Form JD-FM-233 "Supplemental Affidavit and Request for Orders of Maintenance" - Connecticut

What Is Form JD-FM-233?

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 January 1, 2015;
  • 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-233 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-233 "Supplemental Affidavit and Request for Orders of Maintenance" - Connecticut

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SUPPLEMENTAL AFFIDAVIT AND
STATE OF CONNECTICUT
For Court Use Only
REQUEST FOR ORDERS
SUPERIOR COURT
OF MAINTENANCE
REQMAIN
www.jud.ct.gov
JD-FM-233 New 1-15
*REQMAIN*
P.A. 14-217 § 120
ADA NOTICE
The Judicial Branch of the State
Note to Person Filing Request (Applicant):
of Connecticut complies with the
This form may only be used if you and the respondent are spouses or if you and
Americans with Disabilities Act (ADA). If
you need a reasonable accommodation
the respondent live together and have a dependent child or children in common.
in accordance with the ADA, contact a
court clerk or an ADA contact person
listed at www.jud.ct.gov/ADA.
Instructions to Person Filing Request (Applicant):
If you are requesting the court to enter orders to maintain the safety and basic needs of yourself or any dependent child(ren) in your Application for
Relief from Abuse (JD-FM-137), complete Section A, and complete Sections B and C as they apply. If you request any orders in Section C of this
form, those orders cannot enter on an ex parte basis (prior to a hearing) and will be considered when you have a hearing on your application.
Name of Applicant (Last, first, middle initial)
Docket Number
Name of Respondent (Last, first, middle initial)
A. I swear to the following:
The respondent is (select all that apply)
My spouse or a person I have a civil union with
A person who is also the parent of my dependent child
or children in common and we all live together
I request that the court enter the following orders because (select all that apply):
No other orders exist.
An order is necessary to maintain my safety or the safety of any dependent child(ren) in common.
An order is necessary to my basic needs or the basic needs of any dependent child(ren) in common.
B. REQUESTS FOR EX PARTE RELIEF (May also be ordered at the time of the hearing)
An order prohibiting the respondent from:
Taking any action that could result in the termination of any necessary utility services or necessary services related to the family dwelling
or dwelling in which I reside.
CT40
Taking any action that could result in the cancellation, change of coverage or change of beneficiary of any health, automobile, or
homeowner's policy to the detriment of me or any dependent child(ren) the respondent and I have in common.
CT41
Transferring, encumbering, concealing, or disposing of the property specified which is owned or leased by the applicant.
(Specify Below)
CT42
An order that the respondent provide me with:
An automobile (specify)
CT43
A checkbook (specify)
CT44
Documentation of health, automobile or homeowner's insurance (specify)
CT45
A document for the purpose of proving my identity (specify)
CT46
A key to (specify)
CT47
The following personal effects (specify)
CT48
C. REQUESTS FOR RELIEF AT THE TIME OF THE HEARING
An order that the respondent be required to:
Make rent or mortgage payments on the family dwelling or the dwelling in which I reside with any dependent child(ren) the respondent
CT49
and I have in common.
Maintain utility services or any other necessary services related to the family dwelling or the dwelling in which I reside with any dependent
CT50
child(ren) that the respondent and I have in common.
Maintain all existing health, automobile or homeowner's insurance coverage without change in coverage or beneficiary designation.
CT51
Provide financial support for the benefit of any dependent child(ren) that the respondent and I have in common provided that the
CT52
respondent has a legal duty to support such child(ren) and has the ability to pay.
Note: If, at your hearing, no order is entered under section B or C, no such order may be entered thereafter pursuant to this section.
Any order entered pursuant to section C shall not be subject to modification. Any order entered pursuant to Sections B and C shall expire at
120 days or sooner as the court may determine after the date of issuance or upon issuance of a superseding order, whichever occurs first.
Any amounts ordered but not paid or collected under this section may be preserved and collectable in an action for dissolution of marriage,
custody, paternity or support.
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
SUPPLEMENTAL AFFIDAVIT AND
STATE OF CONNECTICUT
For Court Use Only
REQUEST FOR ORDERS
SUPERIOR COURT
OF MAINTENANCE
REQMAIN
www.jud.ct.gov
JD-FM-233 New 1-15
*REQMAIN*
P.A. 14-217 § 120
ADA NOTICE
The Judicial Branch of the State
Note to Person Filing Request (Applicant):
of Connecticut complies with the
This form may only be used if you and the respondent are spouses or if you and
Americans with Disabilities Act (ADA). If
you need a reasonable accommodation
the respondent live together and have a dependent child or children in common.
in accordance with the ADA, contact a
court clerk or an ADA contact person
listed at www.jud.ct.gov/ADA.
Instructions to Person Filing Request (Applicant):
If you are requesting the court to enter orders to maintain the safety and basic needs of yourself or any dependent child(ren) in your Application for
Relief from Abuse (JD-FM-137), complete Section A, and complete Sections B and C as they apply. If you request any orders in Section C of this
form, those orders cannot enter on an ex parte basis (prior to a hearing) and will be considered when you have a hearing on your application.
Name of Applicant (Last, first, middle initial)
Docket Number
Name of Respondent (Last, first, middle initial)
A. I swear to the following:
The respondent is (select all that apply)
My spouse or a person I have a civil union with
A person who is also the parent of my dependent child
or children in common and we all live together
I request that the court enter the following orders because (select all that apply):
No other orders exist.
An order is necessary to maintain my safety or the safety of any dependent child(ren) in common.
An order is necessary to my basic needs or the basic needs of any dependent child(ren) in common.
B. REQUESTS FOR EX PARTE RELIEF (May also be ordered at the time of the hearing)
An order prohibiting the respondent from:
Taking any action that could result in the termination of any necessary utility services or necessary services related to the family dwelling
or dwelling in which I reside.
CT40
Taking any action that could result in the cancellation, change of coverage or change of beneficiary of any health, automobile, or
homeowner's policy to the detriment of me or any dependent child(ren) the respondent and I have in common.
CT41
Transferring, encumbering, concealing, or disposing of the property specified which is owned or leased by the applicant.
(Specify Below)
CT42
An order that the respondent provide me with:
An automobile (specify)
CT43
A checkbook (specify)
CT44
Documentation of health, automobile or homeowner's insurance (specify)
CT45
A document for the purpose of proving my identity (specify)
CT46
A key to (specify)
CT47
The following personal effects (specify)
CT48
C. REQUESTS FOR RELIEF AT THE TIME OF THE HEARING
An order that the respondent be required to:
Make rent or mortgage payments on the family dwelling or the dwelling in which I reside with any dependent child(ren) the respondent
CT49
and I have in common.
Maintain utility services or any other necessary services related to the family dwelling or the dwelling in which I reside with any dependent
CT50
child(ren) that the respondent and I have in common.
Maintain all existing health, automobile or homeowner's insurance coverage without change in coverage or beneficiary designation.
CT51
Provide financial support for the benefit of any dependent child(ren) that the respondent and I have in common provided that the
CT52
respondent has a legal duty to support such child(ren) and has the ability to pay.
Note: If, at your hearing, no order is entered under section B or C, no such order may be entered thereafter pursuant to this section.
Any order entered pursuant to section C shall not be subject to modification. Any order entered pursuant to Sections B and C shall expire at
120 days or sooner as the court may determine after the date of issuance or upon issuance of a superseding order, whichever occurs first.
Any amounts ordered but not paid or collected under this section may be preserved and collectable in an action for dissolution of marriage,
custody, paternity or support.
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