Administrative Appeal Under 4-183 Citation {JD-CV-138}

ADMINISTRATIVE APPEAL UNDER GENERAL STATUTES SECTION 4-183 -- CITATION (For use when service is made by a proper officer or indifferent person) JD-CV-138 Rev. 10-15 C.G.S. § 4-183; P.B. § 14-7A STATE OF CONNECTICUT SUPERIOR COURT www.jud.ct.gov Instructions to Person Appealing Decision : 1. Type or print legibly; sign the form. The Judicial District you name in the Citation must be the Judicial District of New Britain or Judicial District that the person who has filed the Appeal resides in. 2. Attach the original Appeal to the original Citation form. 3. If you are a self-represented plaintiff, bring the Citation and Appeal to a clerk of court for the Judicial District you name in the Citation. The clerk will review the Citation and, if it is complete, will sign it. 4. Give the Citation and Appeal to a proper officer or indifferent person to be served on each defendant. 5. After service has been made by a proper officer or indifferent person, file the Citation and Appeal and the Officer's Return with the clerk of court for the Judicial District you name in the Citation. 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 a court clerk or an ADA contact person listed at www.jud.ct.gov/ADA. ADA NOTICE To Any Proper Officer or Indifferent Person: By the authority of the State of Connecticut, you are commanded to serve, according to law, a copy of the Appeal and this Citation by personal service on the agency that made the decision that is being appealed at the address of the agency or, if allowed by law, at the Office of the Attorney General, 55 Elm Street, Hartford, Connecticut. Also serve, according to law, a copy of the Appeal and this Citation on each party named as a defendant in this appeal, at the address provided on this form. Name of case (Plaintiff v. Defendant) Judicial District Address of Court Case type code (See reverse for codes) Telephone number of Court (with area code) Major: Minor: Number of Plaintiffs: Parties First Plaintiff Additional Plaintiff First Defendant Additional Defendant Additional Defendant Additional Defendant Name: Address: Name: Address: Name: Address: Name: Address: Name: Address: Name: Address: Number of Defendants: Form JD-CV-2 attached for additional parties Name (Last, First, Middle Initial) and Address of Each party (Number; Street; P.O. Box; Town; State; Zip; Country, if not USA) P-01 P-02 D-01 D-02 D-03 D-04 Notice To Defendant 1. The Plaintiff will file the attached Appeal of a final administrative decision. The Appeal attached to these papers states the claims that each Plaintiff is making. 2. To be notified of further proceedings, you or your attorney must file a form called an "Appearance" with the clerk of the above-named Court at the above Court address within thirty (30) days of service of this Citation and Appeal. You do not have to come to court on that date unless you receive a separate notice telling you to come to court. 3. If you do not file an "Appearance" in a timely manner, the Court is authorized to enter a sanction against you. 4. The "Appearance" form may be obtained at the Court address above or at www.jud.ct.gov under "Court Forms." 5. If you have questions about the Citation and the Appeal, you should talk to an attorney quickly. The Clerk of Court is not allowed to give advice on legal questions. Signed (Sign and "x" proper box) * Commissioner of the Superior Court * Assistant Clerk Name of person signing at left Date For Court Use Only File Date If this Citation is signed by a clerk: a. The signing has been done so that the Plaintiff(s)will not be denied access to the courts. b. It is the responsibility of the Plaintiff(s) to see that service is made in the manner provided by law. c. The Clerk is not permitted to give any legal advice in connection with any lawsuit. d. The Clerk signing this Citation at the request of the Plaintiff(s) is not responsible in any way for any errors or omissions in anything contained in the Appeal, or the service of the Citation or Appeal. I certify I have read and understand the above: Signed (Self-Represented Plaintiff) Date Docket number American LegalNet, Inc. www.FormsWorkFlow.com STATE OF CONNECTICUT JUDICIAL BRANCH CASE TYPE CODES October, 2015 MAJOR DESCRIPTION Appeals from Administrative Boards Codes Major/ Minor MINOR DESCRIPTION Zoning Taxation Liquor Motor Vehicle Commissioner Unemployment Worker's Compensation Labor Relations Board Environmental Protection Commissioner - State Commission on Hospitals/Healthcare Employees Review Board Social Services Commission Freedom of Information Commission Inland Wetlands & Conservation Commission - Local Retirement Commission Housing and Building Code Enforcement Human Rights and Opportunities Commission Department of Children and Families All other A 00 A 10 A 20 A 30 A 40 A 50 A 60 A 61 A 62 A 63 A 64 A 65 A 66 A 67 A 68 A 69 A 70 A 90 American LegalNet, Inc. www.FormsWorkFlow.com