SUMMONS ' C'V'L
`JD-CV-1 Rev.4-1E
`C.G.s. §§ 51-346, 51-347, 51-349, 51-350, 52-45a,
`52—43, 52-259, P.B. §§ 3—1 through 3.21, 8-1. 10.13
`See other side for instructions
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`STATE OF CONNECTlCUT
`;.
`‘.;
`SUPERIOR COURT 'W'
`‘ widget/W
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`El "X" if amount, legal interest or property in demand. not including interest and
`.costs is less than $2,500.
`El "X" if amount, legal interest or property in demand, not including interest and
`costs is 52.500 or more.
`
`D "X" if claiming other relief in addition to or in lieu of money or damages.
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`TO: Any proper officer; BY AUTHORITY OF THE STATE OF CONNECTICUT. you are hereby commanded to make due and legal service of
`this Summons and attached Complaint.
`1
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`Address of court clerk where writ and other papers shall be tiled (Number. street, town and zip code) Telephone number of clerk
`Return Date (Must be a Tuesday)
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`{0. G. S. §§ 51-346, 51-350)
`(with area code)
`155 Church Street, Putnam. CT 06260
`( 860 )928-7749
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`E JudicialDislrict
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`Minor: 40
`Majbr; C
`I Housing Session
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`For the Plaintifffs) please enter the appearance of:
`Name and address of attorney, law firm or plaintiff if self—represented (Number, street, town and zip code)
`Mark R. Brouillard, Esq., St. Onge 8. Brouillard, P.0. Box 550. Putnam, CT 06260
`Telephone number (with area code)
`Signature of Plaintiff (if self-represented)
`( 860 ) 928-0481
`The attorney or law firm appearing for the plaintiff. or the plaintiff if
`self-represented, agrees to accept papers (service) electronically in B] Yes El No
`this case under Section 10-13 of the Connecticut Practice Book,
`
`21,2019
`Ma l
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`‘Da—“Té'r
`on
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`Case type code (See iist on page 2}
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`Juris number (to be entered by attorney oniy)
`101898
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`Email address for delivery of papers under Section 10-13 {if agreed to)
`MRB@b5blaw'n8t
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`Number of Plaintiffs:
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`Name (Last. First, Middle Initial) and Address of Each party (Number; Street; Po. Box; Town; State; zip; Country, ifnot USA)
`Name:
`Jolly John's Truck & E uipment
`P-01
`Address: 380 North Main Street, oosup, Connecticut 06354
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`Number of Defendants:
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`|:| Form JD-CV—Z attached for additional parties
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`First
`Plaintiff
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`Additional
`Plaintiff
`First
`Defendant
`Additional
`Defendant
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`Additional
`Defendant
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`Additional
`Defendant
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`Name:
`Address:
`Name: Richard Changy
`Addressr 42 Oak Drive.
`ansfield Center, Connecticut 06250
`Name:
`Address;
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`‘
`.
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`Name:
`Address:
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`Name:
`Address:
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`Notice to Each Defendant
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`p.02
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`°'°1
`D-02
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`[3.03
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`p.04
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`1. YOU ARE BEING SUED. This paper is a Summons in a lawsuit. The complaint attached to these papers states the claims that each plaintiff is making
`against you in this lawsuit.
`.
`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 on or before the second day after the above Return Date. The Return Date is not a hearing date. You do not have to come to court on the
`Return Date unless you receive a separate notice telling you to come to court.
`3. if you or your attorney do not file a written "Appearance" form on time, a judgment may be entered against you by default. The "Appearance" form may be
`obtained at the Court address above or at www.jud.cf.gov under "Court Forms."
`4. If you believe that you have insurance that may cover the claim that is being made against you in this lawsuit, you should immediately contact your
`insurance representative. Other action you may have to take is described in the Connecticut Practice Book which may be found in a superior court law
`library or on-line at www.jud.ct.gov under "Court Rules."
`‘
`5. if you have questions about the Summons and Cor; aint, you should talk to an attorney quickly. The Clerk of Court is not allowed to give advice on
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`uu
`legal questions.
`1 I
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`l
`', was Somerpgsggfnn
`E
`A HI Agspistant Clerk
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`igned by 51 Clerk:
`if this Summons is
`a. The signing has been done so that the Plaintiff ) will not be denied access to the courts.
`b. It is the responsibility of the Plaintiff(s) to see t at service is made in the manner provided by law.
`c. The Clerk is not permitted to give any legal ad ice in connection with any lawsuit.
`d. The Clerk signing this Summons at the request of the Plaintiff(s) is not responsible in any way for any errors or omissions
`in the Summons, any allegations contained in the Complaint, or the service of the Summons or Complaint.
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`Signed (Si "I"
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`i
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`Name of Person Signing at Left
`Mark R. Broulllard
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`Date signed
`04i22t2019
`For Court Use Only
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`File Date
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` l certify I have read and
`Signed (Self-Represented Plaintitt)
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`understand the above:
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`{Page 1 of 2)
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`Instructions
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`1. Type or print iegibly,‘ sign summons.
`2. Prepare or photocopy a summons for each defendant.
`3. Attach the original summons to the original complaint, and attach a copy of the summons to each copy of the complaint. Also, if there are
`more than 2 plaintiffs or more than 4 defendants prepare form JD-CV-2 and attach it to the original and all copies of the complaint.
`4. After service has been made by a proper officer, tile original papers and officer’s return with the clerk of court.
`3
`5. Do not use this form for the following actions:
`
`(a) Family matters (for example divorce, child support,
`custody, paternity, and visitation matters)
`(b) Summary Process actions
`to) Applications for change of name
`(0') Probate appeals
`(e) Administrative appeals
`
`(0 Proceedings pertaining to arbitration
`(9) Any- actions or proceedings in which an attachment,
`gamishment or replevy is sought
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`(h) Entry and Detainer proceedings
`(i) Housing Code Enforcement actions
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`l
`ADA NOTICE
`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.
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`Codes
`nor
`I'I‘llnilljorl
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`Minor Description
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`Foreclosure
`Partition
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`Major Description
`Property
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`Quiet TitleiDischarge of Mortgage or Lien
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`Asset Forfeiture
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`All other
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`Torts (Other than
`Vehlcular)
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`Defective Premises - Private - Snow or Ice
`Detective Premises - Private - Other
`Detective Premises - Public - Snow or Ice
`Defective Premises - Public - Other
`Products Liability - Other than Vehicular
`Malpractice - Medical
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`Malpractice - Legal
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`Malpractice - All other
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`Assault and Battery
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`Defamation
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`Animals - Dog
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`Animals - Other
`False Arrest
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`Case Type Codes
`Codes
`MajorlMinor
`Major Description
` Contracts
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`Insurance Policy
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`Specific Performance
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`Collections
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`All other
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`Eminent Domain
`State Highway Condemnation
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`Redevelopment Condemnation
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`Other State or Municipal Agencies
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`Public Utilities a Gas Transmission Companies
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`All other
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`Miscellaneous
`Injunction
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`Receivership
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`Mandamus
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`Small Claims Transfer to Regular Docket
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`Foreign Protective Order
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`0
`All
`Ih
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`er
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`Housing
`Housing - Return of Security Deposit
`Housing - Renlandlor Damages
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`Housing -Audita Querelailnjunction
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`Housing - Administrative Appeal
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`Housing - Municipal Enforcement
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`Housing -All Other
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`Minor Description
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`Construction - All other
`Construction - State and Local
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`Habeas Corpus (extradition. release from Penal
`Institution}
`Arbitration
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`Declaratory Judgment
`Bar Discipline
`Department of Labor Unemployment Compensation
`Enforcement
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`Bar Discipline - Inactive Status
`Municipal Ordinance and Regulation Enforcement
`Foreign Civil Judgments - C.G.S. 52-604 & C.G.S.
`50a-30
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`Fire Damage
`All other
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`MotorVehicle' - Products Liability Including Warranty
`Motor Vehicle“ - All other
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`5°“
`Airplanes
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`Railroads
`Snowmobiles
`All other
`“Motor Vehicles include cars, trucks. motorcycles,
`and motor scooters.
`1
`Construction of \MIIS and Trusts
`All other
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`Vehicular Torts
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`Motor Vehicles‘ 7 Driver andlor Passenger(s) vs.
`Driver(s)
`1
`Motor Vehicles‘ -l Pedestrian vs. Driver
`Motor Vehicles‘l Property Damage only
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`Wills, Estates
`and Trusts
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`JD-CV-1 Rev. 4-16 (BacklPage 2)
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`(Page 2 of 2)
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