APPLICATION AND WRIT HABEAS CORPUS AD TESTIFICANDUM JD-FM-201 Rev. 4-09 C.G.S. � 46b-231(m)(13) Pr. Bk. �� 23-68, 25-39 STATE OF CONNECTICUT SUPERIOR COURT www.jud.ct.gov Instructions to Preparer 1. Prepare original and 3 copies. 2. File original and two copies with the court, retain last copy for your records. 3. If hearing is to be conducted by interactive audiovisual device, check box below. DO NOT TRANSPORT TO COURT -- VIDEO HEARING TO: The Superior Court The Family Support Magistrate Division Court Appearance Date and Time .M. Application Date Docket Number Inmate Number Date of Birth Address of Court Name of Case Name of Incarcerated Person Place of Confinement Reason for Court Appearance Hearing on Modification of Support Order Hearing on Paternity Order or Order Establishment Other (Specify) Application The undersigned hereby deposes and says, based on information and belief, that the above named incarcerated person is presently confined in the above named place of confinement and that this person's testimony is needed in the above referenced case. Wherefore, the undersigned requests that a Writ of Habeas Corpus be issued, ordering the person confining this prisoner to produce the body of this prisoner before this court to be held at the above address on the Court Appearance Date and Time noted above. Signed (Commissioner of Superior Court, Support Enforcement Officer) Subscribed and Sworn To Before Me On (Date) Fax Number Signed (Judge, FSM, Clerk, Comm. Sup. Ct., SEO, Notary Public) Order and Writ Upon the above application and affidavit, let the Writ of Habeas Corpus be issued. TO: The person by whom said incarcerated person is confined. ("X" one) Transport By authority of the State of Connecticut, you are hereby commanded to bring the body of this person under safe and secure conduct, before this court, to be held at the above address on the Court Appearance Date and Time noted above, and immediately after this person has given testimony and evidence therein, or the proceeding in said case shall be otherwise terminated, to return this person under safe and secure conduct with this writ. Video -- Do Not Transport By authority of the State of Connecticut, you are hereby commanded to bring the body of this person under safe and secure conduct, before this court by interactive audiovisual device (as permitted by Practice Book �� 23-68 and 25-39), to be held at the above address on the Court Appearance Date and Time noted above, and immediately after this person has given testimony and evidence therein, or the proceeding in said case shall be otherwise terminated, to return this person under safe and secure conduct with this writ. By Order of the Court (Name of Judge, FSM) Date of Order Signed (Judge, FSM, Clerk) Distribution: Original - Court Copy 1 - Return with Incarcerated Person Copy 2 - Jail or Prison Copy 3 - Preparer American LegalNet, Inc. www.FormsWorkFlow.com