Form Jd Cr 127 – Fill Out and Use This PDF

JUDICIAL DISTRICT OR G.A. NO.	COURT LOCATION (No., street, town and zip code)		DOCKET NUMBER
NAME OF DEFENDANT		ADDRESS OF DEFENDANT
NAME OF RESPONDENT(Person against whom application is filed)		ADDRESS OF RESPONDENT
NAME OF APPLICANT (Prosecutorial Official)		ADDRESS OF APPLICANT
NAME OF WITNESS
	APPLICATION FOR TEMPORARY RESTRAINING ORDER

The above named Witness is a witness in the above pending criminal matter. Based on the facts set forth in the attached affidavit, there are reasonable grounds to believe that a temporary restraining order directed to the above named Respondent is needed because harassment of the above named Witness exists or such an order is necessary to prevent and restrain the commission of an offense under section 53a-151 of the general statutes or section 1 of public act 99-240.

For the reasons set forth in the attached affidavit, notice should not be required and there is a reasonable probability that the state will prevail on the merits.

EX PARTE TEMPORARY RESTRAINING ORDER (If requested)

The foregoing Affidavit and Application for an Ex Parte Temporary Restraining Order having been presented to and been considered by the undersigned, a judge of the Superior Court, the undersigned (a) is satisfied therefrom that grounds exist to issue this Ex Parte Restraining Order, and (b) finds that said affidavit established that prior notice of the application should not be required and that there are reasonable grounds to believe that harassment of the above Witness in the above criminal case exists or that an order is necessary to prevent and restrain the commission of an offense under section

53a-151 of the general statutes or section 1 of public act 99-240, and that the state is likely to prevail on the merits of said application.

The Respondent named above is hereby ordered to:

Refrain from imposing any restraint upon the person or liberty of the Witness.

Refrain from threatening, harassing, assaulting, molesting or sexually assaulting the Witness.

Refrain from entering the family dwelling, or any dwelling occupied by the Witness.

The Court further orders (Specify:)

This restraining order shall remain in effect until:(not to exceed 10 days) unless extended by order

of the court, except that the order shall be automatically extended if the prosecutorial official files an application for a protective order pursuant to section 3 of public act 99-240, until such time as the court makes a decision on the issuance of such protective order.

The Applicant is ordered to forthwith file this Application and Order with the clerk of court.

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ORDER OF COURT ON MOTION TO DISSOLVE OR MODIFY

The Respondent having appeared and moved to dissolve or modify the temporary restraining order, after hearing it is hereby ordered that said motion be

and that said temporary restraining order is hereby

DISSOLVED

MODIFIED (Specify modification)

DENIED

ORDER AND NOTICE OF HEARING - NON EX PARTE TRO

An Application for a Temporary Restraining Order having been presented to the Court, it is hereby ordered that a hearing be held at the Court Location shown below. The Clerk shall cause notice of the Date and Time of Hearing, a copy of the Application and of any affidavit(s) in support of said Application to be sent to the Respondent and the Defendant, if different, and to the State's Attorney not less than two days before the Date of Hearing.

NOTICE TO RESPONDENT

A hearing on the Application for Temporary Restraining Order has been scheduled by the court. At this hearing, the court may order relief as requested in the Application. If you wish to be heard concerning the application, you must appear in court on the date and time shown above.

IMPORTANT - SEE HANDGUN RESTRICTIONS BELOW

NOTICE - HANDGUN RESTRICTIONS FOR PERSONS SUBJECT TO RESTRAINING OR PROTECTIVE ORDERS

If you are subject to a restraining or protective order issued by a court in a case involving the use, attempted use or threatened use of physical force against another person:

1.You are not eligible to receive a permit or eligibility certificate allowing you to carry a pistol or revolver (Connecticut General Statutes Sections 29-28(b)(6), 29-36f(b)(6));

2.Any permit or eligibility certificate which you now hold shall be revoked and you must surrender such permit or eligibility certificate to the authority that issued it within 5 days of being notified that it has been revoked. If you do not surrender such permit or eligibility certificate as required, you will be guilty of a class C misdemeanor which is punishable by a fine of up to five hundred dollars or imprisonment of up to three months or both (Connecticut General Statutes Sections 29-32 and 29-36i);

3.You must transfer all pistols and revolvers which you possess to a person who is eligible to possess them or surrender them to the Commissioner of Public Safety within two business days of becoming subject to such order. If you do not do so, you will be subject to a fine of up to five thousand dollars or imprisonment of up to five years or both (Connecticut General Statutes Sections 29-36k and 29-33); and

4.If you possess any pistol or revolver after you have had notice of such order and an opportunity to be heard, you will be guilty of criminal possession of a pistol or revolver. Criminal possession of a pistol or revolver is a class D felony which is punishable by a fine of up to five thousand dollars or a term of imprisonment of up to five years or both (Connecticut General Statutes Section 53a-217c(5)).

JD-CR-127 (Page 2) New 11/99

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