Form JD-CR-186 "Application for Municipal Ceo/Designee Agency Code Eo-9b/Affidavit" - Connecticut

What Is Form JD-CR-186?

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 November 1, 2020;
  • 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-186 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-186 "Application for Municipal Ceo/Designee Agency Code Eo-9b/Affidavit" - Connecticut

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STATE OF CONNECTICUT
APPLICATION FOR MUNICIPAL CEO/DESIGNEE
AGENCY CODE EO-9B/AFFIDAVIT
JUDICIAL BRANCH
JD-CR-186 New 11-20
CENTRALIZED INFRACTIONS BUREAU
www.jud.ct.gov
Section 2 of Executive Order 9B, issued by the Governor in response to the COVID-19 civil preparedness and public
health emergencies, authorizes municipal chief executive officers and their designees (among others) to enforce
certain violations payable to the Centralized Infractions Bureau (CIB). A CIB-issued agency code is required to issue
citations for such violations. An authorized municipal chief executive or designee may apply for an agency code by
completing this form and submitting it to traffictickets@jud.ct.gov.
Note: The agency code provided in response to this application may only be used to enforce violations contained in
EO9B-2, and/or to enforce violations established by any subsequent executive order which authorize municipal chief
executive officers and their designees to issue fines for violations of executive orders issued by the Governor in
response to the public health and civil preparedness emergencies throughout the State of Connecticut as a result of
the coronavirus disease 2019 (COVID-19) outbreak in the United States and Connecticut.
Municipality Information
Municipality name
Address
Zip/postal code
Person submitting application
Municipal Chief Executive Officer
Phone number
Municipal CEO Designee
E-mail
(Municipality name) requests an agency code to enforce violations contained in
EO9B-2, subject to the extension, modification, or repeal of such violations by the Governor.
I,
swear under the penalties of perjury that I am the
for
.
Municipal Chief Executive Officer
Municipal CEO Designee
Signed (Affiant)
Print or type name of person signing
Date signed
u
on Date
Signed (Assistant Clerk, Notary, Commissioner of the Superior Court)
Subscribed and
sworn to before me:
ADA NOTICE
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.
Print Form
Reset Form
STATE OF CONNECTICUT
APPLICATION FOR MUNICIPAL CEO/DESIGNEE
AGENCY CODE EO-9B/AFFIDAVIT
JUDICIAL BRANCH
JD-CR-186 New 11-20
CENTRALIZED INFRACTIONS BUREAU
www.jud.ct.gov
Section 2 of Executive Order 9B, issued by the Governor in response to the COVID-19 civil preparedness and public
health emergencies, authorizes municipal chief executive officers and their designees (among others) to enforce
certain violations payable to the Centralized Infractions Bureau (CIB). A CIB-issued agency code is required to issue
citations for such violations. An authorized municipal chief executive or designee may apply for an agency code by
completing this form and submitting it to traffictickets@jud.ct.gov.
Note: The agency code provided in response to this application may only be used to enforce violations contained in
EO9B-2, and/or to enforce violations established by any subsequent executive order which authorize municipal chief
executive officers and their designees to issue fines for violations of executive orders issued by the Governor in
response to the public health and civil preparedness emergencies throughout the State of Connecticut as a result of
the coronavirus disease 2019 (COVID-19) outbreak in the United States and Connecticut.
Municipality Information
Municipality name
Address
Zip/postal code
Person submitting application
Municipal Chief Executive Officer
Phone number
Municipal CEO Designee
E-mail
(Municipality name) requests an agency code to enforce violations contained in
EO9B-2, subject to the extension, modification, or repeal of such violations by the Governor.
I,
swear under the penalties of perjury that I am the
for
.
Municipal Chief Executive Officer
Municipal CEO Designee
Signed (Affiant)
Print or type name of person signing
Date signed
u
on Date
Signed (Assistant Clerk, Notary, Commissioner of the Superior Court)
Subscribed and
sworn to before me:
ADA NOTICE
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.
Print Form
Reset Form