Form Jd-Jm-90 - Petition For Emancipation - Connecticut Superior Court For Juvenile Matters Page 3
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3Docket number
Return of Service
STATE OF CONNECTICUT
County of
Name of person(s) served
Date of service
SS.
Fees
Copy
Then and there, I duly served the foregoing petition, order and summons on the above-named
respondent(s), by either (check one):
Endorsement
leaving with (for in hand); or
leaving at the usual place of abode (for abode)
Service
at__________________________________________
Travel
The within and foregoing is a true and attested copy of the original petition, order, and summons.
Attest (Signature and title of proper officer)
Total
STATE OF CONNECTICUT
County of
Name of person(s) served
Date of service
SS.
Fees
Copy
Then and there, I duly served the foregoing petition, order and summons on the above-named
respondent(s), by either (check one):
Endorsement
leaving with (for in hand); or
leaving at the usual place of abode (for abode)
Service
at__________________________________________
Travel
The within and foregoing is a true and attested copy of the original petition, order, and summons.
Attest (Signature and title of proper officer)
Total
STATE OF CONNECTICUT
County of
Name of person(s) served
Date of service
SS.
Fees
Copy
Then and there, I duly served the foregoing petition, order and summons on the above-named
respondent(s), by either (check one):
Endorsement
leaving with (for in hand); or
leaving at the usual place of abode (for abode)
Service
at__________________________________________
Travel
The within and foregoing is a true and attested copy of the original petition, order, and summons.
Attest (Signature and title of proper officer)
Total
For Mail Service
STATE OF CONNECTICUT
County of
United States Port Office at (Town)
Date of service
SS.
Then and there, by virtue hereof, I made service of the within petition, order and summons by
Fees
depositing a true and attested copy by United States Post mail, postage prepaid, addressed to
Copy
______________________________________________________________, by (check one):
restricted delivery, return receipt requested; or
Endorsement
first class mail; or
certified mail, return receipt requested.
Service
The within and foregoing is the original petition, order and summons with my doings thereon endorsed.
Travel
Attest (Signature and title of proper officer)
Total
JD-JM-90 (Page 3) Rev. 7-11
Page 3 of 3
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