Form JD-JM-114A "Request for Hearing, Denied Application for Counsel or Waiver of Fees - Juvenile" - Connecticut

What Is Form JD-JM-114A?

This is a legal form that was released by the Connecticut Superior Court - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2020;
  • The latest edition provided by the Connecticut Superior Court;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form JD-JM-114A by clicking the link below or browse more documents and templates provided by the Connecticut Superior Court.

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Download Form JD-JM-114A "Request for Hearing, Denied Application for Counsel or Waiver of Fees - Juvenile" - Connecticut

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STATE OF CONNECTICUT
REQUEST FOR HEARING, DENIED APPLICATION
SUPERIOR COURT
FOR COUNSEL OR WAIVER OF FEES - JUVENILE
JUVENILE MATTERS
JD-JM-114A Rev. 9-20
C.G.S. §§ 46b-135, 136, 53a-157b, § 52-259b,
www.jud.ct.gov
P.A. 11-51 § 19; P.B. §§ 8-2, 30a-1, 32a-1
Instructions To Person Applying for Counsel or Waiver of Fees
1. If your application for counsel or waiver of fees is denied you may request a hearing on your application using this form.
2. Print or type all information requested.
3. Sign the Request for Hearing section.
For information on ADA
4. Submit this form in person, by mail or fax to the superior court where your case will be filed or is pending.
accommodations,
Instructions To Clerk
contact a court clerk or go to:
1. Upon receipt of this form, schedule a hearing on the application and notify the applicant.
www.jud.ct.gov/ADA.
2. After the hearing, give a copy of this form containing the Court Order to the applicant.
3. If the application is granted, notify the applicant and counsel, if appointed.
To: The Superior Court
Name of applicant (Last, first, middle initial)
Date of birth
Address of applicant (Number, street, town, state and zip)
Name of employer
Address of employer (Number, street, town, state and zip)
Telephone (Area code first)
Telephone (Area code first)
Relationship to child
Mother
Father
Legal guardian
Other:
Name of child
Date of birth
Name of child
Date of birth
Name of child
Date of birth
Docket number (If applicable)
Address of Court
Type of proceeding
Delinquency
Probate appeal
Other (Specify):
Emancipation
Probate transfer
Neglect, uncared-for, abused petition
Transfer/Reinstatement of guardianship
Termination of parental rights petition
Appeal from Juvenile Court Decision
Request for Hearing on Denied Application
I request a court hearing on the Application for Appointment of Counsel/Waiver of Fees denied on
.
Date
Date signed
Signed (Applicant)
HEARING TO BE HELD AT THE COURT LOCATION SHOWN ON THE DATE AND TIME SHOWN BELOW:
Hearing on (Date)
At (Time)
Signed (Assistant Clerk)
Order After Hearing
The Court, having found the applicant (Select all that apply)
Indigent and unable to pay
Not indigent and able to pay
hereby orders the application:
Granted as follows:
1. Counsel is
Appointed
Appointed in the interests of justice pursuant to Connecticut General Statutes Section 46b-136.
The applicant is ordered to reimburse the Public Defender Services Commission at its approved rate for
the costs of providing an attorney and said costs shall be payable upon receipt of an invoice from the
Public Defender Services Commission.
2. The following fees are waived
Entry fee
Filing fee
Other (Specify:)
3. The following fees are ordered paid by the State
Marshal's fee not to exceed $
Other (Specify:)
Denied.
Date signed
By the Court (Print or type name of Judge)
On (Date)
Signed (Judge, Assistant Clerk)
Print Form
Reset Form
STATE OF CONNECTICUT
REQUEST FOR HEARING, DENIED APPLICATION
SUPERIOR COURT
FOR COUNSEL OR WAIVER OF FEES - JUVENILE
JUVENILE MATTERS
JD-JM-114A Rev. 9-20
C.G.S. §§ 46b-135, 136, 53a-157b, § 52-259b,
www.jud.ct.gov
P.A. 11-51 § 19; P.B. §§ 8-2, 30a-1, 32a-1
Instructions To Person Applying for Counsel or Waiver of Fees
1. If your application for counsel or waiver of fees is denied you may request a hearing on your application using this form.
2. Print or type all information requested.
3. Sign the Request for Hearing section.
For information on ADA
4. Submit this form in person, by mail or fax to the superior court where your case will be filed or is pending.
accommodations,
Instructions To Clerk
contact a court clerk or go to:
1. Upon receipt of this form, schedule a hearing on the application and notify the applicant.
www.jud.ct.gov/ADA.
2. After the hearing, give a copy of this form containing the Court Order to the applicant.
3. If the application is granted, notify the applicant and counsel, if appointed.
To: The Superior Court
Name of applicant (Last, first, middle initial)
Date of birth
Address of applicant (Number, street, town, state and zip)
Name of employer
Address of employer (Number, street, town, state and zip)
Telephone (Area code first)
Telephone (Area code first)
Relationship to child
Mother
Father
Legal guardian
Other:
Name of child
Date of birth
Name of child
Date of birth
Name of child
Date of birth
Docket number (If applicable)
Address of Court
Type of proceeding
Delinquency
Probate appeal
Other (Specify):
Emancipation
Probate transfer
Neglect, uncared-for, abused petition
Transfer/Reinstatement of guardianship
Termination of parental rights petition
Appeal from Juvenile Court Decision
Request for Hearing on Denied Application
I request a court hearing on the Application for Appointment of Counsel/Waiver of Fees denied on
.
Date
Date signed
Signed (Applicant)
HEARING TO BE HELD AT THE COURT LOCATION SHOWN ON THE DATE AND TIME SHOWN BELOW:
Hearing on (Date)
At (Time)
Signed (Assistant Clerk)
Order After Hearing
The Court, having found the applicant (Select all that apply)
Indigent and unable to pay
Not indigent and able to pay
hereby orders the application:
Granted as follows:
1. Counsel is
Appointed
Appointed in the interests of justice pursuant to Connecticut General Statutes Section 46b-136.
The applicant is ordered to reimburse the Public Defender Services Commission at its approved rate for
the costs of providing an attorney and said costs shall be payable upon receipt of an invoice from the
Public Defender Services Commission.
2. The following fees are waived
Entry fee
Filing fee
Other (Specify:)
3. The following fees are ordered paid by the State
Marshal's fee not to exceed $
Other (Specify:)
Denied.
Date signed
By the Court (Print or type name of Judge)
On (Date)
Signed (Judge, Assistant Clerk)
Print Form
Reset Form