APPLICATION FOR TAKE INTO CUSTODY ORDER JD-JM-135 Rev. 7-18 C.G.S. 247247 46b-120, 46b-133, 46-140a; P.A. 18-31; P.B. 247 31a-13STATE OF CONNECTICUT SUPERIOR COURT JUVENILE MATTERS www.jud.ct.gov Address of court Docket number Name of child Date of birth Address of child Date of petition Name of parent/guardian Name, address and title of applicantAffidavit and Application for Take Into Custody OrderThe 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.I. 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: and has violated the conditions of the probation supervision or probation supervision with residential placement and failed to respond to the court process including graduated sanctions. 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 and failed to respond to the court process including graduated sanctions. The child was placed on probation supervision or probation supervision with residential placement on: and has absconded, escaped, or run away from a residential facility in which such child has been placed by the court.II. Delinquency - Failure to Appear 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 to come to court on for a ("X" one) court hearing other (specify) and said child did not come to court as ordered.III. The ground(s) for detention indicated below are applicable: (At least one box must be checked) A. There is probable cause to believe that the level of risk the child poses to public safety if released to the community prior to the court hearing or disposition cannot be managed in a less restrictive setting. B. There is a need to hold the child to ensure the child's appearance before the court or compliance with court process, as demonstrated by the child's previous failure to respond to the court process. C. There is a need to hold the child for another jurisdiction.Believing that there is no appropriate less restrictive alternative available and that the child should be immediately taken into custody and placed in detention, I make this affidavit voluntarily 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 self-represented parties of record. Signed (Juvenile Probation Officer/Prosecutorial Official) Print/type name of person signing Signed at (Town) On (Date) Subscribed and sworn to before me Signed (Judge, Clerk, Commissioner of Superior Court, Notary) At (Town) On (Date) American LegalNet, Inc. www.FormsWorkFlow.com