Form JD-JM-58 "Motion/Order of Temporary Custody/Order to Appear" - Connecticut

What Is Form JD-JM-58?

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 December 1, 2015;
  • The latest edition provided by the Connecticut Superior Court;
  • Easy to use and ready to print;
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  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form JD-JM-58 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-58 "Motion/Order of Temporary Custody/Order to Appear" - Connecticut

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MOTION/ORDER OF TEMPORARY
STATE OF CONNECTICUT
SUPERIOR COURT
CUSTODY/ORDER TO APPEAR
JUVENILE MATTERS
JD-JM-58
Rev. 12-15
www.jud.ct.gov
C.G.S. § 46b-129(b) & (k), P.A. 09-185, Sec. 3, P.B. 33a-6
Address of Court
Docket Number
Name of Child/Youth
Address of Child/Youth
Date of Birth
Name, address, and type (if applicable) (mother, father, guardian, putative father)
Date of birth
Indian tribe/reservation
Name, address, and type (if applicable) (mother, father, guardian, putative father)
Date of birth
Indian tribe/reservation
Name, address, and type (if applicable) (mother, father, guardian, putative father)
Date of birth
Indian tribe/reservation
Name, address, and type (if applicable) (mother, father, guardian, putative father)
Date of birth
Indian tribe/reservation
If parent(s) is/are minor(s), name(s) and address(es) of grandparent(s) or guardian(s):
Motion
The child or youth has been placed in the care and custody of the Commissioner of Children and Families pursuant to
section 17a-101g (96 hour hold) on (date)
at (time)
.
Based on the allegations of the petition and verified affirmations of fact, the petitioner requests an ex parte Order of Temporary
Custody/Order to Appear under section 46b-129(b) of the general statutes.
Name of Petitioner
Address of Petitioner
Relationship to Child
Subscribed and sworn to before me on (Date)
Signed (Petitioner)
Signed (Judge, Assistant Clerk, Notary, Comm. Superior Court)
Order
The court having reviewed the verified affirmations of fact accompanying this motion hereby finds that there is reasonable cause to
believe that:
A. Said child or youth is suffering from serious physical illness, or
B. Said child or youth is suffering from serious physical injury, or
C. Said child or youth is in immediate physical danger from surroundings;
And
As a result of said conditions, the child's or youth's safety is endangered and immediate removal from such surroundings is
necessary to ensure the child's or youth's safety and continuation in the home is contrary to the welfare of said child or youth.
It is Hereby Ordered That:
A.
The temporary care and custody of said child or youth shall be vested in:
pending a hearing as set forth below on the confirmation of this order;
And it is further found that:
Reasonable efforts to prevent or eliminate the need for removal of said child or youth were made by the state, or
Reasonable efforts to prevent or eliminate the need for removal of said child or youth were not possible, or
Reasonable efforts to prevent removal were not made.
OR
B.
The respondent(s) appear before the court as set forth below to determine whether an order vesting temporary custody of said child
or youth, in a person related to the child or youth by blood or marriage or in some other person or suitable agency, should be issued
pending disposition of the petition.
And it is further ordered that the above-named mother/father/guardian be and hereby is/are summoned to appear before the court on the
Hearing Date(s) set out below, at the address shown above, by having a proper officer leave a true and attested copy of this order and
summons with them or at their usual place of abode, or if so ordered, by publication or mail and return same to the court on or before the
date indicated.
OR
C.
The motion is denied.
Hearing Date - Preliminary
Date
Time of Hearing
Hearing On Temporary Custody
.M.
Date
Time of Hearing
Hearing Date - Petition
.M.
Court Location (Number, street, and town)
Telephone Number
Court Location
Publication For:
Statutory Mail For:
Service on or Before (Date)
Return Date
Name of Judge
Signed (Judge)
Date Signed
(Continued)
Print Form
Reset Form
MOTION/ORDER OF TEMPORARY
STATE OF CONNECTICUT
SUPERIOR COURT
CUSTODY/ORDER TO APPEAR
JUVENILE MATTERS
JD-JM-58
Rev. 12-15
www.jud.ct.gov
C.G.S. § 46b-129(b) & (k), P.A. 09-185, Sec. 3, P.B. 33a-6
Address of Court
Docket Number
Name of Child/Youth
Address of Child/Youth
Date of Birth
Name, address, and type (if applicable) (mother, father, guardian, putative father)
Date of birth
Indian tribe/reservation
Name, address, and type (if applicable) (mother, father, guardian, putative father)
Date of birth
Indian tribe/reservation
Name, address, and type (if applicable) (mother, father, guardian, putative father)
Date of birth
Indian tribe/reservation
Name, address, and type (if applicable) (mother, father, guardian, putative father)
Date of birth
Indian tribe/reservation
If parent(s) is/are minor(s), name(s) and address(es) of grandparent(s) or guardian(s):
Motion
The child or youth has been placed in the care and custody of the Commissioner of Children and Families pursuant to
section 17a-101g (96 hour hold) on (date)
at (time)
.
Based on the allegations of the petition and verified affirmations of fact, the petitioner requests an ex parte Order of Temporary
Custody/Order to Appear under section 46b-129(b) of the general statutes.
Name of Petitioner
Address of Petitioner
Relationship to Child
Subscribed and sworn to before me on (Date)
Signed (Petitioner)
Signed (Judge, Assistant Clerk, Notary, Comm. Superior Court)
Order
The court having reviewed the verified affirmations of fact accompanying this motion hereby finds that there is reasonable cause to
believe that:
A. Said child or youth is suffering from serious physical illness, or
B. Said child or youth is suffering from serious physical injury, or
C. Said child or youth is in immediate physical danger from surroundings;
And
As a result of said conditions, the child's or youth's safety is endangered and immediate removal from such surroundings is
necessary to ensure the child's or youth's safety and continuation in the home is contrary to the welfare of said child or youth.
It is Hereby Ordered That:
A.
The temporary care and custody of said child or youth shall be vested in:
pending a hearing as set forth below on the confirmation of this order;
And it is further found that:
Reasonable efforts to prevent or eliminate the need for removal of said child or youth were made by the state, or
Reasonable efforts to prevent or eliminate the need for removal of said child or youth were not possible, or
Reasonable efforts to prevent removal were not made.
OR
B.
The respondent(s) appear before the court as set forth below to determine whether an order vesting temporary custody of said child
or youth, in a person related to the child or youth by blood or marriage or in some other person or suitable agency, should be issued
pending disposition of the petition.
And it is further ordered that the above-named mother/father/guardian be and hereby is/are summoned to appear before the court on the
Hearing Date(s) set out below, at the address shown above, by having a proper officer leave a true and attested copy of this order and
summons with them or at their usual place of abode, or if so ordered, by publication or mail and return same to the court on or before the
date indicated.
OR
C.
The motion is denied.
Hearing Date - Preliminary
Date
Time of Hearing
Hearing On Temporary Custody
.M.
Date
Time of Hearing
Hearing Date - Petition
.M.
Court Location (Number, street, and town)
Telephone Number
Court Location
Publication For:
Statutory Mail For:
Service on or Before (Date)
Return Date
Name of Judge
Signed (Judge)
Date Signed
(Continued)
Print Form
Reset Form
Docket number
RETURN OF SERVICE
State of Connecticut
County of
Name of person(s) served
Date of service
SS.
Fees
Then and there, I duly served the foregoing petition, order and summons on the above-named
Copy
respondent(s), by either (check one):
leaving with (for in hand); or
Endorsement
leaving at the usual place of abode (for abode) at ______________________________________
Service
The within and foregoing is a true and attested copy of the original petition, order, and summons.
Travel
Attest (Signature and title of proper officer)
Total
State of Connecticut
County of
Name of person(s) served
Date of service
SS.
Fees
Then and there, I duly served the foregoing petition, order and summons on the above-named
Copy
respondent(s), by either (check one):
leaving with (for in hand); or
Endorsement
leaving at the usual place of abode (for abode) at ______________________________________
Service
The within and foregoing is a true and attested copy of the original petition, order, and summons.
Travel
Attest (Signature and title of proper officer)
Total
State of Connecticut
County of
Name of person(s) served
Date of service
SS.
Fees
Then and there, I duly served the foregoing petition, order and summons on the above-named
Copy
respondent(s), by either (check one):
leaving with (for in hand); or
Endorsement
leaving at the usual place of abode (for abode) at ______________________________________
Service
The within and foregoing is a true and attested copy of the original petition, order, and summons.
Travel
Attest (Signature and title of proper officer)
Total
For Mail Service
State of Connecticut
County of
Name of person(s) served
Date of service
SS.
Then and there, by virtue hereof, I made service of the within petition, order and summons by
Fees
depositing a true and attested copy by United States Post mail, postage prepaid, addressed to
Copy
_________________________________________________________________, by (check one):
Endorsement
restricted delivery, return receipt requested; or
first class mail; or
Service
certified mail, return receipt requested.
The within and foregoing is the original petition, order and summons with my doings thereon endorsed.
Travel
Attest (Signature and title of proper officer)
Total
(Page 2 of 2)
JD-JM-58
Rev. 12-15
Print Form
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