Form Jd-Cr-44 - Pretrial Alcohol Education Program Application (Page 2 of 2) in pdf

Oath

The applicant stated under penalties of perjury before me, duly designated by the clerk and authorized to administer oaths, that

(1) if (s)he is charged with a violation of section 14-227a, 14-227g, 15-133(d), or 15-140n of the Connecticut General Statutes or a violation

of Public Act 16-126 section 1 or section 2(a)(1) or (2), (s)he has not had the Pretrial Alcohol Education Program invoked in his/her

behalf within the preceding ten (10) years for a violation of section 14-227a, 14-227g, 15-133(d), or 15-140n of the Connecticut General

Statutes or a violation of Public Act 16-126 section 1 or section 2(a)(1) or (2);

(2) that (s)he has never been convicted of a violation of:

a. Section 14-227g, 53a-56b, or 53a-60d of the Connecticut General Statutes;

b. Public Act 16-126 section 1 or section 2(a)(1) or (2);

c. Section 14-227a(a) of the Connecticut General Statutes before, on or after October 1, 1981; or

d. Section 14-227a(a)(1) or (2) of the Connecticut General Statutes on or after October 1, 1985;

(3) that (s)he has not been convicted of a violation of section 15-132a, 15-133(d), 15-140l, or 15-140n of the Connecticut General Statutes;

(4) that (s)he has not been convicted in any other state, at any time, of an offense that has essential elements that are substantially the

same as sections 14-227a(a)(1) or (2), 15-132a, 15-133(d), 15-140l, 15-140n, 53a-56b, or 53a-60d of the Connecticut General Statutes

or a violation of Public Act 16-126 section 1 or section 2(a)(1) or (2);

(5) if (s)he is charged with a violation of section 14-227a of the Connecticut General Statutes or a violation of Public Act 16-126 section 1 or

section 2(a)(1) or (2), (s)he was not operating a commercial motor vehicle as that term is defined in section 14-1 of the Connecticut

General Statutes or holding a commercial driver's license or commercial driver's inspection permit at the time of the violation; and

(6) that (s)he has given, by registered or certified mail, notice of this application to any victim(s) of the alleged violation(s) or crime(s) who

suffered a serious physical injury, as that term is defined by section 53a-3 of the Connecticut General Statutes, so that those victim(s)

are aware of the opportunity to give the court his or her opinion on this application.

Print name

Date Signed

Signed (Duly authorized person)

First Order of the Court

("X" all that apply)

The application is denied.

The court waives the following fee(s) or portion of fees having found that the defendant is indigent or unable to pay:

Application fee: all ; $

Evaluation fee: all ; $

The applicant's oath under section 54-56g of the Connecticut General Statutes was taken:

("X" one)

in open court.

outside of court by a person duly designated by the clerk and authorized to administer oaths.

The case is continued until the date and time listed below to consider the CSSD assessment of eligibility and the DMHAS evaluation

and/or for the applicant to file an affidavit of indigency and for CSSD to seek to confirm such indigency.

The Court orders the court file sealed as to the public.

Case Continued To (Date and time)

Signed (Judge, Assistant Clerk)

Date Signed

JD-CR-44 (Back) Rev. 10-16

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Form Jd-Cr-44 - Pretrial Alcohol Education Program Application Page 2