SPLIT SENTENCE DOMESTIC VIOLENCE VICTIM NOTICE JD-AP-182 Rev. 5-19 C.G.S. 247247 53a-30, 54-108STATE OF CONNECTICUT JUDICIAL BRANCH COURT SUPPORT SERVICES DIVISION ADULT PROBATION SERVICES www.jud.ct.gov Name of probationer CMIS case number Docket number(s) Date Name and address of victimThe probationer in this case, in which you are a victim, has been sentenced to a term of incarceration followed by probation, which is scheduled to begin on . The court has imposed conditions of probation that include: No contact with you. No threats, violence, or harassment towards you. Other: If you are in need of support or assistance with safety planning because of this case or another incident of domestic violence, the Family Violence Victim Advocate may be able to assist you. The advocate may be reached at:If you cannot reach the Family Violence Victim Advocate, please call Connecticut's 24-hour, toll-free domestic violence hotline at 888-774-2900 (English) or 844-831-9200 (Spanish). All services are free and confidential. If you feel that the probationer has violated one of the conditions above or if you have any questions or concerns, please contact the probation officer named below. If you have any immediate concern about your safety, please contact your local police department. Telephone number of originating court Family Violence Victim Advocate Name of probation officer E-mail address Telephone number 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