COURT COUNTY OFCLAIM OF EXEMPTION SUMMARY PROCESS (EVICTION) JD-HM-3 Rev. 12-95 C.G.S. ยง 47a-26h P.A. 95-247, Sec. 3STATE OF CONNECTICUT SUPERIOR COURT OFFICE OF THE CLERK www.jud.state.ct.us. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Calendar No.NAME AND ADDRESS OF PLAINTIFF OR PLAINTIFF'S ATTORNEYJUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)INSTRUCTIONS TO OCCUPANT1. Complete Section 1 on typewriter. 2. File in triplicate with the clerk. 3. The clerk will schedule a hearing date and will return the pink copy to you for your records.NAME AND ADDRESS OF OCCUPANT OR OCCUPANT'S ATTORNEY. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Fold 1THE PEOPLE OF THE STATE OF NEW YORK TOSECTION I (To be completed by Occupant)DOCKET NO. NAME OF CASE (Summary Process Action)Fold 2ADDRESS OF COURTNAME OF OCCUPANT(S)GREETINGS:DATE OF JUDGMENT (If applicable)LOCATION OF PREMISESWE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,located at County ofI, the undersigned, duly depose and say that I am an occupant of the premises involved in the above-entitled matter, that I am over the age of eighteen and believe in the obligation of an oath, that I have not been named in this summary process action, and that I have a right to continue to occupy the premises based on the following: ("X" all that apply)o'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in rooma. that my occupancy commenced prior to the service of the notice to quit; b. that my occupancy commenced or continued with the consent of the plaintiff; c. that I have a right to occupy equal or superior to the rights of the plaintiff.Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply., one of the Justices of theI am therefore claiming an exemption from the summary process action indicated above.Court in Witness, Honorableday of, 20 County,SIGNED (Occupant)SIGNED (Asst. Clerk/Comm. of Superior Court) DATESubscribed and sworn to before me on:SECTION II (To be completed by court clerk)(Attorney must sign above and type name below)NOTICE OF COURT HEARING ON CLAIM OF EXEMPTIONThe above-named occupant(s) has/have filed a claim of exemption from the summary process action indicated above. This is to notify you that the Superior Court will hold a hearing on this claim. If you wish to be heard concerning this claim, you must personally appear in court on the date and time shown below. If the plaintiff (Landlord) does not appear, an order granting the claim and affecting this summary process action may be entered in the plaintiff's absence.Attorney(s) forOffice and P.O. AddressIf the occupant(s) does/do not appear, an order denying this claim may be entered in his/her absence. PLACE OF HEARING (If different from address of court shown above)Telephone No.: Facsimile No.: E-Mail Address:DATE OF HEARINGTIME OF HEARINGDATE NOTICE MAILEDMobile Tel. No.:DISTRIBUTION:COPY 2 -returned to OccupantCOPY 1 -mailed to PlaintiffORIGINAL -retained by CourtAmerican LegalNet, Inc. www.USCourtForms.com
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