ADMINISTRATIVE APPEAL UNDER GENERAL
STATE OF CONNECTICUT
STATUTES SECTION 4-183 — CITATION
SUPERIOR COURT
(For use when service is made by a
proper officer or indifferent person)
www.jud.ct.gov
JD-CV-138 Rev. 10-15
C.G.S. § 4-183; P.B. § 14-7A
Instructions to Person Appealing Decision :
1. Type or print legibly; sign the form. The Judicial District you name in the Citation must be the Judicial
ADA NOTICE
District of New Britain or Judicial District that the person who has filed the Appeal resides in.
The Judicial Branch of the State of Connecticut
2. Attach the original Appeal to the original Citation form.
complies with the Americans with Disabilities Act
3. If you are a self-represented plaintiff, bring the Citation and Appeal to a clerk of court for the Judicial
(ADA). If you need a reasonable accommodation in
District you name in the Citation. The clerk will review the Citation and, if it is complete, will sign it.
accordance with the ADA, contact a court clerk or an
4. Give the Citation and Appeal to a proper officer or indifferent person to be served on each defendant.
ADA contact person listed at www.jud.ct.gov/ADA.
5. After service has been made by a proper officer or indifferent person, file the Citation and Appeal and
the Officer's Return with the clerk of court for the Judicial District you name in the Citation.
To Any Proper Officer or Indifferent Person:
By the authority of the State of Connecticut, you are commanded to serve, according to law, a copy of the Appeal and this Citation by personal service on the
agency that made the decision that is being appealed at the address of the agency or, if allowed by law, at the Office of the Attorney General, 55 Elm Street,
Hartford, Connecticut. Also serve, according to law, a copy of the Appeal and this Citation on each party named as a defendant in this appeal, at the address
provided on this form.
Name of case (Plaintiff v. Defendant)
Case type code (See reverse for codes)
Major:
Minor:
Judicial District
Address of Court
Telephone number of Court (with area code)
Form JD-CV-2 attached for additional parties
Number of Plaintiffs:
Number of Defendants:
Parties
Name (Last, First, Middle Initial) and Address of Each party (Number; Street; P.O. Box; Town; State; Zip; Country, if not USA)
P-01
First
Name:
Address:
Plaintiff
P-02
Additional
Name:
Address:
Plaintiff
D-01
First
Name:
Address:
Defendant
D-02
Additional
Name:
Address:
Defendant
D-03
Additional
Name:
Address:
Defendant
D-04
Additional
Name:
Address:
Defendant
Notice To Defendant
1. The Plaintiff will file the attached Appeal of a final administrative decision. The Appeal attached to these papers states the
claims that each Plaintiff is making.
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 within thirty (30) days of service of this Citation and Appeal.
You do not have to come to court on that date unless you receive a separate notice telling you to come to court.
3. If you do not file an "Appearance" in a timely manner, the Court is authorized to enter a sanction against you.
4. The "Appearance" form may be obtained at the Court address above or at www.jud.ct.gov under "Court Forms."
5. If you have questions about the Citation and the Appeal, you should talk to an attorney quickly. The Clerk of Court is not
allowed to give advice on legal questions.
*
Name of person signing at left
Date
Signed (Sign and "x" proper box)
Commissioner of the Superior Court
*
Assistant Clerk
For Court Use Only
If this Citation is signed by a clerk:
File Date
a. The signing has been done so that the Plaintiff(s)will not be denied access to the courts.
b. It is the responsibility of the Plaintiff(s) to see that service is made in the manner provided
by law.
c. The Clerk is not permitted to give any legal advice in connection with any lawsuit.
d. The Clerk signing this Citation at the request of the Plaintiff(s) is not responsible in any way
for any errors or omissions in anything contained in the Appeal, or the service of the Citation
or Appeal.
Date
Signed (Self-Represented Plaintiff)
Docket number
I certify I have read and
understand the above:
Print Form
Reset Form
ADMINISTRATIVE APPEAL UNDER GENERAL
STATE OF CONNECTICUT
STATUTES SECTION 4-183 — CITATION
SUPERIOR COURT
(For use when service is made by a
proper officer or indifferent person)
www.jud.ct.gov
JD-CV-138 Rev. 10-15
C.G.S. § 4-183; P.B. § 14-7A
Instructions to Person Appealing Decision :
1. Type or print legibly; sign the form. The Judicial District you name in the Citation must be the Judicial
ADA NOTICE
District of New Britain or Judicial District that the person who has filed the Appeal resides in.
The Judicial Branch of the State of Connecticut
2. Attach the original Appeal to the original Citation form.
complies with the Americans with Disabilities Act
3. If you are a self-represented plaintiff, bring the Citation and Appeal to a clerk of court for the Judicial
(ADA). If you need a reasonable accommodation in
District you name in the Citation. The clerk will review the Citation and, if it is complete, will sign it.
accordance with the ADA, contact a court clerk or an
4. Give the Citation and Appeal to a proper officer or indifferent person to be served on each defendant.
ADA contact person listed at www.jud.ct.gov/ADA.
5. After service has been made by a proper officer or indifferent person, file the Citation and Appeal and
the Officer's Return with the clerk of court for the Judicial District you name in the Citation.
To Any Proper Officer or Indifferent Person:
By the authority of the State of Connecticut, you are commanded to serve, according to law, a copy of the Appeal and this Citation by personal service on the
agency that made the decision that is being appealed at the address of the agency or, if allowed by law, at the Office of the Attorney General, 55 Elm Street,
Hartford, Connecticut. Also serve, according to law, a copy of the Appeal and this Citation on each party named as a defendant in this appeal, at the address
provided on this form.
Name of case (Plaintiff v. Defendant)
Case type code (See reverse for codes)
Major:
Minor:
Judicial District
Address of Court
Telephone number of Court (with area code)
Form JD-CV-2 attached for additional parties
Number of Plaintiffs:
Number of Defendants:
Parties
Name (Last, First, Middle Initial) and Address of Each party (Number; Street; P.O. Box; Town; State; Zip; Country, if not USA)
P-01
First
Name:
Address:
Plaintiff
P-02
Additional
Name:
Address:
Plaintiff
D-01
First
Name:
Address:
Defendant
D-02
Additional
Name:
Address:
Defendant
D-03
Additional
Name:
Address:
Defendant
D-04
Additional
Name:
Address:
Defendant
Notice To Defendant
1. The Plaintiff will file the attached Appeal of a final administrative decision. The Appeal attached to these papers states the
claims that each Plaintiff is making.
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 within thirty (30) days of service of this Citation and Appeal.
You do not have to come to court on that date unless you receive a separate notice telling you to come to court.
3. If you do not file an "Appearance" in a timely manner, the Court is authorized to enter a sanction against you.
4. The "Appearance" form may be obtained at the Court address above or at www.jud.ct.gov under "Court Forms."
5. If you have questions about the Citation and the Appeal, you should talk to an attorney quickly. The Clerk of Court is not
allowed to give advice on legal questions.
*
Name of person signing at left
Date
Signed (Sign and "x" proper box)
Commissioner of the Superior Court
*
Assistant Clerk
For Court Use Only
If this Citation is signed by a clerk:
File Date
a. The signing has been done so that the Plaintiff(s)will not be denied access to the courts.
b. It is the responsibility of the Plaintiff(s) to see that service is made in the manner provided
by law.
c. The Clerk is not permitted to give any legal advice in connection with any lawsuit.
d. The Clerk signing this Citation at the request of the Plaintiff(s) is not responsible in any way
for any errors or omissions in anything contained in the Appeal, or the service of the Citation
or Appeal.
Date
Signed (Self-Represented Plaintiff)
Docket number
I certify I have read and
understand the above:
Print Form
Reset Form
STATE OF CONNECTICUT JUDICIAL BRANCH
CASE TYPE CODES
October, 2015
Codes
MAJOR
MINOR DESCRIPTION
Major/
DESCRIPTION
Minor
Appeals from
A 00
Zoning
Administrative
A 10
Taxation
Boards
A 20
Liquor
A 30
Motor Vehicle Commissioner
A 40
Unemployment
A 50
Worker's Compensation
A 60
Labor Relations Board
A 61
Environmental Protection Commissioner - State
A 62
Commission on Hospitals/Healthcare
A 63
Employees Review Board
A 64
Social Services Commission
A 65
Freedom of Information Commission
A 66
Inland Wetlands & Conservation Commission - Local
A 67
Retirement Commission
A 68
Housing and Building Code Enforcement
A 69
Human Rights and Opportunities Commission
A 70
Department of Children and Families
A 90
All other
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