APPLICATION FOR TAKE INTO CUSTODY ORDER STATE OF CONNECTICUT SUPERIOR COURT JD-JM-135 Rev. 3-10 C.G.S. §§ 46b-120, 46b-133, 46-140a, P.B. § 31a-13 Spec. Sess. P.A. 09-7, §§ 69 & 72 JUVENILE MATTERS www.jud.ct.gov Address of Court Juvenile district number Docket number Name of child Date of birth Address of child Date of petition Name, address and title of applicant Affidavit And Application For Take Into Custody Order The person signing this application affirms and says the following about the above named child and requests that the court issue a Take Into Custody Order and the child be taken into custody and placed in a Juvenile Detention Center. A. Violation of Delinquency Court Order/Probation The child is the subject of a pending delinquency Petition/Information, is subject to a suspended Order of Detention and has violated the conditions of the order. The child was placed on probation on: of the probation. and has violated the conditions The child is the subject of a pending delinquency Petition/Information, is subject to a valid court order and has violated the conditions of the order. B. Delinquency - Failure to Appear ("X" one only) The child was served in hand with a Juvenile Summons and Complaint by a police officer. The child was served in hand with a Summons relative to a pending delinquency case. The child was ordered by the court on for a ("X" one) to come to court on court hearing pretrial conference evaluation appointment with (specify) other (specify) and said child did not come to court as ordered on: C. Graduated sanctions have/have not been attempted, and it would not be in the best interest of the child and the community to attempt further graduated sanctions. (Continued) American LegalNet, Inc. www.FormsWorkFlow.com D. The ground(s) for detention indicated below are applicable: A. There is a strong probability that the child will run away before the court hearing or disposition. B. There is a strong probability that the child will commit or attempt to commit other offenses injurious to him/her or the community before court disposition. C. There is probable cause to believe that the child's continued residence in the home pending disposition poses a risk to the child or the community because of the serious and dangerous nature of the acts set forth in the attached petition of delinquency. D. There is a need to hold the child for another jurisdiction. E. There is a need to hold the child to assure the child's appearance before the court, in view of a previous failure to respond to the court process. F. The child has violated one or more of the conditions of a suspended detention order. Believing that there is no less restrictive alternative available and that the child should be immediately taken into custody and placed in detention, I make this affidavit voluntarily, knowing that it may result in the arrest and detention of the child named above, and affirm that it is true to the best of my knowledge and belief. I certify that a copy of the foregoing has this day been hand delivered or sent by U.S. mail to all counsel and selfrepresented parties of record. Signed (Juvenile probation offficer/prosecutorial official) Subscribed and sworn to before me Print/type name of person signing Signed (Judge, Clerk, Commissioner of Superior Court, Notary) Signed at (Town) On (Date) At (Town) On (Date) JD-JM-135 (Back) Rev. 3-10 American LegalNet, Inc. www.FormsWorkFlow.com