Fill and Sign the And Order for Form

1. Amount Due On Claims . . . . . . . . . . . . . . 2. Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Reasonable Attorney's Fees . . . . . . . . . . 4. Other Lawful Charges . . . . . . . . . . . . . . . 5. Total Amount Of Judgment . . . . . . . . . . . 6. Plaintiff's Costs . . . . . . . . . . . . . . . . . . . . Mail a copy of this notice and order to plaintiff/plaintiff'sattorney and keep the original in the court file. Judgment is rendered for the Plaintiff(s) and the Defendant(s) named above must pay the Total Amount of Judgment and costs to the Plaintiff(s). It is also ordered that the Defendant(s) who must pay the judgment must make weekly payments as follows: NOTICE OF JUDGMENT AND ORDER FOR WEEKLY PAYMENTSJD-CV-50 Rev. 9-09P.B. § 17-23 et seq. Name of case (Plaintiff v. Defendant) Docket number Signed (Plaintiff/Attorney for Plaintiff) Address of court (Number, street, town, and zip code) By the Court (Name of Judge) Payable to (Name and address of person who is to receive payments) Section II — Notice To All Parties (To be completed by clerk) Signed (Judge/Assistant clerk) Date signed Section III — Certification Of Service Of Notice And Judgment To All Parties The following judgment may be enforced 21 (twenty-one) days after the clerk receives a certification that a copy of this notice was served on each judgment debtor (defendant). I certify that a copy of this Notice and Judgment has been delivered or mailed by U.S. Mail, to the Defendants named below and that I paid the postage for that mailing. (Enter name(s) and address(es) of Defendant(s)): 1. Complete Section I.2. Complete "Payable to" line in Section lI by filling in the nameand address of the person who is to receive payments.3. After notification of judgment send a copy of this notice to theDefendant(s) and return the original to Clerk's Office with thecertification below completed (Section III). Instructions to Plaintiff/Plaintiff's Attorney Amount of weekly payment $ Date first payment is due Weekly Payments Section l (To be completed by Plaintiff/Plaintiff's Attorney) After reviewing the affidavits filed in this matter, the court finds that the defendant(s) named above is/are not in the milita ry or naval service and that the following are owed to the Plaintiff(s): 7. Total Amount Of Judgment And Costs (Total of lines 5 and 6) Judgment $ $ $ $ $ $ Name(s) of Defendant's who must pay the judgment Date signed Date delivered/mailed RETJGOR Court Use Only HousingSession GeographicAreaNumber JudicialDistrict Instructions to Clerk $ (Total of lines 1-4) STATE OF CONNECTICUT SUPERIOR COURT