CLAIM OF EXEMPTION - ORDER SUMMARY PROCESS (EVICTION) JD-HM-3 Rev. 3-19 C.G.S. 247 47a-26h Signed (Occupant)I am an occupant of the premises in the case named above. I am over the age of eighteen (18) and I believe in the obligation of an oath. I have not been named in this eviction (summary process) action. I have a right to continue to occupy the premises because: ("X" all that apply)Section I - Claim of Exemption (To be completed by occupant)Instructions to occupant 1. Complete Sections I and III of this form. 2. File the original and your Appearance (form JD-CL-12) with the clerk. 3. The clerk will schedule a hearing date.I claim an exemption from the eviction (summary process) action named above. Subscribed and sworn to before me on: Signed (Assistant Clerk/Commission of Superior Court)The occupant(s) named above has/have filed a claim of exemption from the eviction (summary process) action named above. This is to notify you that the court will hold a hearing on this claim within seven (7) days after it was filed with the court. You will receive a separate notice of the date and time of this hearing. If you wish to be heard about this claim, you or your attorney must come to court on the date and time scheduled by the court. If the plaintiff (landlord) does not come to court, an order granting the claim may be entered, and the plaintiff (landlord) may have to file additional papers with the court before a judgment of possession may enter. If the occupant(s) does/do not come to court, an order denying this claim may be entered.Section II - Notice to Parties Name of case (eviction (summary process) action) Docket number Address of court Name of occupant(s) Location of premises Date of judgment (if applicable) a. my occupancy began before the service of the notice to quit; b. my occupancy began or continued with the consent of the plaintiff (landlord); c. I have a right to occupy the premises that is equal to or greater than the rights of the plaintiff (landlord). Date 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. STATE OF CONNECTICUT SUPERIOR COURT www.jud.ct.gov Mailing address (Number, street, town, state and zip code) Signed (Signature of filer/Connecticut Attorney) uSection III - Certification Print or type name of person signing Telephone number Date signed(date) to all attorneys and self-represented parties of record and that written consent for electronic delivery was received from all attorneys and self-represented parties of record who received or will immediately be receiving electronic delivery.I certify that a copy of this document was or will immediately be mailed or delivered electronically or non-electronically on *If necessary, attach additional sheet or sheets with name and address which the copy was or will be mailed or delivered to. Name and address of each party and attorney that copy was or will be mailed or delivered to* American LegalNet, Inc. www.FormsWorkFlow.com