Form JD-VS-3 "Notice of Application" - Connecticut

What Is Form JD-VS-3?

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 July 1, 2016;
  • 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-VS-3 by clicking the link below or browse more documents and templates provided by the Connecticut Judicial Branch.

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Download Form JD-VS-3 "Notice of Application" - Connecticut

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NOTICE OF APPLICATION
STATE OF CONNECTICUT
OFFICE OF VICTIM SERVICES
JD-VS-3 (Page 1 of 2)
Rev. 7-16
C.G.S. § 54-227
JUDICIAL BRANCH
ADA Notice
www.jud.ct.gov
The
Judicial
Branch
of
the
State
of
Connecticut
complies with the Americans
with Disabilities Act (ADA). If you need a
reasonable accommodation in accordance
with the ADA, contact a court clerk or an ADA
contact person listed at www.jud.ct.gov/ADA.
Instructions
1. You must fill out this form and have a Commissioner of the Superior Court or a Department of Correction (DOC) official sign the form
acknowledging that you have provided a copy of this form to the Office of Victim Services (OVS) and DOC Victim Services Unit.
2. Send the original form with the application that you file with the Superior Court, Board of Pardons and Paroles, or DOC.
3. Keep a copy of this form for your records.
To: Office of Victim Services, 225 Spring Street, 4th Floor, Wethersfield, CT 06109
To: Department of Correction - Victim Services Unit, 24 Wolcott Hill Road, Wethersfield, CT 06109
Name of person completing form (Applicant)
JD/GA court location where application is filed
Docket number
Name of inmate/defendant
Department of Correction inmate number (If known)
Inmate/defendant's date of birth (If known)
Please check the box that describes the application to be filed. If you check more than one box, this form will be returned to
you. You MUST complete a Notice of Application form for each application you file.
Board of Pardons and Paroles:
for parole - Parole Unit
for clemency by current offender - Pardons Unit
Department of Correction
for release other than a furlough
Superior Court
for sentence modification, motion and order
for review of sentence
to restrict or to remove restriction on dissemination of sex offender registration information
for exemption from the sex offender registration requirements
By signing this application, I am stating that I am the person completing this form and the information in this Notice of
Application is true and accurate.
I understand that the application will not be accepted unless I provide proof that I have given a copy of this application to the
Office of Victim Services and to the Department of Correction - Victim Services Unit at the addresses listed above and on the
date and in the way listed below:
Date provided to Office of Victim Services
Please check one box:
Hand
Sent by first class
delivered
Other (Specify)
mail, postage paid
Date provided to Department of Correction
Please check one box:
Sent by first class
Hand
mail, postage paid
delivered
Other (Specify)
Signed (Applicant)
On (Date)
Witness Statement
I acknowledge that the applicant noted above provided a copy of this Notice of Application to the Office of Victim Services
and to the Department of Correction - Victim Services Unit in the way specified above.
Signed (Commissioner of the Superior Court/Corrections Official)
On (Date)
Title
Print Form
Reset Form
NOTICE OF APPLICATION
STATE OF CONNECTICUT
OFFICE OF VICTIM SERVICES
JD-VS-3 (Page 1 of 2)
Rev. 7-16
C.G.S. § 54-227
JUDICIAL BRANCH
ADA Notice
www.jud.ct.gov
The
Judicial
Branch
of
the
State
of
Connecticut
complies with the Americans
with Disabilities Act (ADA). If you need a
reasonable accommodation in accordance
with the ADA, contact a court clerk or an ADA
contact person listed at www.jud.ct.gov/ADA.
Instructions
1. You must fill out this form and have a Commissioner of the Superior Court or a Department of Correction (DOC) official sign the form
acknowledging that you have provided a copy of this form to the Office of Victim Services (OVS) and DOC Victim Services Unit.
2. Send the original form with the application that you file with the Superior Court, Board of Pardons and Paroles, or DOC.
3. Keep a copy of this form for your records.
To: Office of Victim Services, 225 Spring Street, 4th Floor, Wethersfield, CT 06109
To: Department of Correction - Victim Services Unit, 24 Wolcott Hill Road, Wethersfield, CT 06109
Name of person completing form (Applicant)
JD/GA court location where application is filed
Docket number
Name of inmate/defendant
Department of Correction inmate number (If known)
Inmate/defendant's date of birth (If known)
Please check the box that describes the application to be filed. If you check more than one box, this form will be returned to
you. You MUST complete a Notice of Application form for each application you file.
Board of Pardons and Paroles:
for parole - Parole Unit
for clemency by current offender - Pardons Unit
Department of Correction
for release other than a furlough
Superior Court
for sentence modification, motion and order
for review of sentence
to restrict or to remove restriction on dissemination of sex offender registration information
for exemption from the sex offender registration requirements
By signing this application, I am stating that I am the person completing this form and the information in this Notice of
Application is true and accurate.
I understand that the application will not be accepted unless I provide proof that I have given a copy of this application to the
Office of Victim Services and to the Department of Correction - Victim Services Unit at the addresses listed above and on the
date and in the way listed below:
Date provided to Office of Victim Services
Please check one box:
Hand
Sent by first class
delivered
Other (Specify)
mail, postage paid
Date provided to Department of Correction
Please check one box:
Sent by first class
Hand
mail, postage paid
delivered
Other (Specify)
Signed (Applicant)
On (Date)
Witness Statement
I acknowledge that the applicant noted above provided a copy of this Notice of Application to the Office of Victim Services
and to the Department of Correction - Victim Services Unit in the way specified above.
Signed (Commissioner of the Superior Court/Corrections Official)
On (Date)
Title
Print Form
Reset Form
NOTICE OF APPLICATION
STATE OF CONNECTICUT
OFFICE OF VICTIM SERVICES
JD-VS-3 (Page 2 of 2) Rev. 7-16
C.G.S. § 54-227
JUDICIAL BRANCH
www.jud.ct.gov
To Be Completed By The Applicant
Name of person completing form (Applicant)
JD/GA Court location where application filed
Docket number
Name of inmate/defendant
Department of Correction inmate number (If known)
Inmate/defendant's date of birth (If known)
For OVS Use Only
OVS Compliance Requirement
Certified letter mailed to registrant/victim at last known address.
No registrant/victim on file.
Signed (OVS Staff)
Date signed
For DOC Use Only
DOC Compliance Requirement
Certified letter mailed to registrant/victim at last known address.
No registrant/victim on file.
Signed (DOC Staff)
Date signed
Print Form
Reset Form
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