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Denied Appeal to Connecticut State Supreme Court

Denied Appeal to Connecticut State Supreme Court

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Published by: URBNAnthony.com on Jul 03, 2012
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JudicialDistrictofNewHavenSuperiorCourtOfficeoftheChiefClerk
235ChurchStreetJudicialBranchWebsite:
wwwjud.ct.gov
NewHaven,CT06510-0999Phone:(203)503-6800Fax:(203)503-6885
THEENCLOSEDPAPERSARERETURNEDFORTHEFOLLOWINGREASON(S):
o
'otsigned
(F.B.
Sec.
4-2
and
7-6)
o
Certificationrequired(p.B.Sec.10-14and
7-6)
DOrerrequi(F.B.Sec.11-1
and
7-6)
OF"
g
feeof
12~.OO
requiredCC.G.~.Sec.52-259c)
o
Docketnumber/casecaptionnot
provided(P.B.
Sec.
4-2
and
7-5)
o
"InlieuofAppearancenotcertifiedtoattorney/firmbeingreplaced
(p.B.
Sec.
3-8
and
7-6)
o
Appearancefor"thedefendant"doesnotspecifywhichdefendant
a
YouhavenotfiledanAppearanceinthiscase
o
Judgmententeredon:~~_
tJ
Casewithdrawnon:
o
Casedismissedon:
.o
Mailedtowrangcourt.Casependingat:~__";""""""_'--_~Incorr,eg.d6cketnumber.}.".~Other:
t-«
-e
lI\J
Q
l
Vt'_(,
g.P£)
L£
d
RetumedbY~.Date:'
~LChep~
PLEASE'NOTE:FAILURETOCOMPLYWITHP.B.SEC.4-2MAYRESULTINADELAYINRETURNINGPAPERS.
Rev.
7/09
 
APPLICA.TIONFORWAIVItROFFEESCIVIL,HOUSING,SMALLCLAIMS
JD-CV-120New11-10
C.G.S.
§§
52-259,52-259b,52-259c
P.B.
§
8-2
To:TheSuperiorCourt
Instructions
to
personasking
to
havethefeeswaived(applicant)
1.Printortypeallinformationrequested.2.SigntheFinancialAffidavitsectioninfrontof
a
courtclerk,
a
notarypublicoranattorney.3.Bringthisformtothesuperiorcourtwhereyourcasewillbefiledor
is
pending.4.
If
yourapplicationforfeespayabletothecourtorforcostsofserviceofprocessisdenied,youmayaskfor
a
hearingontheapplication.
STATEOFCONNECTICUT
SUPERIORCOURT
Instructions
to
Clerk
1.Bringcompletedformto
a
judge.2.Iftheapplicationisgranted,notifytheapplicant.
S
3.
If
theapplicationforfeespayabletothecourt
h\\
l-
orforcostsofserviceofprocessisdenied,
"'0
andupontherequestoftheapplicant,
0..
0
()C)
schedule
a
he(ticti
0
'Telephone
(Areacodefirst)
M
0/5'
-lll..'L
Typeofproceing
51
Civilcase
(Regulardocket)-
0
Smallclaimscase
o
MotiontoOpen,SetAside,ModifyorExtendCivilJudgment
FeeWaiver
IaskthatthecourtorderthatIdonothavetopayfeesorordertheStatetopaythefeesbelow.
(Checkallthatapply)
~ntryfee
0
Entryfee
r:-l
1tingfeer-:-v8erviceofProcess~Otherfee
A.,().t!UA..,4
I~<
(Regulardocket)(SmallClaims)
~1l1
L::::J
(deliveryofpapers)~(Specify):
___[._---'-n.LU-"'l/:..:....:._/'I=v_L~-=='/_
FinancialAffidavit
1_Dependents4.Assets
'1
Totalnumberofdependents
(notincludingyourself)
[2J,
2.MonthlyIncome
A.Grossmonthlyincome
(beforedeductlons},..__.._..._._..._....._.___..._
B.Netmonthlyincomeaftertaxesfrommonthlyemployment..._-'-__.._..C.Otherincome
(forexample,TANF,SocialSecurity,etc.)(Specifysourcei.s:.._.,
Source:
5fE
A
f
03;CH-W
TotalMonthlyIncome(B+C)
3.MonthlyExpenses
A.RentiMortgage_..._._.........__....._..__B.RealEstateTaxes._.___._C.Utilities
(Telephone,heat,electric,water,
gas,
etc.}:_.....
D.Food........_._..___.....___
E.Clothing__.__.______..._.._.___.___F.InsurancePremiums
(MedicaIIOental,Auto,Ufe,Home)...__.__
G.MedicaI/Dental.__._._...A.Real
Estate.,__
EstimatedValueLoanBalanceEquity
tJ/A
;VIA:
Rea:J~
,A-
I
J
MotorYehicle
.Aj~
i-
1/
OtherPwperty
;JIll'
try,
furniture,etc.)
Sf/7
f
l
tBalance
(Total
of
allaccounts).___
C~g
ntBalance
(Total
of
allaccounts)__
'/A
~~
Ci3~
.iJ~~~[~~\~fM-~Ji.:~~--
therAssets
.FILED
_
..
pecity):......
...........
_
......
_
.•........
_
.....
-
-
..........
_
....
__
..
_._
.•....
......
_
...
-
.........
C,OtherPersonalProperty
(forexample,jewe
D.SavingsAccounE.Checking~uF.cash_____...
L
G.OtherAssets(S
APR202012
let'i'}
oD
,.CH'EfCLE~K'Sl)'~SJ-
5.Liabilities/Debts
(forexample,creditcardbalances,loans,etc.Donotincludemortgageorloanbalancesthatarelistedunder"Assets".)
'3DD-
tfru'
r:P
MonthlyPaymentypeofDebtAmountOwed
I
.'4J-,.
TotalLiabilities
Page1of2
 
Icertifythattheinformationonpage1istrueandaccuratetothebestofmyknowledgeandthatIcan,ifasked,documentallincome,expenses,andliabilitieslistedonpage1.
Anyfalsestatementmadebyyouunderoathwhichyoudonotbelieve
to
be
Notice..
trueandwhichisintended
to
mislead
a
publicservantintheperformance
of
hisorherofficialfunctionmaybepunishable
by
a
fineand/orimprisonment.
Signed
Order
Havingreviewedtheapplication,thecourtfindsasfollows:
D
LThgapplicantisindigentandunableto.paythefollowingfeeswhicharewaived:
D
Entryfee
(Regulardocket)
D
Entryfee
(SmallClaims)
D
Filingfee
D
Otherfee
(Specify):
D
2.Theapplicantisindigentandunabletopaythecostofservice.Astatemarshal'sfeenottoexceed
$_
shallbepaidbythestate.
On
(Date)
.,2f.o
-I::;;
Datesigned
RequestForHearingOnDeniedApplication
Thissectionshouldbefilledoutonlyifthecourthaschecked#3or#4aboveanddeniedtheapplication.
D
Irequestacourthearingonmyapplication.
Signed
(Applicant)
Datesigned
HearingtobeheldattheCourtlocationshownonpage1onthedateandtimeshownbelow:
I
At
(Time)
I
Roomnumber
I
Signed
(Clerk)
earingon
(Date)
OrderAfterHearing
Havingreviewedtheapplication,thecourtfindsasfollows:
D
1.Theapplicantisindigentandunabletopaythefollowlnqft(Jtthi~arewaived:_
D
Entryfee
(Regulardocket)
D
Entryfee
(SmallClaims)
D
Filingfee
D
Otherfee
(Specify):.'
D
2.Theapplicantisindigentandunabletopaythecostofservice.Astatemarshal'sfeenottoexceed
$---'~__
shallbepaidbythestate.
D
3.Theapplicantisindigentbutabletopayfeesandcostsofserviceandtheapplicationisdenied.
D
4.Theapplicantisnotindigentandtheapplicationisdenied.
.!
By
theC?url
(Printortypename
of
Judge)
On
(Date)
Signed
(Judge,Clerk)
Datesigned
JD-CV-110New11-10
,
__
-
Page2of2

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