State of Connecticut
`Post Teter Lif tf2022
`
`APPLICATION FOR JUDGMENTOF POSSESSION-
`PayfiSTATESOR‘CONNECTICUT 63
`DECEASED TENANT/OCCUPANT-
`R COURT &
`SUMMARY PROCESS(EVICTION)
`-
`hocket? SOEWofcotelgov XY
`JD-HM-39 Rev. 4-19
`we
`inet Here
`QHALTLS
`C.G.S. § 47a-11d
`Recent Moats
`Uabtied
`Amount:
`30.08
`Instructions:
`1. Type orprint legibly
`|
`a
`——
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`2. Attach probate court certificate.
`List Total (caeitypau oS
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`3. File completed application andprobate court certificate with the clerk of the superior court.
`Minor
`Major H
`03
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` Address of court
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`[| Judicial District
`Telephone numberofclerk
`[x] Housing Session
`(203)789-7937
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`121 Elm Street, New Haven, CT 06510
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`Address of premises
`;
`200 Oak Street, #112, West Haven, CT 06515
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`Parties=‘[Name (Last, First, MiddleInitial) and Address of Each party (Number; Street; P.O. Box;
`Town; State; Zip; Country, if not USA)
`[P-01|
`First Plaintiff
`Name:
`Savin Rock, LLC
`
`
`
`
`(Landlord)
`Address: 200-204 Oak Street, West Haven, CT 06516
`Additional Plaintiff
`Name:
`[P-02,
`
`
`.
`(Landlord)
`Address:
`[D-04|
`Defendant (Deceased|Name: ThomasGillis
`
`
`Tenant/Occupant)_|Address: 200 Oak Street, #112, West Haven, CT 06516 |
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`Next of Kin/ }O-04|Name: Toni Siedlarz ]
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`Emergency Contact|Address: 200 Oak Street, #77, West Haven, CT 06516
`[0-02
`Additional Next of Kini
`|Name: Elaine Gibbs
`
`
`
`[L-01|
`
`
`L-01
`Probate
`Name: West Haven Probate Court, PD-39
`Court
`Address: 355 Main Street 2nd Floor, West Haven, CT 06516
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`[_] Form JD-CV-2 attached for additional parties
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`!|‘
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`Emergency Contact|address: 12 West Read Street, New Haven, CT 06511 ,
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`Application for Judgment of Possession:
`1. The plaintiff (landlord) and defendant (deceased tenant/occupant) agreed that the defendant (deceased tenant/occupant)
`would lease (rent) on a monthly basis or for a term, the premises (rental property) named above.
`|
`2. The defendant (deceased tenant/occupant) was the sole occupantof the dwelling.
`wo
`. The right of the defendant (deceased tenant/occupant) to occupy the premises terminated uponhis/her death.
`4. Theplaintiff (landlord) obtained from the probate court having jurisdiction over the premisesa certificate indicating that the
`landlord has complied with the notice and inventory andfiling requirements contained in Section 47a-11d of the Connecticut
`General Statutes.
`5. The probate court certificate has beenfiled with this application.
`6. Based on the above,theplaintiff (landlord) asks this court for judgment for immediate possession of the premises.
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`Signed (Plaintifi{(sapdiGpcie
`Printortype nameandtitle of person signing
`Date signed
`
`Oa GEE
`>
`Karen Baldwin Kravetz
`11/18/2022
`
`
`
`Forthe plaintiff(s) enter the appearanceof:
`Name and addressofattorney, law firm,orplaintiff(s) (number, street, fown and zip code)
`Susman, Duffy & Segaloff, P.C.
`The attomeyorlawfirm appearingfortheplaintiff, or the plaintiff ifself-represented, agrees to accept oy.
`papers (service)electronically in this case under Section 10-13 ofthe Connecticut Practice Book.
`E-mail addressfor delivery of papers under Section 10-13 of the Connecticut Practice Book (if agreedto)
`
`Telephone number
`Juris Number(iattomeyorlawfirm)
`(203)624-9830
`062505
`DN Signature of piaintifi(s) or-attorney
`9
`LEEea
`_———
`I
`fo
`=
`Rib
`in
`2EorCourtt
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` File Date
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`es
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` ADA NOTICE
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`
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`Docket Number
`NHHCV>2 -00:
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`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 ADAcontact personlisted at www.jud.ct.gov/ADA.
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`
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