SUMMARY PROCESS EXECUTION
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`FOR POSSESSION (EVICTION)
`JD-HM-Z Rev. 6-10
`C.G.S. §§ 473-26h, 473-42, P.A. 10-171, Sec. 1
`Court
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`STATE OF CONNECTICUT
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`SUPERIOR COURT
`WWWJUd. ct-gov
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`Docket number
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`[VI-Hi a/ 175003;” ~§
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`fiHousing Session
`El Judicial District
`Address of court location (Number street town and zip code)
`Date of judgm nt
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`121 Elm Jt— New Haven or
`(179510
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`E] Geographical Area Number
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`Instructions To Plaintiff Or Attorney
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`I.
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`Name and Mailing Address of Plaintiff or Attorney
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`[44% 6
`[fibmdenl 4&7
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`35’
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`Name(s) of Plaintiff(s) (Landlord)
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`‘1)er I §m rI’L'
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`1. Complete this form.
`2. Give both copies ofthis form to the clerkforthe
`3. The clerk willgive the originalform backtoyou.
`clerk to sign.
`4. Keep a copy of the form for your records and give
`the original to a State Marshal for serwce on the
`defendant(s) (tenants and/or occupant(s)).
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`Name(s) of Defendant(s) (Tenant(s) and/or Occupant(s))
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`Meir/".3 W/IIIMMJ
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` Address of premises (Number, street, town and apartment number)
`LI s (a Iumbnfm awe/Ia.
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`TO: Any Proper State Marshal
`By the authority of the State of Connecticut, you are commanded to give the Plaintiff(s) possession of the premises above, by putting the Defendant(s) and
`any other Occupant(s) bound by the judgment out of possession; if the Defendant(s) and such other Occupant(s) have not removed all their possessions and
`personal effects then you may remove them and deliver them to the place of storage designated by the chief executive officer of the town; prior to removal
`you must give the chief executive officer of the town 24 hours notice of the eviction, stating the date, time and address of the eviction as well as a general
`description, if known, of the types and amount of property to be removed from the premises and delivered to the designated place of storage. Prior to giving
`notice to the chief executive officer you must use reasonable efforts to locate and notify the Defendant(s) and any other Occupant(s) bound by the judgment
`of the date and time the eviction'Is to take place and the possibility ofa sale of their possessions pursuant to General Statutes § 47a-42.
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`Make service of a true copy upon each defendant and occupant bound
`Signed (Clerk).
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`by the judgment and due return within 60 days of the date hereof.
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`Notice To Defendant(s) (Tenant(s) and/or Occupant(s))
`(To be completed by State Marshal)
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`Your landlord (the plaintiff) has won a judgment against you in this eviction
`case giving the landlord possession of the premises. This means that you
`I will return to move
`_.M.
`must move out of the premises at the address above by this date. —’
`If you think you have a right to stay in the premises, you should
`your possessions and personal effects out of the premises and store them.
`contact an attorney immediately.
`Your possessions and personal effects will be stored at:
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`If you do ”Ot move your possessions and personal effects on or before
`Date
`At (T'me)
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`If you do not move out by that date, this paper, which does not have to be
`handed to you personally, gives a State Marshal the legal right to move your
`possessions and personal effects out of the premises and deliver them to
`the place of storage designated by the chief executive officer of the town.
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`You may call.
`to reclaim any of those possessions and personal effects and to arrange to
`have them given back to you. (If your possessions and personal effects are
`removed and stored and you do not rec/aim them and pay the expense of
`storage within 15 days, then they may be sold by the town under General
`Statutes
`47a—42.
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`Return of Service
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`By virtue of the
`foregoing execution,
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`On
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`At (Time)
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`_,M_
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`saId premIses.
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`At (Time)
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`[:l l notified the Defendant(s) and Occupant(s).
`[:I I used reasonable efforts to locate the Defendant(s) and
`Occupant(s) but was unable to notify the following:
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`And afterwards,
`the Defendant's(s') and Occupant's(s') posseSSIons,
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`[:1 had been removed.
`I: were removed by me and stored and I put the Plaintiff(s) in possession
`0f said premises.
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`Signed (State Marshal)
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`Date signed
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`Fees
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`Thereafter l notified the chief executive officer of the town where the premises
`are situated,
`At T
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`Ime)
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`O
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`.M.
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`that the eviction of the Defendants(s ) and Occupant's(s') possessions and
`personal effects would take place,
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`At (Time)
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`.M.
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`and I further advised said chief executive officer, so far as known of the
`general description, types and amount of the property to be removed from
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`g.“il
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