Affidavit of Service, Petition For Order

If the affiant in a case wants to certify that a copy of the Petition and Notice of Hearing was successfully served to the defendants within the pre-defined deadline, he/she has to execute this affidavit. The form has to be completed and sent along with information that proves the delivery of the hearing notices.

Extracted Text for Proper Search

STATE OF CONNECTICUT SUPERIOR COURT	
JD-CV-69    Rev. 10-15 
C.G.S. § 46a-82e(d)
Instructions To Petitioner
Complete the Affidavit (the Docket Number is the number assigned by the\
 
clerk to your original petition), attach your return receipts and file \
the Affidavit 
with the clerk of court no later than five days after service was made.
AFFIDAVIT OF SERVICE PETITION FOR ORDER 
RE: COMMISSION ON HUMAN RIGHTS AND 
OPPORTUNITIES AND NOTICE OF HEARING
TO: Superior Court for the Judicial District of Hartford,  95 Washington Street, Hartford, CT 06106
Affidavit of Service AFFIDAVIT OF SERVICE 
PETITION FOR ORDER RE: COMMISSION ON HUMAN RIGHTS AND OPPORTUNITIES AND \
NOTICE OF HEARING
I, the undersigned Petitioner in the above referenced Petition for Order\
 RE: Commission on Human Rights and 
Opportunities and Notice of Hearing, certify that a copy of the Petition\
 and Notice of Hearing in the above referenced matter 
was served on the date and in the manner noted below for each of the def\
endants, and that I have attached the return 
receipts that I have received indicating the delivery of the Petition an\
d Notice of Hearing:	
Name of Respondent	Method Of Service 
Certified/Registered	Date of 
Service	Return Receipt  Number	
1.
2.
3.
4.	
(If additional Respondents were served, complete a second affidavit)	
Insert town where signed	Dated at , Connecticut on	Insert date you sign the affidavit of service	
Subscribed and sworn to before me at thisday of ,.	
Commissioner of the Superior Court/Notary Public	
My Commission Expires
SIGNED	
Petitioner/Attorney	
Docket number	
Name of petitioner	Address of petitioner 
(Number, street, town, zip code)	
Name of respondent	Address of respondent  (Number, street, town, zip code)	
CHRO Case name	CHRO Case number	
25 SIGOURNEY STREET, HARTFORD, CT 06106
COMMISSION ON HUMAN RIGHTS & OPPORTUNITIES	
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.