PETITION: YOUTH IN CRISIS STATE OF CONNECTICUT JD-JM-144 Rev. 7-11 C.G.S. §§ 46b-120, 46b-121, 46b-128, 46b-150f, PA 11-51, Sec. 19 SUPERIOR COURT JUVENILE MATTERS www.jud.ct.gov Address of Court Court phone number Name of youth Docket number Sex Date of birth Address of youth Name of petitioner Address of petitioner Indian reservation, if any Relationship to youth Probation officer Parent Other (Specify): Name of mother Address of mother Name of father Address of father Name of guardian, if any Address of guardian Indian tribe/reservation, if any The Petitioner represents that the youth named above is a youth in crisis, because the youth is seventeen years of age and within the last two years: has without just cause run away from parental home or other properly authorized and lawful place of abode on or at . about (date(s)) was beyond the control of parents, guardian, or other custodian on or about (date(s)) at . has four unexcused absences from school in any one month or ten unexcused absences in any school year . on or about (date(s)) Petitioner prays that process issue to bring the youth and parent/guardian before the Court. Dated Petitioner Signed (Judge, Assistant Clerk, Notary, Commissioner Superior Court) 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 youth and parent/guardian 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 or abode, or, if so ordered, by mail on or before the date for service shown below and return same to the court: Hearing date T Court location T Date Time of hearing .M. Number, street and town Services by (Date) Telephone 1st class/restricted mail, return receipt: By order of the Court (Signed - Judge/Clerk) Date signed Notice To Parents And guardians An appearance in court as a result of first class mail notice may subject the appearing party to court jurisdiction. Since the youth is a minor, he or she must be accompanied by a parent or adult guardian. Failure to appear and obey court orders may result in your being held in contempt and you may be Fined or Jailed or both. See Sections 46b-121 and 51-33 of the Connecticut General Statutes. Right To Counsel: The child is entitled to an attorney. If the parent or guardian cannot afford to hire an attorney for the child and the family meets eligibility guidelines, the child will be provided with a state paid attorney by the Office of the Chief Public Defender. A request for an attorney should be made immediately at the court office where your hearing is to be held. The Judicial Branch of the State of Connecticut complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation in accordance with 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) (Continued...) American LegalNet, Inc. www.FormsWorkFlow.com Docket number Return of Service 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. Copy Endorsement Service Travel Attest (Signature and title of proper officer) 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. Copy Endorsement Service Travel Attest (Signature and title of proper officer) 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. Fees Copy Endorsement Service Travel Attest (Signature and title of proper officer) Total JD-JM-144 Rev. 7-11 (Back) (Page 2 of 2) American LegalNet, Inc. www.FormsWorkFlow.com