APPLICATION AND WRIT HABEAS CORPUS JD-JM-34 Rev. 3-16 P.B. § 35a-22 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 JUVENILE MATTERS TO: The Superior Court For Juvenile Matters Address of court Court appearance date and time Name of prisoner Inmate number Place of confinement Name of case Docket number Reason for court appearance Plea Hearing Pre-trial Trial Other (Specify) The undersigned deposes and says: On information and belief that the prisoner is presently confined in the place of confinement named above and the prisoner's testimony or response is needed in the case named above; On information and belief that the prisoner is presently confined in the federal place of confinement named above and the prisoner's testimony or response is needed in the case. All costs incident to the production of the prisoner before the court have been granted by the Department of Justice, Bureau of Prisons, of the United States of America. (Letters of authority must accompany application.) For the reason checked above, I request that a Writ of Habeas Corpus be issued, ordering the person responsible for the place of confinement in which the prisoner is confined to produce the body of the prisoner before the court to be held at the above address on the Court Appearance Date and Time noted above. Signed Title Fax Telephone Subscribed and sworn to before me on: Date Signed (Judge, Commissioner of the Superior Court, Notary Public) Order and Writ Upon the within application and affidavit, let the Writ of Habeas Corpus be issued. By Order of the Court Date of Order Signed (Assistant Clerk) To: The person by whom the prisoner is confined, and, if the prisoner is confined in a federal penitentiary, to the United States Marshall for the District of Connecticut. ("x" one) Transport By authority of the State of Connecticut, you are hereby commanded to bring the body of this person under safe and secure conduct, before this court, to be held at the above address on the Court Appearance Date and Time noted above, and immediately after this person has given testimony and evidence therein, or the proceeding in said case shall be otherwise terminated, to return this person under safe and secure conduct with this writ. Video -- Do Not Transport By authority of the State of Connecticut, you are hereby commanded to bring the body of this person under safe and secure conduct, before this court by interactive audiovisual device (as permitted by Practice Book Section 35a-22), to be held at the above address on the Court Appearance Date and Time noted above, and immediately after this person has given testimony and evidence therein, or the proceeding in said case shall be otherwise terminated, to return this person under safe and secure conduct with this writ. Dated at (Town) On (Date) Signed (Assistant Clerk) Distribution: ORIGINAL - Court COPY 1 - Return With Prisoner COPY 2 - Jail or Prison COPY 3 - Preparer American LegalNet, Inc. www.FormsWorkFlow.com