Reviewed (Judge) Jurat Signed (Judge/Clerk, Commissioner of Superior Court, Notary Public) Date and signature Signed (Affiant) (This is page 1 of a 4 page Affidavit.) Reviewed (Prosecutorial Official) Date Date Subscribed and sworn to before me on (Date) DateJUVENILE ARREST WARRANT APPLICATION JD-JM-176 Rev. 7-18 C.G.S. 247247 46b-120, 128, 133, 142; P.A. 18-31Instructions: The jurat is to be completed for each page of the affidavit. The Prosecutorial Official and Judge are to date and sign or initial each page to indicate that they have reviewed it. STATE OF CONNECTICUT SUPERIOR COURT Name and residence (Town) of child Juvenile court to be held at (Town)Application for Arrest WarrantTo: A Judge of the Superior Court The undersigned hereby applies for a warrant for the arrest of the above-named child on the basis of the facts set forth in the: Affidavit below. Affidavit(s) attached. Date and Signature Date Signed (Prosecutorial Official) Type or print name of Prosecutorial OfficialAffidavit The undersigned affiant, being duly sworn, deposes and says: American LegalNet, Inc. www.FormsWorkFlow.com ARREST WARRANT AFFIDAVIT CONTINUATION PAGE JD-JM-176 Rev. 7-18 C.G.S. 247247 46b-120, 128, 133, 142; P.A. 18-31STATE OF CONNECTICUT SUPERIOR COURT Affidavit - Continued Reviewed (Prosecutorial Official) Date Reviewed (Judge) Date Signed (Judge/Clerk, Commissioner of Superior Court, Notary Public) Signed (Affiant) Date and signature Jurat (This is page 2 of a 4 page Affidavit.)Instructions: The jurat is to be completed for each page of the affidavit. The Prosecutorial Official and Judge are to date and sign or initial each page to indicate that they have reviewed it. Name and residence (Town) of child Court to be held at (Town) Date Subscribed and sworn to before me on (Date) American LegalNet, Inc. www.FormsWorkFlow.com Signed (Prosecutorial Official)(This is page 3 of a 4 page Affidavit.) Date See other sheet(s) for additional countsJUVENILE PETITION/INFORMATION ARREST WARRANT JD-JM-176 Rev. 7-18 C.G.S. 247247 46b-120, 128, 133, 142, P.A. 18-31Instructions: To be completed by the Prosecutorial Official after review of the Juvenile Arrest Warrant Application.STATE OF CONNECTICUT SUPERIOR COURT JUVENILE MATTERS www.jud.ct.gov Court location Name of child Address of child Sex Date of birth Name of mother Address of mother Name of father Address of father Name of guardian, if any Address of guardian The Prosecutorial Official of the Superior Court of the State of Connecticut charges that said child: Count 1 - Did commit delinquent act: At (Town) On or about (Date) In violation of C.G.S. Count 2 - Did commit delinquent act: At (Town) On or about (Date) In violation of C.G.S. Count 3 - Did commit delinquent act: At (Town) On or about (Date) In violation of C.G.S. Count 4 - Did commit delinquent act: At (Town) On or about (Date) In violation of C.G.S. Count 5 - Did commit delinquent act: At (Town) On or about (Date) In violation of C.G.S. Count 6 - Did commit delinquent act: At (Town) On or about (Date) In violation of C.G.S. Count 7 - Did commit delinquent act: At (Town) On or about (Date) In violation of C.G.S. Count 8 - Did commit delinquent act: At (Town) On or about (Date) In violation of C.G.S. Count 9 - Did commit delinquent act: At (Town) On or about (Date) In violation of C.G.S. Count 10 - Did commit delinquent act: At (Town) On or about (Date) In violation of C.G.S. Count 11 - Did commit delinquent act: At (Town) On or about (Date) In violation of C.G.S. Count 12 - Did commit delinquent act: At (Town) On or about (Date) In violation of C.G.S. Count 13 - Did commit delinquent act: At (Town) On or about (Date) In violation of C.G.S. Count 14 - Did commit delinquent act: At (Town) On or about (Date) In violation of C.G.S. Count 15 - Did commit delinquent act: At (Town) On or about (Date) In violation of C.G.S. Count 16 - Did commit delinquent act: At (Town) On or about (Date) In violation of C.G.S. American LegalNet, Inc. www.FormsWorkFlow.com (This is page 4 of a 4 page Affidavit.) . If the child is unable to post bail in the amount specified, the child may be delivered to the custody of the Superintendent of the Juvenile Detention Center at until the specified bail is posted, or until further order of the court. Address of child Name of childJUVENILE ARREST WARRANT JD-JM-176 Rev. 7-18 C.G.S. 247247 46b-120, 128, 133, 142, P.A. 18-31To: Any Proper Officer of the State of ConnecticutBy Authority of the State of Connecticut, you are hereby commanded to arrest the body of the within-named child: ("X" A, B, or C below)The child and the parent or guardian of the child or some other suitable person or agency is to be issued a Juvenile Summons form JD-JM-95 to appear in the Superior Court for juvenile matters at no less than five (5) days and no more than ten (10) days after the date of service of this warrant upon the child. B. C.Bail set at $On the basis of the facts alleged in the affidavit(s) in support of this warrant, the Court finds probable cause to believe that one or more of the circumstances indicated below is/are applicable and that detention is the appropriate least restrictive alternative available: And therefore you are hereby commanded to: To take the above named child into custody and deliver him or her to the custody of the Superintendent of the Juvenile Detention Center at to be held until review. Date (Month, day, year) Date, Time and Signature Signed (Judge of the Superior Court)Return on Arrest Warrant State of ConnecticutThen and there, by virtue of the within and foregoing petition/information/warrant, I arrested the body of the child and have executed the issuance of said warrant on the child pursuant to the order of the Court. Attest (Officer's signature and department) A. Name of mother Court location Sex Date of birth Address of mother Name of father Address of father Name of guardian, if any Address of guardianFindingThe foregoing Application for an arrest warrant, and affidavit(s) attached to the Application, having been submitted to and considered by the undersigned, the undersigned finds from said affidavit(s) that there is probable cause to believe that a delinquent act has been committed and that the child committed it and, therefore, that probable cause exists for the issuance of a warrant for the arrest of the above-named child.Instructions to officer: 1.To be presented to a Judge of the Superior Court with the Juvenile ArrestWarrant Application and Juvenile Arrest Warrant Petition/Information. 2.If admission to a juvenile detention center is not warranted or approved, butthe child is in need of immediate care, call the DCF Careline at 860-550-6550. Date Town of At (Time, A.M. or P.M.)1.There is probable cause to believe that the level of risk that the child poses to public safety if released to the communityprior to the court hearing or disposition cannot be managed in a less restrictive setting.2.There is a need to hold the child to ensure the child's appearance before the court or compliance with court process, asdemonstrated by the child's previous failure to respond to the court process.3.There is a need to hold the child for another jurisdiction. Said child is ordered not to be released by the Juvenile Detention Superintendent or designee. American LegalNet, Inc. www.FormsWorkFlow.com