ADJUDICATORY/DISPOSITIONAL ORDERS JD-JM-65 Rev. 4-12 C.G.S. §§ 46b-120, 121, 129j, 17a-93(i) PA 11-240, Sec. 2 STATE OF CONNECTICUT SUPERIOR COURT JUVENILE MATTERS www.jud.ct.gov 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. Address of court Docket number Name of petitioner Name of child or youth Date of birth Name of father Address of father Name of mother Address of mother Name of guardian (if applicable) Address of guardian (if applicable) The court makes the following findings and enters the following orders in the best interest of the child or youth named above at a session of the Superior Court and in accordance with the statutes that apply to the case. Adjudication The court finds the child or youth: The court has found the child or youth: Neglected Neglected Uncared for Uncared for Abused Abused or on . Reasonable Efforts Finding (If necessary) Continuation in the home is contrary to the welfare of the child or youth and Voluntary placement Such out-of-home placement is in the best interests of the child or youth. Reasonable efforts to prevent removal finding: Reasonable efforts to prevent or eliminate the need for removal of the child or youth were made by the state. Reasonable efforts to prevent or eliminate the need for removal of the child or youth from the home were not possible. Reasonable efforts were not made. Disposition 1. 2. The court finds that the following disposition is in the best interest of the child or youth: or The court grants the motion to reopen and modify the prior disposition in this case, and finds the following modified disposition to be in the best interest of the child or youth: A. Commitment The child or youth is committed until further order of the court to the Commissioner of Children and Families who shall be the guardian of the child or youth according to the statutes in such cases. Commitment is effective . B. Protective Supervision Continuation in the home is not contrary to the best interest of the child or youth. The Commissioner of Children and Families shall provide Protective Supervision for the child or youth beginning until . Child's place of abode is with (name) who is a suitable and worthy person. Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com C. Custody/Guardianship The (name) custody guardianship of the child or youth is vested in who is or are found to be suitable and worthy caretaker(s). Subject to an order of Protective Supervision for the child or youth beginning until . D. Extension of protective supervision The Commissioner of Children and Families shall provide Protective Supervision for the child or youth for an additional period beginning until E. Termination of Protective Supervision The period of Protective Supervision previously ordered will end on . . Further Order Of The Court The above order incorporates the services and steps set out in the attached Specific Steps. The Commissioner of Children and Families shall file: A Status Report on or about . . . A Motion for Review of Permanency Plan on or before A hearing to review the permanency plan shall be held on A Motion for: Revocation/Transfer of Guardianship no later than (date): Modification of disposition no later than (date): A hearing to review the motion shall be held on (date): A Petition for Termination of Parental Rights no later than (date): An In-Court Judicial Review shall be held on (date): . . . . . Other orders: Name of Judge Signed (Judge) Date ordered The above is a true copy of the order and was mailed to the Commissioner of Children and Families. Signed (Judge, Clerk) At (Town) On (Date) JD-JM-65 Rev. 4-12 (Page 2) American LegalNet, Inc. www.FormsWorkFlow.com