SMALL CLAIMS WRIT AND NOTICE OF SUIT, JD-CV-40

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SD-CV-40 Rev. 9-17 Dentin Tite Soace

C.G.S, $§ 51-15, 51-345(g)
Type or print legibly. This Writ and Notice of Suit must be served Barcode
on (delivered to) the defendant(s) before filing I with the court. Label Only
‘See Instructions to Plaintiff on reverse.

2.) Is this a claim between a landlord and a tenant (renter)? (X" one) ‘Yes No
3.) If you answered "yes" to question #2 above,
‘state the town where the rental premises is located:
Address of Each party (Number; Street; P.O. Box; Town; State; Zip; Country, If not USA)

CX" One) tc |] Partnership
Di individuat DBA [| Corporation

mation that will determine where the trial will be
Defendant's residence: | danbury
[Parties | Name (Last, First, Middle Initial) and

Danbury Hospital
24 Hospital Ave., Danbury, CT 06810

Telephone number
203-791-1900

6.) Name, address and zip code of Attorney for Plaintif(s)
Robert L. Peat, 57 North Street, Sulte 102, Danbury, CT 06810

Ato
102661

(One) [] ite …