Form Jd-Cr-9 - Application For Accelerated Pretrial Rehabilitation Page 2
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1
2Military Status
Have you ever served in the U.S. Armed Forces, including the Connecticut National Guard
(as defined in section 27-103 of the Connecticut General Statutes)?
Yes
No
If you have ever served in the armed forces: (“X” one)
I am an active member of the armed forces.
I was discharged or released from active service in the armed forces honorably or under conditions other than dishonorable.
I was dishonorably discharged from active service in the armed forces.
By signing this form, I am saying that I understand all of the information included on this form, and I request that I be allowed into
Accelerated Pretrial Rehabilitation under section 54-56e of the Connecticut General Statutes.
Signed (Defendant)
Date signed
I have read the above
Consented to by (Parent or Guardian)
►
information and understand it.
Signed (Duly authorized person)
Print name
Date signed
Oath
The defendant stated under penalties of perjury before me, duly designated by the clerk and authorized to administer oaths, that he or she
never has never used this program before, that he or she used this program only once before for a misdemeanor or a motor vehicle
violation that had a potential penalty of 1 year of imprisonment or less, and at least 10 years have gone by since that charge was dismissed,
or that he or she is a veteran (a person who was discharged or released under conditions other than dishonorable from active service in the
armed forces as defined in section 27-103 of the Connecticut General Statutes), and has only used this program once before.
Date signed
Signed (Assistant Clerk/Duly authorized person)
Print name
First Order of the Court
The Application is denied.
The defendant's oath under section 54-56e of the Connecticut General Statutes was taken ("X" one):
In open court.
Outside of court by a person designated by the clerk and duly authorized to administer oaths.
The Application is continued to the Court Hearing Date listed below, and the defendant is referred to the Court Support Services
Division for a determination of eligibility and a confirmation of inability to pay or indigency if the defendant has filed an affidavit
claiming an inability to pay or indigency. The defendant must also send notice to any victim(s) of his or her offense(s) telling them
of the opportunity to tell the court whether they think the court should grant the application. This notice must be sent on form
JD-CR-10 by Registered or Certified Mail on or before the Notice Date listed below.
The court orders the court file sealed as to the public.
Court hearing date and time
Notice date
Signed (Judge or Assistant Clerk)
Date signed
JD-CR-9 Rev. 10-16
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