Form JD-CV-163 "Request for Nondisclosure of Location Information - Civil Protection Order" - Connecticut

What Is Form JD-CV-163?

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, 2017;
  • 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-CV-163 by clicking the link below or browse more documents and templates provided by the Connecticut Superior Court.

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Download Form JD-CV-163 "Request for Nondisclosure of Location Information - Civil Protection Order" - Connecticut

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STATE OF CONNECTICUT
REQUEST FOR NONDISCLOSURE
Court Use Only
SUPERIOR COURT
OF LOCATION INFORMATION -
REQNON
www.jud.ct.gov
CIVIL PROTECTION ORDER
*REQNON*
JD-CV-163
New 10-17
C.G.S. § 46b-16a(b)
Instructions To Party
Instructions To Clerk
ADA NOTICE
1. Complete the information below if you believe that disclosure of
1. Seal any location information except
The Judicial Branch of the State of
location information would jeopardize you and/or your child(ren)'s
disclosable mailing address.
Connecticut
complies
with
the
health, safety or liberty.
2. Do not disclose the location
Americans with Disabilities Act (ADA). If
2. You must swear that your statement is true and sign it in front of a
information to the public, including
you need a reasonable accommodation
court clerk, a notary public or an attorney who will also sign and date it.
anyone involved in the case, except
in accordance with the ADA, contact a
3. Keep a copy for your records.
by order of the court after hearing.
court clerk or an ADA contact person
4. Do not file anything further with the court containing location
listed at www.jud.ct.gov/ADA.
information other than to report a change in your mailing address.
Name of Case
Docket number (If known)
Plaintiff's name (First, middle initial, last)
Defendant's name (First, middle initial, last)
1. I, the above-named
plaintiff
defendant believe that the health, safety or liberty of
(check one)
(check one or both)
myself
my child(ren)
(Specify name(s))
would be jeopardized by disclosure of location information. I therefore request that no location information contained in this
case pertaining to
(check one or both)
myself
my child(ren)
be disclosed to anyone including parties to this case and that this information be sealed.
2. (check one)
Attorney's name (First, middle initial, last)
I have an attorney representing me in this case. My attorney is:
I do not have an attorney representing me in this case. Therefore, I am providing my mailing address below.
I understand that this address will be public information.
Full mailing address for
your attorney or your
mailing address if you
are self-represented.
(Public Information)
3. (check one)
There have been no documents previously filed with the court that contain location information that poses the risk.
There is location information posing the risk contained in documents previously filed with the court. The location
information can be found in the following documents (Attach additional sheet if necessary).
(Do not indicate what the location information is.)
NOTICE TO APPLICANT:
DO NOT FILE ANY PAPERWORK WITH THE COURT THAT CONTAINS ANY LOCATION INFORMATION
IN ANY FURTHER PLEADINGS OTHER THAN TO REPORT A CHANGE IN YOUR MAILING ADDRESS.
Signature
Print name of person signing
I hereby certify that the foregoing statements are
true to the best of my knowledge and belief
Subscribed and sworn to before me (Assistant Clerk, Commissioner of Superior Court, Notary Public)
Date signed
Distribution:
Original — For the Court
Copy — For your records
Print Form
Reset Form
STATE OF CONNECTICUT
REQUEST FOR NONDISCLOSURE
Court Use Only
SUPERIOR COURT
OF LOCATION INFORMATION -
REQNON
www.jud.ct.gov
CIVIL PROTECTION ORDER
*REQNON*
JD-CV-163
New 10-17
C.G.S. § 46b-16a(b)
Instructions To Party
Instructions To Clerk
ADA NOTICE
1. Complete the information below if you believe that disclosure of
1. Seal any location information except
The Judicial Branch of the State of
location information would jeopardize you and/or your child(ren)'s
disclosable mailing address.
Connecticut
complies
with
the
health, safety or liberty.
2. Do not disclose the location
Americans with Disabilities Act (ADA). If
2. You must swear that your statement is true and sign it in front of a
information to the public, including
you need a reasonable accommodation
court clerk, a notary public or an attorney who will also sign and date it.
anyone involved in the case, except
in accordance with the ADA, contact a
3. Keep a copy for your records.
by order of the court after hearing.
court clerk or an ADA contact person
4. Do not file anything further with the court containing location
listed at www.jud.ct.gov/ADA.
information other than to report a change in your mailing address.
Name of Case
Docket number (If known)
Plaintiff's name (First, middle initial, last)
Defendant's name (First, middle initial, last)
1. I, the above-named
plaintiff
defendant believe that the health, safety or liberty of
(check one)
(check one or both)
myself
my child(ren)
(Specify name(s))
would be jeopardized by disclosure of location information. I therefore request that no location information contained in this
case pertaining to
(check one or both)
myself
my child(ren)
be disclosed to anyone including parties to this case and that this information be sealed.
2. (check one)
Attorney's name (First, middle initial, last)
I have an attorney representing me in this case. My attorney is:
I do not have an attorney representing me in this case. Therefore, I am providing my mailing address below.
I understand that this address will be public information.
Full mailing address for
your attorney or your
mailing address if you
are self-represented.
(Public Information)
3. (check one)
There have been no documents previously filed with the court that contain location information that poses the risk.
There is location information posing the risk contained in documents previously filed with the court. The location
information can be found in the following documents (Attach additional sheet if necessary).
(Do not indicate what the location information is.)
NOTICE TO APPLICANT:
DO NOT FILE ANY PAPERWORK WITH THE COURT THAT CONTAINS ANY LOCATION INFORMATION
IN ANY FURTHER PLEADINGS OTHER THAN TO REPORT A CHANGE IN YOUR MAILING ADDRESS.
Signature
Print name of person signing
I hereby certify that the foregoing statements are
true to the best of my knowledge and belief
Subscribed and sworn to before me (Assistant Clerk, Commissioner of Superior Court, Notary Public)
Date signed
Distribution:
Original — For the Court
Copy — For your records
Print Form
Reset Form