I am ("x" the box that applies)agreed to in the stipulation (please explain):1.I am more than 18 years old. 2.I object to a summary process execution being issued in this case for the following reason(s): ("x" all that apply)was made on or before Housing Session at: Judicial District of: DEFENDANT'S AFFIDAVIT AND OBJECTION TO EXECUTION JD-HM-26 Rev. 4-19 P.B. 247 17-53STATE OF CONNECTICUT SUPERIOR COURT www.jud.ct.govand was refused. Signed (Defendant/Defendant's attorney) Signed (Clerk/Assistant Clerk, Comm. of the Superior Court, Notary Public)was offered on3. I request a court hearing in this matter. Docket Number Address of court Name(s) of plaintiff(s) (landlord(s)) Name(s) of defendant(s) (tenant(s)) A. The use and occupancy arrearage payment of $ . B. The use and occupancy arrearage payment of $ C. The landlord has not done the things agreed to in the stipulation, or ordered to do by the court (please explain): D. ("x" the boxes that apply: "I" if you are the defendant or "The defendant" if you are the defendant's attorney.) E. Other (please explain): Subscribed and sworn to before me on (Date) the defendant or the defendant's attorney I I The defendant was prevented from doing what The defendant in this case and: 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. Mailing address (Number, street, town, state and zip code) Signed (Signature of filer/Connecticut Attorney) uCertification 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