Form JD-CR-173 "Under 21 Motor Vehicle/Underage Drinking Program Application" - Connecticut

What Is Form JD-CR-173?

This is a legal form that was released by the Connecticut Judicial Branch - 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 Judicial Branch;
  • 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-CR-173 by clicking the link below or browse more documents and templates provided by the Connecticut Judicial Branch.

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Download Form JD-CR-173 "Under 21 Motor Vehicle/Underage Drinking Program Application" - Connecticut

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UNDER 21 MOTOR VEHICLE/UNDERAGE
STATE OF CONNECTICUT
DRINKING PROGRAM APPLICATION
JUDICIAL BRANCH
JD-CR-173 Rev. 10-17
COURT SUPPORT SERVICES DIVISION
C.G.S. § 54-56p;
www.jud.ct.gov
P.A. 17-48 § 17, P.A. 17-79 § 15, P.A. 17-99 § 39
ADA Notice
The Judicial Branch of the State of Connecticut
Instructions To Person Filling Out This Application
complies with the Americans with Disabilities Act
1. Fill out the Application and sign it.
(ADA). If you need a reasonable accommodation in
2. File the original with the Clerk of the Court, and keep a copy for your records.
accordance with the ADA, contact a court clerk or an
3. Send a copy to the prosecuting attorney (the State's Attorney for your case).
ADA contact person listed at www.jud.ct.gov/ADA.
TO: The Superior Court of the State of Connecticut
Address of court
Docket number
GA/JD
number
Name of defendant
Address of defendant (Number, street, apartment number, town, and zip code)
Telephone number of defendant
Operator's license number
Issuing state
Alias/Maiden name of defendant
Offense(s) charged
I am charged with the offense(s) listed above, and I ask that I be allowed into the Under 21 Motor Vehicle/Underage Drinking
Program. I agree with the following statements:
1. I was under twenty-one (21) years of age at the time of the offense(s) listed above.
2. I am charged with one or more of the following: a motor vehicle violation, or a violation of section 30-88a, 30-89a, or
30-89(a) or (b) of the Connecticut General Statutes.
3. If I am charged with a motor vehicle violation, I did not hold a commercial driver's license or a commercial driver's
instruction permit, and I was not operating a commercial motor vehicle at the time of the violation.
4. I am not charged with a motor vehicle violation that caused serious injury or death.
5. I am not charged with a violation of section 14-227a, 14-227g, or 14-296aa of the Connecticut General Statutes.
6. If I am charged with a motor vehicle violation that is classified as a felony, there is good cause for allowing me into this
program.
7. I have not used this program before.
8. I will attend one (1) forum (meeting) within nine months of the court allowing me into this program to hear from
victims who have been affected by underage drinking, drunk driving, distracted driving, or other motor vehicle violations.
I give my permission to the Court Support Services Division (CSSD) to get information about whether I was allowed into this
program before so that CSSD can tell the court whether I am eligible for this program.
By signing this form, I am saying that I understand all of the information above, and I request that I be allowed into the Under 21
Motor Vehicle/Underage Drinking Program under section 54-56p of the Connecticut General Statutes.
Date Signed
Signed (Parent or Guardian if under 18)
Signed (Defendant)
I have read this entire
application, and I understand it.
First Order of the Court
The application is denied.
The Application is continued to the date listed below and the defendant is referred to CSSD for a determination of eligibility.
Case Continued To (Date and time)
Signed (Judge, Magistrate, Assistant Clerk)
Date Signed
Print Form
Reset Form
UNDER 21 MOTOR VEHICLE/UNDERAGE
STATE OF CONNECTICUT
DRINKING PROGRAM APPLICATION
JUDICIAL BRANCH
JD-CR-173 Rev. 10-17
COURT SUPPORT SERVICES DIVISION
C.G.S. § 54-56p;
www.jud.ct.gov
P.A. 17-48 § 17, P.A. 17-79 § 15, P.A. 17-99 § 39
ADA Notice
The Judicial Branch of the State of Connecticut
Instructions To Person Filling Out This Application
complies with the Americans with Disabilities Act
1. Fill out the Application and sign it.
(ADA). If you need a reasonable accommodation in
2. File the original with the Clerk of the Court, and keep a copy for your records.
accordance with the ADA, contact a court clerk or an
3. Send a copy to the prosecuting attorney (the State's Attorney for your case).
ADA contact person listed at www.jud.ct.gov/ADA.
TO: The Superior Court of the State of Connecticut
Address of court
Docket number
GA/JD
number
Name of defendant
Address of defendant (Number, street, apartment number, town, and zip code)
Telephone number of defendant
Operator's license number
Issuing state
Alias/Maiden name of defendant
Offense(s) charged
I am charged with the offense(s) listed above, and I ask that I be allowed into the Under 21 Motor Vehicle/Underage Drinking
Program. I agree with the following statements:
1. I was under twenty-one (21) years of age at the time of the offense(s) listed above.
2. I am charged with one or more of the following: a motor vehicle violation, or a violation of section 30-88a, 30-89a, or
30-89(a) or (b) of the Connecticut General Statutes.
3. If I am charged with a motor vehicle violation, I did not hold a commercial driver's license or a commercial driver's
instruction permit, and I was not operating a commercial motor vehicle at the time of the violation.
4. I am not charged with a motor vehicle violation that caused serious injury or death.
5. I am not charged with a violation of section 14-227a, 14-227g, or 14-296aa of the Connecticut General Statutes.
6. If I am charged with a motor vehicle violation that is classified as a felony, there is good cause for allowing me into this
program.
7. I have not used this program before.
8. I will attend one (1) forum (meeting) within nine months of the court allowing me into this program to hear from
victims who have been affected by underage drinking, drunk driving, distracted driving, or other motor vehicle violations.
I give my permission to the Court Support Services Division (CSSD) to get information about whether I was allowed into this
program before so that CSSD can tell the court whether I am eligible for this program.
By signing this form, I am saying that I understand all of the information above, and I request that I be allowed into the Under 21
Motor Vehicle/Underage Drinking Program under section 54-56p of the Connecticut General Statutes.
Date Signed
Signed (Parent or Guardian if under 18)
Signed (Defendant)
I have read this entire
application, and I understand it.
First Order of the Court
The application is denied.
The Application is continued to the date listed below and the defendant is referred to CSSD for a determination of eligibility.
Case Continued To (Date and time)
Signed (Judge, Magistrate, Assistant Clerk)
Date Signed
Print Form
Reset Form