VERIFIED LOCKOUT COMPLAINT AND APPLICATION FOR TEMPORARY INJUNCTION JD-HM-24 Rev. 4-19 C.G.S. 247 47a-43V.1. Since, the plaintiff(s) have been in actual possession of the premises located at 2. The defendant(s) or their agents have taken the following actions without the consent of the plaintiff(s) in violation of Section 47a-43(a) of the Connecticut General Statutes: ("X" applicable paragraphs), the defendant(s) entered the premises and locked the plaintiff(s) out by: personal property of the plaintiff(s) including, but not limited to, the following items:3. The defendant(s) or their agent's actions have caused irreparable loss or damage because the plaintiff(s) are being deprived of the premises and of their personal property.4. The plaintiff(s) are without any adequate remedy at law.The plaintiff(s) request that the court:1. If applicable, issue an ex parte (without hearing) temporary injunction preventing the defendant(s) and their agents from depriving the plaintiff(s) of the premises and the personal property described above, and, for good cause shown, waive the bond requirement for the temporary injunction (see Section 52-471 of the Connecticut General Statutes);2. Issue a permanent injunction preventing the defendant(s) and their agents from depriving the plaintiff(s) of access to the premises and to the personal property described above (see Section 52-471 of the Connecticut General Statutes);3. Award the plaintiff(s) a writ of restitution ordering that the plaintiff(s) be restored to the premises and/or to their personal property (see Section 47a-45a of the Connecticut General Statutes); and4. Order any other legal or equitable relief that the court deems proper.I swear that the above statements are true to the best of my knowledge. (Date possession began) (Address of land, tenement, or dwelling unit) Judicial District of Judicial District Housing Session at (a) On or about (date) Padlocking the door Other (specify below) Changing the locks (b) The defendant(s) prevented the plaintiff(s) from occupying the premises since (date) (c) The defendant(s) damaged the premises described above or removed, damaged or took possession and control of Describe other method of locking plaintiff(s) out if "other" box is checked above List items that were removed, damaged, or taken Signed (Plaintiff(s)) On (Date) Current address of plaintiff(s) Signed (Clerk, Notary Public, Commissioner of the Superior Court) Plaintiff(s) Defendant(s) Note: Use this form with form JD-HM-23 and, if applicable, form JD-HM-37. (Form JD-HM-37 is available only at Clerks' offices.) 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 Subscribed and sworn to before me American LegalNet, Inc. www.FormsWorkFlow.com