFFIDAVIT CONCERNING MILITARY SERVICE JD-FM-178 Rev. 11-11 P.B. § 17-21 STATE OF CONNECTICUT SUPERIOR COURT Court Use Only AE ößÛö Instructions Anyone who knows the military status of the defendant may complete the form below. You must swear that your statement is true and sign it in front of a court clerk, a notary public, or an attorney who will also sign and date the affidavit. Make one copy for yourself and give the original to the court clerk. Explanation: A military service affidavit is required in every case where the defendant has not filed an Appearance form with the court clerk's office by the time of the court hearing. The purpose is to protect men and women serving in the U.S. military from getting a court judgment against them without first receiving notice of the lawsuit and a chance to defend the case. The affidavit gives the court the necessary facts to find that the defendant is not in the U.S military. Judicial District of Plaintiff's name (Last, first, middle initial) At (Town) Return date (Month, day, year) Defendant's name (Last, first, middle initial) Docket number I certify that the following is true (check all that apply and complete): 1. The defendant is in the U.S. Military. 2. The defendant is not in the U.S. Military. I know this because: the defendant is working at the defendant currently lives at the defendant is other (state reasons) years old. 3. I do not know whether the defendant is in the U.S. military service. Signature Print name Date signed Signed and sworn to before me (Assistant Clerk/Notary Public/Commissioner of Superior Court) At (Town, State) ADA NOTICE 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. American LegalNet, Inc. www.FormsWorkFlow.com