ORDER/SUMMONS STATE OF CONNECTICUT SUPERIOR COURT JUVENILE MATTERS JD-JM-70 Rev. 7-12 C.G.S. §§ 46b-120; 46b-128(b); 46b-129(a); 46b-149(d) Pr. Bk. Sec. 29-2, 32a-1(g) www.jud.ct.gov Court location Telephone number Name of child Docket number Address of child A petition has been filed alleging delinquency family with service needs neglect uncared for Date of birth abused termination of parental rights other By authority of the State of Connecticut, the following persons are summoned to appear before the court on the Hearing Date and at the Court Location shown below by having the Marshal of the appropriate County, a Probation Officer, Court Officer for Juvenile Matters, or any officer authorized by law to serve process leave a true and attested copy of the Order, Summons and Petition (if applicable) on or before (date) with or at their usual place of abode of: Name Address Name Address Name Address Name Address Name Address Date Time of Hearing .m. Hearing Date T Number, street Telephone Court Location T Town, state and zip code If the petition claims delinquency or family with service needs, the child must be accompanied by at least one parent. By order of the court (Signed - Judge/Clerk) Date signed Right to Counsel: You have the right to be represented by an attorney and if you want an attorney but cannot pay for one, and if you give proof that you cannot pay, the court will make sure that an attorney is provided for you by the Chief Public Defender. Your request should be made immediately at the court office where your hearing is to be held. Right to Remain Silent: You have the right to refuse to make any statements; any statements that you make may be introduced in evidence and used against you. ADA Notice 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. Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Return of Service STATE OF CONNECTICUT County of Docket number Name of person(s) served Date of service SS. Fees Then and there, I duly served the foregoing petition, order and summons on the above-named respondent(s), by either (check one): leaving with (for in hand); or leaving at the usual place of abode (for abode) at__________________________________________ The within and foregoing is a true and attested copy of the original petition, order, and summons. Attest (Signature and title of proper officer) Copy Endorsement Service Travel Total STATE OF CONNECTICUT County of Name of person(s) served Date of service SS. Fees Then and there, I duly served the foregoing petition, order and summons on the above-named respondent(s), by either (check one): leaving with (for in hand); or leaving at the usual place of abode (for abode) at__________________________________________ The within and foregoing is a true and attested copy of the original petition, order, and summons. Attest (Signature and title of proper officer) Copy Endorsement Service Travel Total STATE OF CONNECTICUT County of Name of person(s) served Date of service SS. Fees Copy Then and there, I duly served the foregoing petition, order and summons on the above-named respondent(s), by either (check one): leaving with (for in hand); or leaving at the usual place of abode (for abode) at__________________________________________ Endorsement Service Travel The within and foregoing is a true and attested copy of the original petition, order, and summons. Attest (Signature and title of proper officer) Total For Mail Service STATE OF CONNECTICUT County of United States Port Office at (Town) Date of service SS. Then and there, by virtue hereof, I made service of the within petition, order and summons by depositing a true and attested copy by United States Post mail, postage prepaid, addressed to ______________________________________________________________, by (check one): restricted delivery, return receipt requested; or first class mail; or certified mail, return receipt requested. The within and foregoing is the original petition, order and summons with my doings thereon endorsed. Attest (Signature and title of proper officer) JD-JM-70 Rev. 7-12 Fees Copy Endorsement Service Travel Total Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com