PETITION FOR EXTENSION OF COMMITMENT STATE OF CONNECTICUT SUPERIOR COURT JUVENILE MATTERS JD-JM-15 Rev. 4-97 C.G.S. 46b-120, 121, 129 TO: THE SUPERIOR COURT FOR JUVENILE MATTERS ADDRESS OF COURT JUVENILE MATTERS DISTRICT NAME OF CHILD/YOUTH SEX AGE DOCKET NO. DATE AND PLACE OF BIRTH ADDRESS OF CHILD/YOUTH RESIDES WITH NAME OF PETITIONER CHILD/YOUTH COMMITTED AS A COMMITTED AT (Juvenile Matters District) DATE OF COMMITMENT PETITION FOR EXTENSION OF COMMITMENT Your Petitioner respectfully represents unto the court as follows: 1. That the child/youth identified above is under the age of eighteen years and resides with the person(s) and at the address specified above. 2. Said child/youth was committed to the custody of the Commissioner of the Department of Children and Families as stated above by the Superior Court, Juvenile Matters for the District shown above on the date of commitment indicated. 3. Said commitment expires on (date): 4. Continuing efforts to reunify the child/youth with family are appropriate inappropriate. 5. That it is in the best interests of said child/youth to extend his/her commitment for a period of for the following reasons 6. That the said child's/youth's parents or legal custodians are: NAMES OF PARENTS OR LEGAL GUARDIANS Name Relationship Residence 7. WHEREFORE your Petitioner requests appropriate action by the Court in conformity with the statutes in such cases made and provided. SIGNED (Petitioner) (PAGE 1 OF 2) American LegalNet, Inc. www.FormsWorkflow.com ORDER FOR HEARING AND SUMMONS Upon the foregoing petition, it is hereby ORDERED, that said petition be heard and determined at the Court Location shown below on the Hearing Date and time indicated, AND FURTHER ORDERED, that the petitioner shall serve a copy of the foregoing petition by delivery or mail to each other party who has appeared and that the non-appearing respondent(s) named in this petition be and hereby are summoned to appear before the court on the Hearing Date and at the Court Location shown below by having a proper officer leave a true and attested copy of this order and summons with said respondent(s) or at the usual place of abode, or, if so ordered, by publication or mail on or before the date for service shown below and return same to the court. DATE TIME OF HEARING HEARING DATE COURT LOCATION .M. NO., STREET AND TOWN PUBLICATION FOR: CERTIFIED MAIL FOR: SERVICE TO BE MADE ON OR BEFORE (Date) BY ORDER OF THE COURT (Signed - Judge/Clerk of Superior Court) RIGHT TO COUNSEL: DATE SIGNED If you wish an attorney but are unable to pay for one, upon proof of your inability to pay, the court will provide one for you. Any such request should be made immediately at the court office where your hearing is to be held. RETURN OF SERVICE STATE OF CONNECTICUT __________________________, Connecticut ss. ________________COUNTY On (date)____________________________19_____ then and there I served the foregoing petition, order, and summons on _______________________________________the person(s) named therein, by leaving with (cross out if abode) or at their usual place of abode of (cross out if in hand) the within named, a true and attested copy of the original petition, order, and summons. Attest:___________________________________ (Proper Officer) STATE OF CONNECTICUT ss. ________________COUNTY __________________________, Connecticut On (date)____________________________19_____ then and there I served the foregoing petition, order, and summons on _______________________________________the person(s) named therein, by leaving with (cross out if abode) or at their usual place of abode of (cross out if in hand) the within named, a true and attested copy of the original petition, order, and summons. Attest:___________________________________ (Proper Officer) JD-JM-15 (Page 2) 4-97 (PAGE 2 OF 2) American LegalNet, Inc. www.FormsWorkflow.com