NOTICE OF TEMPORARY CUSTODY/ORDER TO APPEAR JD-JM-58A Rev. 12-15 C.G.S. § 46B-129(B); PA 11-51, Sec. 19; P.B. §§ 32a-1(g); 33a-6(e) STATE OF CONNECTICUT SUPERIOR COURT JUVENILE MATTERS www.jud.ct.gov Telephone number Address of child/youth Date of birth Date of birth Date of birth Date of birth Address(es) of grandparent(s) or guardian(s) Fax number Docket number Date of birth Indian tribe/reservation Indian tribe/reservation Indian tribe/reservation Indian tribe/reservation Address of court Name of child/youth Name, address, and type (if applicable) (mother, father, guardian, putative father) Name, address, and type (if applicable) (mother, father, guardian, putative father) Name, address, and type (if applicable) (mother, father, guardian, putative father) Name, address, and type (if applicable) (mother, father, guardian, putative father) If parent(s) is/are minor(s), name(s) of grandparent(s) or guardian(s) Notice 1. The attached order is based on allegations that conditions in the home or elsewhere endanger the safety and welfare of the child or youth; at (date) (time) 3. If you do not come to the hearing, the court may take action against you; 2. A preliminary hearing will be held on .m.; 4. At the hearing you will have the opportunity to tell the court your position concerning the alleged facts; 5. You have the right to remain silent; any statement that you make may be introduced into evidence against you; 6. You have the right to be represented by an attorney. If you want an attorney but cannot pay for one, the court will make sure that an attorney is provided to you by the Chief Public Defender if you prove you cannot pay for one; 7. You may apply for an attorney by going in person to the court address listed above and completing the JD-JM-114 Application for Appointment of Counsel/Waiver of Fees form. If you are unable to go to court in person, mail or fax the completed application form to the court before the court date on the attached order form. It is recommended that you submit the application form as soon as possible so the attorney can prepare for the hearing. If you have any questions about the case or appointment of counsel you should go to the court, or contact the clerk's office or contact the Chief Public Defender as soon as possible. The court will promptly determine if you are eligible for state-paid representation. If the court determines that you are eligible for an attorney, the court will promptly notify the Chief Public Defender who will assign an attorney to represent you. 8. You may request that the Department of Children and Families investigate placing the child or youth with a person related to the child or youth by blood or marriage who might serve as a licensed foster parent or temporary custodian for the child or youth. 9. No parent who is the subject of a petition shall be compelled to testify if the testimony might tend to incriminate in any criminal proceeding or to establish the validity of the facts alleged in the petition. The Judicial Branch of the State of Connecticut complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation under the ADA, contact the court clerk at the number listed above or an ADA contact person listed at www.jud.ct.gov/ADA. American LegalNet, Inc. www.FormsWorkFlow.com