STATE OF CONNECTICUT SUPERIOR COURT www.jud.ct.govSTAY OF EXECUTION APPLICATION - SUMMARY PROCESS JD-HM-21 Rev. 2-19 C.G.S. 247247 47a-26i, 47a-30, 47a-35, 47a-36, 47a-37, 47a-38, 47a-39Name and mailing address of plaintiff or plaintiff's attorneyName and mailing address of defendant or defendant's attorney Instructions to tenant Fill-out this application and file all three (3) copies with the clerk of the court location where the judgment was entered. One (1) copy will be returned to you showing the date of hearing. To: The Superior Court 1.I request that my eviction be delayed (stay of execution of the judgment) because: A.I live in the premises. B.I have tried to find other premises for me and my family somewhere else in my city or town or in a city or town near my city or town in a neighborhood like my neighborhood and cannot find one. C.This application is made honestly and I will do whatever the court orders me to do. 2.The eviction was not granted because of nuisance committed or permitted by me or because of the use of or permitting the use of the premises for an immoral or illegal purpose or because I never had a right or privilege to live in the premises. 3.If the eviction was granted because of nonpayment of rent, then within 5 days of the date of judgment, I deposited with the clerk the full arrearage (amount of back rent and/or use and occupancy owed to the landlord) of $ required by section 47a-37 of the Connecticut General Statutes; OR Signed (defendant/applicant)Notice of Court Hearing - Stay of Execution ApplicationTo: The parties named above The tenant(s) named above has filed an application in this court requesting a stay of execution of the judgment entered on the Date of Judgment shown above, as stated in the application above. The Superior Court will hold a hearing on this application at the Place, Date and Time shown below. This is to notify you that if you want to talk to the court about this application, you or your attorney must come to the court on that date and at that time. If the landlord does not come to the hearing, the court may grant the application and delay the eviction. If the tenant(s) does not come to the hearing, the court may deny the application. Time of hearing.m. Signed (Assistant Clerk)Distribution: Original - Court Copy 1 - Plaintiff Copy 2 - Defendant/Applicant STAY OF EXECUTION Docket number Clerk's office address (number, street, town and zip code) Name and address of plaintiff (landlord) (If not indicated above) Name of defendant/applicant (tenant) (If not indicated above) and address (if not indicated above or if different from location of premises below) Location of premises Date of judgment No arrearage exists. (Applicant should bring proof of payment to the hearing.) Telephone number of defendant/applicant Date signed Place of hearing (If different from clerk's office address shown above) Date of hearing Date signed 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. Provide explanation of how much time is needed and why: American LegalNet, Inc. www.FormsWorkFlow.com