Form JD-FM-138 "Affidavit - Relief From Abuse" - Connecticut

What Is Form JD-FM-138?

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 October 1, 2014;
  • 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-FM-138 by clicking the link below or browse more documents and templates provided by the Connecticut Superior Court.

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Download Form JD-FM-138 "Affidavit - Relief From Abuse" - Connecticut

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AFFIDAVIT - RELIEF
For Court Use Only
STATE OF CONNECTICUT
AFFRFA
FROM ABUSE
SUPERIOR COURT
www.jud.ct.gov
*AFFRFA*
JD-FM-138 Rev. 10-14
C.G.S. §§ 46b-15, 52-231a, P.B. § 25-57
Instructions to Person Applying for Relief from Abuse (Affiant)
This affidavit must be filled out completely and given to the clerk along with your filled out Application for Relief From Abuse, form JD-FM-137. Your affidavit
must include a statement of the conditions you seek relief from and must be made under oath (you must swear that your statement is true and sign it in front
of a court clerk, a notary public, or an attorney who will also sign and date the affidavit). The statement must be true to the best of your knowledge. State if
any arrest was made related to the incidents outlined in this statement.
Do not write on the back of this form.
If you need additional room, use another Affidavit - Relief From Abuse form, JD-FM-138. You must sign
and swear to all pages.
If you are asking for temporary custody of your minor child or minor children, you must also fill out an Affidavit Concerning Children, form
JD-FM-164.
Name of applicant (Your name)
Name of respondent (Person you want a restraining order against)
Docket number (For court use only)
Statement Of Conditions From Which You Seek Relief
I, the person signing below, duly depose and say that I am the Applicant in this matter and state as follows: (Explain for each
incident: (1) what happened, (2) when it happened, (3) where it happened, and (4) who was there when it happened.)
Statement Concerning Temporary Custody Of Children
"X" one of the following:
I am not asking for temporary custody of any minor child or minor children in this matter.
I am asking for temporary custody of my minor child or minor children in this matter.
(Fill out an Affidavit Concerning Children, form JD-FM-164, and bring it to the clerk along
with this form and your filled out Application For Relief From Abuse, form JD-FM-137.)
Print name of person signing
Signature
I certify that the statements above are true to the
best of my knowledge and belief.
Date signed
Subscribed and sworn to before me (Assistant Clerk, Commissioner of Superior Court, Notary Public)
Print Form
Reset Form
AFFIDAVIT - RELIEF
For Court Use Only
STATE OF CONNECTICUT
AFFRFA
FROM ABUSE
SUPERIOR COURT
www.jud.ct.gov
*AFFRFA*
JD-FM-138 Rev. 10-14
C.G.S. §§ 46b-15, 52-231a, P.B. § 25-57
Instructions to Person Applying for Relief from Abuse (Affiant)
This affidavit must be filled out completely and given to the clerk along with your filled out Application for Relief From Abuse, form JD-FM-137. Your affidavit
must include a statement of the conditions you seek relief from and must be made under oath (you must swear that your statement is true and sign it in front
of a court clerk, a notary public, or an attorney who will also sign and date the affidavit). The statement must be true to the best of your knowledge. State if
any arrest was made related to the incidents outlined in this statement.
Do not write on the back of this form.
If you need additional room, use another Affidavit - Relief From Abuse form, JD-FM-138. You must sign
and swear to all pages.
If you are asking for temporary custody of your minor child or minor children, you must also fill out an Affidavit Concerning Children, form
JD-FM-164.
Name of applicant (Your name)
Name of respondent (Person you want a restraining order against)
Docket number (For court use only)
Statement Of Conditions From Which You Seek Relief
I, the person signing below, duly depose and say that I am the Applicant in this matter and state as follows: (Explain for each
incident: (1) what happened, (2) when it happened, (3) where it happened, and (4) who was there when it happened.)
Statement Concerning Temporary Custody Of Children
"X" one of the following:
I am not asking for temporary custody of any minor child or minor children in this matter.
I am asking for temporary custody of my minor child or minor children in this matter.
(Fill out an Affidavit Concerning Children, form JD-FM-164, and bring it to the clerk along
with this form and your filled out Application For Relief From Abuse, form JD-FM-137.)
Print name of person signing
Signature
I certify that the statements above are true to the
best of my knowledge and belief.
Date signed
Subscribed and sworn to before me (Assistant Clerk, Commissioner of Superior Court, Notary Public)
Print Form
Reset Form