PETITION FOR EXTENSION OF COMMITMENTSTATE OF CONNECTICUT SUPERIOR COURT JUVENILE MATTERSTO: THE SUPERIOR COURT FOR JUVENILE MATTERSADDRESS OF COURT JD-JM-15EL Rev. 4-97 C.G.S. 46b-120, 121, 129DOCKET NO.JUVENILE MATTERS DISTRICTNAME OF CHILD/YOUTHSEXAGEDATE AND PLACE OF BIRTHADDRESS OF CHILD/YOUTHRESIDES WITHNAME OF PETITIONERCHILD/YOUTH COMMITTED AS ACOMMITTED AT (Juvenile Matters District)DATE OF COMMITMENTPETITION FOR EXTENSION OF COMMITMENTYour Petitioner respectfully represents unto the court as follows: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. 2. 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. 1.3. Said commitment expires on (date):4. Continuing efforts to reunify the child/youth with family areappropriateinappropriate.5.That it is in the best interests of said child/youth to extend his/her commitment for a period offor the following reasons6. That the said child's/youth's parents or legal custodians are:NameResidence NAMES OF PARENTS OR LEGAL GUARDIANSRelationship7. WHEREFORE your Petitioner requests appropriate action by the Court in conformity with the statutes in suchcases made and provided.SIGNED (Petitioner)(PAGE 1 OF 2)2000 (C) American LegalNet, Inc.ORDER FOR HEARING AND SUMMONSUpon 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.DATETIME OF HEARING.M.NO., STREET AND TOWNHEARING DATE COURT LOCATIONCERTIFIED MAIL FOR: PUBLICATION FOR:SERVICE TO BE MADE ON OR BEFORE (Date)DATE SIGNED BY ORDER OF THE COURT (Signed -Judge/Clerk of Superior Court)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. RIGHT TO COUNSEL:RETURN OF SERVICE, Connecticutss. STATE OF CONNECTICUTCOUNTYOn (date)19 then and there I served the foregoing petition, order, and summons onthe person(s) named therein, by leaving with (cross out if abode) or at theirusual 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 CONNECTICUTss.COUNTY, ConnecticutOn (date)19 then and there I served the foregoing petition, order, and summons onthe person(s) named therein, by leaving with (cross out if abode) or at theirusual 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-15EL (Page 2) 4-97(PAGE 2 OF 2)2000 (C) American LegalNet, Inc.
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