Fill and Sign the Notice of Ex Parte Pre Judgment Remedy Claim for Hearing to Dissolve or Modify Form

SECTION I - CASE INFORMATION (To be completed by Plaintiff/Applicant) SECTION II - NOTICE TO DEFENDANT SECTION III - DEFENDANT'S CLAIM AND REQUEST FOR HEARING (To be completed by Defendant) STATE OF CONNECTICUT SUPERIOR COURT NOTICE OF EX PARTE PRE- JUDGMENT REMEDY/CLAIM FOR HEARING TO DISSOLVE OR MODIFY JD-CV-55 Rev. 3-03 C.G.S. §§ 52-278e, 52-278f COURT ADDRESS Housing Session G.A. No. Judicial District Has a temporary restraining order been requested? NAME OF CASE (First-named plaintiff vs. First-named defendant) SEE ATTACHED FORM JD-CV-67 FOR CONTINUATION PARTIES CASE TYPE (From Judicial Branch code list) MAJOR: MINOR: NO. COUNTS YES NO NAME AND ADDRESS OF PLAINTIFF/APPLICANT (Person making application for Prejudgment Remedy) (No., street, town and zip code) NAME AND ADDRESS OF DEFENDANT (Person against whom Prejudgment Remedy is sought) (No., street, town and zip code) NAME AND ADDRESS OF ANY THIRD PERSON HOLDING PROPERTY OF DEFENDANT WHO IS SUBJECT TO GARNISHEE PROCESS PREVENTING DISSIPATION O F SUCH PROPERTY FOR THE PLAINTIFF(S) ENTER THE APPEARANCE OF: NAME AND ADDRESS OF ATTORNEY, LAW FIRM OR PLAINTIFF IF PRO SE (No., street, town and zip code) TELEPHONE NO. JURIS NO. (If atty. or law firm) SIGNED You have rights specified in the Connecticut General Statutes, including Chapter 903a, that you may wish to exercise concerning this prejudgment remedy. These rights include the right to a hearing: (1) to object to the prejudgment remedy because you have a defense to or set-off against the action or a counterclaim against the plaintiff or because the amount of the prejudgment remedy allowed by the court is unreasonably high or because payment of any judgment that may be rendered against you is adequately secured by any insurance that you may have; (2) to request that the plaintiff post a bond in accordance with section 52-278d of the General Statutes to secure you against a ny damages that may result from the prejudgment remedy; (3) to request that the prejudgment remedy be dissolved or modified or that you be allowed to substitute a bond for the prejudgm ent remedy; and (4) to show that the property subject to the prejudgment remedy is exempt from such prejudgment remedy. You may request a hearing to move to dissolve or modify the prejudgment remedy. The hearing may be requested by any proper motion or by completing section III below and returning this form to the superior court at the Court Address listed above. NAME OF EACH PARTY SERVED* ADDRESS AT WHICH SERVICE WAS MADE* TYPE OR PRINT NAME AND ADDRESS OF DEFENDANT DOCKET NO.PJR CV DATE MAILED OR DELIVERED SIGNED (Defendant) DATE SIGNED I, the defendant, request a hearing to dissolve or modify the prejudgment remedy, and claim: I certify that a copy of the above claim was mailed/delivered to the Plaintiff or the Plaintiff's attorney on the Date Mailed or Delivered shown below.a defense, counterclaim, set-off, or exemption. that any judgment that may be rendered is adequately secured by insurance. that the amount of the prejudgment remedy is unreasonably high. that the plaintiff be required to post a bond to secure me againstany damages which may result from the prejudgment remedy. that I be allowed to substitute a bond for the prejudgment remedy. *If necessary, attach additional sheet with names of each party served and the address at which service was made. AMOUNT, LEGAL INTEREST, OR PROPERTY IN DEMAND, EXCLUSIVE OF INTEREST AND COSTS IS ("X" one of the following) LESS THAN $2500 $2500 THROUGH $14,999.99 $15,000 OR MORE ("X" if applicable) CLAIMING OTHER RELIEF IN ADDITION TO OR IN LIEU OF MONEY DAMAGES C L P J R X C L P J R X P COURT USE ONLY CLPJRX Ex Parte Application INSTRUCTIONS TO PLAINTIFF/APPLICANT 1. This form MUST be used in connection with ex parte prejudgment remedies issued pursuant to Gen. Stat. § 52-278e, and MAY be used in connection with prejudgment remedies issued in an action upon a commercial transaction pursuant to Gen. Stat. § 52-278f. 2. Complete Section I below and submit to the Clerk along with, and immediately followed by your application and the other required documents for ex parte prejudgment remedy. 3. If prejudgment remedy issued, include this form in the process served on the defendant. CLPJRXP Contest Ex Parte PJR Application FOR COURT USE ONLY DATE SIGNED