Form Jd Cr 104 PDF Details

Form JD-CR 104 is a form used by the state of California to collect information from employers who have had an employee file a Workers' Compensation claim. The form allows the employer to provide details about the injury, as well as the dates and circumstances surrounding it. The information collected on this form will help the state determine whether or not benefits are owed to the employee. Filing Form JD-CR 104 is mandatory for any employer who has had an employee file a Workers' Compensation claim.

QuestionAnswer
Form NameForm Jd Cr 104
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesct sentence application, ct sentence reviewed, ct notice right, ct notice application

Form Preview Example

NOTICE OF RIGHT TO HAVE SENTENCE

STATE OF CONNECTICUT

REVIEWED/APPLICATION FOR REVIEW

SUPERIOR COURT

JD-CR-104 Rev. 3-12

www.jud.ct.gov

C.G.S. §§ 51-195, 54-227, Pr. Bk. §§ 43-24, 43-26

Instructions To Clerk

1.Give defendant one form per docket number.

2.Complete top portion of form with case information.

3.Do not accept this Application if the Applicant indicates being in the custody of the Department of Correction and fails to submit a completed form JD-VS-3, Inmate Notice of Application.

4.Complete For Court Use Only section at bottom of Application section of form.

5.Make 5 copies. Submit original to Sentence Review Division. Give one copy each to the Sentencing Judge, Court Reporter, Defense Counsel, and State's Attorney, and put one copy in the Court File.

6.When sending to Sentence Review Division, complete transmittal on back of this form.

Instructions To Court Reporter

Upon receipt, transcribe and forward to Sentence Review Division the sentencing hearing for applicant unless such transcript has already been ordered and will be provided to the clerk.

Inmate number

State of Connecticut vs. (Name of Defendant)

From (Judicial district or Geographical area)

At (Town)

Docket number

Address of court where sentenced (Number, street, town and zip code)

Date of sentence

Notice to the Defendant Named Above

You have the right to have the sentence you received today reviewed by the Sentence Review Division of the Superior Court. If it is reviewed, your sentence may be made longer or shorter within the limits of the sentence set by law, another sentence or sentences that you could have been given at the time of your sentencing may be given to you, or the Sentence Review Division may decide that the sentence you were given is correct and should not be changed.

If the court decides that you cannot afford to hire an attorney, you have the right to ask the court at the court location listed above to appoint an attorney to represent you before the Sentence Review Division of the Superior Court.

To have your sentence reviewed, fill-out the Application below, sign it, and file it (all pages) with the Clerk of the Superior Court at the address listed above within thirty (30) days from the date of sentence above or, if you received a suspended sentence that was revoked, within thirty (30) days from the date that your sentence was revoked. Fill-out a separate application for each case you are requesting a review of your sentence for.

If you are in the custody of the Department of Correction, your application cannot be accepted by the clerk unless you fill out, sign, and file an Inmate Notice of Application, form JD-VS-3, with your application. Under section 54-227 of the Connecticut General Statutes, receipt of the completed Inmate Notice of Application form by the clerk is proof that you have given notice of your application to the Office of Victim Services and to the Department of Correction, Victim Services Unit.

Application For Review Of Sentence

To: The Superior Court

I am applying to the Sentence Review Division of the Superior Court for a review of the sentence I received in the case named above ("X" one):

I was represented by counsel in this matter.

I represented myself in this matter and I do not want an attorney to represent me. I represented myself in this matter and I do want an attorney to represent me.

I ask the clerk to give to the Sentence Review Division the documents listed below that were given to the court at the time I was sentenced (specify documents ):

("X" one):

I am not in the custody of the Department of Correction.

I am in the custody of the Department of Correction. I notified the Office of Victim Services and the Department of Correction, Victim Services Unit of this application. I filled out form JD-VS-3, Inmate Notice of Application, and it is attached to this application to prove that I notified the Office of Victim Services and the Department of Correction, Victim Services Unit.

Correctional facility where you are incarcerated (If this applies to you)

Signed (Defendant/Applicant)

Date signed

 

 

For Court Use Only (To be completed by clerk)

Name of sentencing Judge

Name, address and juris number of prosecuting authority

 

 

Court Use Only - Stamp Date Received

Name, address and juris number of defense counsel

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/

Sentence Review Division

 

225 Spring Street

 

Date

Second Floor

 

Wethersfield, CT 06109

 

 

Dear Sentence Review Division:

An application for review of sentence has been filed with the court. Enclosed is the original application and the item(s) checked below:

1. Copy of Transcript of proceedings at time of sentencing, if already in the court file.

2. Copy of Presentence Investigation.

3. Copy of any medical or psychiatric examinations.

4. Copy of Information including Part B or Part II Information(s).

5. Copy of Substitute Information.

6. Copy of Judgment File.

7. Name and address of guardian ad litem.

8. Other (specify):

Very truly yours,

Clerk of the Court

JD-CR-104 (Back) Rev. 3-12

How to Edit Form Jd Cr 104 Online for Free

You could fill out ct sentence application easily using our PDFinity® online tool. Our editor is continually developing to give the very best user experience achievable, and that is because of our commitment to continuous enhancement and listening closely to user comments. Starting is easy! All you need to do is take these simple steps below:

Step 1: Click the "Get Form" button above on this page to open our tool.

Step 2: Using this online PDF editing tool, you can actually do more than simply complete blank fields. Try all of the features and make your docs seem sublime with custom textual content put in, or adjust the file's original content to excellence - all comes with the capability to add any graphics and sign the file off.

With regards to the blanks of this precise form, here is what you should know:

1. To start off, when filling out the ct sentence application, start in the part that has the following blanks:

notice reviewed conclusion process outlined (part 1)

2. Once your current task is complete, take the next step – fill out all of these fields - Application For Review Of Sentence, I was represented by counsel in, I ask the clerk to give to the, X one, I am not in the custody of the, I am in the custody of the, Correctional facility where you, Court Use Only Stamp Date Received, Signed DefendantApplicant, Date signed, For Court Use Only To be completed, Name of sentencing Judge, Name address and juris number of, and Name address and juris number of with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

notice reviewed writing process detailed (portion 2)

It is easy to get it wrong when filling in your Court Use Only Stamp Date Received, so be sure to look again prior to deciding to submit it.

3. The following part is all about Sentence Review Division Spring, Dear Sentence Review Division, Date, An application for review of, Copy of Transcript of proceedings, Copy of Presentence Investigation, Copy of any medical or, Copy of Information including, Copy of Substitute Information, Copy of Judgment File, Name and address of guardian ad, and Other specify - type in all of these blank fields.

Stage no. 3 for submitting notice reviewed

Step 3: Go through all the details you've inserted in the blank fields and hit the "Done" button. Right after registering afree trial account at FormsPal, you will be able to download ct sentence application or email it promptly. The file will also be accessible through your personal cabinet with your each edit. FormsPal is dedicated to the personal privacy of our users; we make sure that all information coming through our editor stays protected.

Form Jd Cr 104 isn’t the one you’re looking for?

Related Documents