Preview
SUMMONS - CIVIL STATE OF CONNECTICUT &2&3 xx <
For information on
JD-CV-1_ Rev. 2-22 ADA accommodations, SUPERIOR COURT
C.G.S. §§ 51-346, 51-347, 51-349, 51-350, 52-45a, 52-48, 52-259; contact a court clerk or
P.B. §§ 3-1 through 3-21, 8-1, 10-13 go to: www.jud.ct.gov/ADA.
www.jud.ct.gov
Instructions are on page 2.
oO Select if amount, legal interest, or property in demand, not including interest and costs, is LESS than $2,500.
kk] Select if amount, legal interest, or property in demand, not including interest and costs, is $2,500 or MORE.
oO Select if claiming other relief in addition to, or in place of, money or damages.
TO: Any proper officer
By authority of the State of Connecticut, you are hereby commanded to make due and legal service of this summons and attached complaint.
‘Address of court clerk (Number, street, town and zip code) Telephone number of clerk Return Date (Must be a Tuesday)
300 Grand Street, Waterbury, CT 06762 (203 )591 -3300 May 7, 2024
[x] Judicial District ‘At (City/Town) Case type code (See list on page 2)
(1 Housing Session CO Number: Waterbury Major: V Minor: €20
For the plaintiff(s) enter the appearance of:
Name and address of attorney, law firm or plaintiff if self-represented (Number, street, town and zip code) Juris number (Fatiomey or faw firm)
Mark F. Griffin, Griffin Injury Law LLC, P.O. Box 1004, Middlebury, CT 06762 440190
Telephone number Signature of plaintiff ( self represented)
(860 )317 - 7007
The attorney or law firm appearing for the plaintiff, or the plaintiff if
self-represented, agrees to accept papers (service) electronically
E-mail address for deliver
Connecticut Practice Boot x eee under Section 10-13 of the
in this case under Section 10-13 of the Connecticut Practice Book. . [x] Yes [] No mfgriffin@griffinilawct.com
Parties Name (Last, First, Middle Initial) and address of each party (Number; street; P.O. Box; town; state; zip; country, if not USA)
First Name: Poplaski, Rachel P01
plaintiff Address: 201 Bluebird Drive, Naugatuck, CT 06770
Additional Name: P02
plaintiff Addres
First Name: - Progressive Direct Insurance Company, 6300 Wilson Mills Road, Mayfield Village, Ohio 44143
D-01
defendant Addres 3: Agent-For-Service: Insurance Commissioner Andrew N. Mais, 153 Market Street, Hartford, CT 06103
Additional Name: D-02|
defendant Address;
Additional Name: D-03|
defendant Address:
Additional Name: D-04)
defendant Address:
Total number of plaintiffs: 1 Total number of defendants: 1 [J Form JD-CV-2 attached for additional parties
Notice to each defendant
1 You are being sued. This is a summons in a lawsuit. The complaint attached states the claims the plaintiff is making against you.
2 To receive further notices, you or your attorney must file an Appearance (form JD-CL-12) with the clerk at the address above. Generally,
it must be filed on or before the second day after the Return Date. The Return Date is not a hearing date. You do not have to come to
court on the Return Date unless you receive a separate notice telling you to appear.
If you or your attorney do not file an Appearance on time, a default judgment may be entered against you. You can get an Appearance
form at the court address above, or on-line at https://jud.ct.gov/webforms/.
If you believe that you have insurance that may cover the claim being made against you in this lawsuit, you should immediately contact
your insurance representative er actions you may take are described in the Connecticut Practice Book, which may be found in a
‘superior court law library or 6n-line‘at https:/Awww.jud.ct.gov/pb.htm.
If you have questions about the sami ns and complaint, you should talk to an attorney.
The court staff is not all ed jiv@\advice on legal matters.
Date ‘Signed (Sign ct Ipebiox) De] Commissioner of Superior Court | Name of person signing
oO Clerk | Mark F. Griffin
Vv For Court Use Only
If this summons is signed by a Oerk:
File Date
a. The signing has been done so that the plaintiff(s) will not be denied access to the courts.
b. It is the responsibility of the plaintiff(s) to ensure that service is made in the manner provided by law.
c. The court staff is not permitted to give any le vice in connection with any lawsuit.
d. The Clerk signing this summons at the requést of the plaintiff(s) is not responsible in any way for any
errors or omissions in the summons, any“allegations contained in the complaint, or the service of the
summons or complaint. A_/
I certify | have read and | Signed (Seif Date Docket Number
understand the above:
v
[Print Fora jf Page 1 of 2 I Reset Form |
Instructions
1. Type or print legibly. If you are a self-represented party, this summons must be signed by a clerk of the court.
2. If there is more than one defendant, make a copy of the summons for each additional defendant. Each defendant must receive a copy of
this summons. Each copy of the summons must show who signed the summons and when it was signed. If there are more than two
plaintiffs or more than four defendants, complete the Civil Summons Continuation of Parties (form JD-CV-2) and attach it to the original
and all copies of the summons.
Attach the summons to the complaint, and attach a copy of the summons to each copy of the complaint. Include a copy of the Civil
Summons Continuation of Parties form, if applicable.
After service has been made by a proper officer, file the original papers and the officer's return of service with the clerk of the court.
Use this summons for the case type codes shown below.
Do not use this summons for the following actions:
(a) Family matters (for example divorce, child support, (e) Administrative appeals
custody, parentage, and visitation matters) (f) Proceedings pertaining to arbitration
(b) Any actions or proceedings in which an attachment, (g) Summary Process (Eviction) actions
gamishment or replevy is sought (h) Entry and Detainer proceedings
(c) Applications for change of name (i) Housing Code Enforcement actions
(d) Probate appeals
Case Type Codes
MAJOR CODE MAJOR CODE
Major! MINOR DESCRIPTION Major! MINOR DESCRIPTION
DESCRIPTION Minor
DESCRIPTION Minor
Contracts coo Construction - All other Property Poo Foreclosure
c10 Construction - State and Local P10 Partition
c20 Insurance Poticy P20 Quist Tite/Dischargo of Mortgage or Lien
cs Specific Performance P30 Assot Forfeiture
c40 Collections: Po All other
cso Uninsured/Underinsured Moterist Coverage
cé Uniform Limited Liabilty Company Act —C.G.S. 34-243
cso Allother Torts (Other T02 Defective Premises - Private - Snow or Ice
than Vehicular) TOS Defective Premises - Private - Other
Eminent Eco ‘State Highway Condemnation TW Defective Premises - Public - Snow or Ice
Domain E10 Redevelopment Condemnation T12 Defective Premises - Public
- Other
E20 Other State or Municipal Agencios T20 Products Liability - Other than Vehicular
E30 Public Utilities & Gas Transmission Companies T28 Malpractice - Medical
E80 Allother T29 Malpractice -
T30 Malpractice - All other
Housing - Retum of Security Deposit T40 Assault and Battery
Housing H10
T50 Defamaticn
H12 Housing - Rent and/or Damages Te Animals - Dog
H40 Housing - Housing - Auclta Querela/injunction 768 Animals - Other
H50 Housing - Administrative Appeal T70 False Arrest
H60 Housing - Municipal Enforcement Hm Fire Damago
Ho Housing.Al Other T80 All other
Miscellaneous M00 Injunetion
M10 Recelvership Vehicular Torts vor Motor Vehicles' - Driver and/or Passenger(s) vs. Driver(s)
M15 Receivership for Abandoned/Blighted Property vo4 Motor Vehiclos® - Pedestrianvs. Driver
M20 Mandamus vos Motor Vehiclos* - Proparty Damage only
M30 Habeas Corpus (extradition, reloase from Penal institution) vos Motor Vehicle* - Products Liabilty including Warranty
veo Motor Vehicle’ - All other
M40 Asbitration
vi0 Boats
M50 Declaratory Judgment v20 Airplanes
M63 Bar Disciptine
v30 Raitroads
M66 Department of Labor Unemployment Compensation
va Snowmobiles
Enforcement
M68 Bar Discipline - Inactive Status v80 All other
*Motor Vehicles include cars, trucks,
M70 Municipal Ordinance and Regulation Enforcement motorcycles, and moter scooters.
M80 Foreign Civil Judgments - C.G.S. 62-604 & C.G.S. 50-30
M83 ‘Small Claims Transferto Regular Docket Wills, Estates wi0 Construction of Wills and Trusts.
Med Foreign Protective Order and Trusts weso All other
Meo CHRO Action in the Public Interest - PA. 19-93
M80 All other
Page 2 of 2
Preview
SUMMONS - CIVIL STATE OF CONNECTICUT &2&3 xx < For information on JD-CV-1_ Rev. 2-22 ADA accommodations, SUPERIOR COURT C.G.S. §§ 51-346, 51-347, 51-349, 51-350, 52-45a, 52-48, 52-259; contact a court clerk or P.B. §§ 3-1 through 3-21, 8-1, 10-13 go to: www.jud.ct.gov/ADA. www.jud.ct.gov Instructions are on page 2. oO Select if amount, legal interest, or property in demand, not including interest and costs, is LESS than $2,500. kk] Select if amount, legal interest, or property in demand, not including interest and costs, is $2,500 or MORE. oO Select if claiming other relief in addition to, or in place of, money or damages. TO: Any proper officer By authority of the State of Connecticut, you are hereby commanded to make due and legal service of this summons and attached complaint. ‘Address of court clerk (Number, street, town and zip code) Telephone number of clerk Return Date (Must be a Tuesday) 300 Grand Street, Waterbury, CT 06762 (203 )591 -3300 May 7, 2024 [x] Judicial District ‘At (City/Town) Case type code (See list on page 2) (1 Housing Session CO Number: Waterbury Major: V Minor: €20 For the plaintiff(s) enter the appearance of: Name and address of attorney, law firm or plaintiff if self-represented (Number, street, town and zip code) Juris number (Fatiomey or faw firm) Mark F. Griffin, Griffin Injury Law LLC, P.O. Box 1004, Middlebury, CT 06762 440190 Telephone number Signature of plaintiff ( self represented) (860 )317 - 7007 The attorney or law firm appearing for the plaintiff, or the plaintiff if self-represented, agrees to accept papers (service) electronically E-mail address for deliver Connecticut Practice Boot x eee under Section 10-13 of the in this case under Section 10-13 of the Connecticut Practice Book. . [x] Yes [] No mfgriffin@griffinilawct.com Parties Name (Last, First, Middle Initial) and address of each party (Number; street; P.O. Box; town; state; zip; country, if not USA) First Name: Poplaski, Rachel P01 plaintiff Address: 201 Bluebird Drive, Naugatuck, CT 06770 Additional Name: P02 plaintiff Addres First Name: - Progressive Direct Insurance Company, 6300 Wilson Mills Road, Mayfield Village, Ohio 44143 D-01 defendant Addres 3: Agent-For-Service: Insurance Commissioner Andrew N. Mais, 153 Market Street, Hartford, CT 06103 Additional Name: D-02| defendant Address; Additional Name: D-03| defendant Address: Additional Name: D-04) defendant Address: Total number of plaintiffs: 1 Total number of defendants: 1 [J Form JD-CV-2 attached for additional parties Notice to each defendant 1 You are being sued. This is a summons in a lawsuit. The complaint attached states the claims the plaintiff is making against you. 2 To receive further notices, you or your attorney must file an Appearance (form JD-CL-12) with the clerk at the address above. Generally, it must be filed on or before the second day after the Return Date. The Return Date is not a hearing date. You do not have to come to court on the Return Date unless you receive a separate notice telling you to appear. If you or your attorney do not file an Appearance on time, a default judgment may be entered against you. You can get an Appearance form at the court address above, or on-line at https://jud.ct.gov/webforms/. If you believe that you have insurance that may cover the claim being made against you in this lawsuit, you should immediately contact your insurance representative er actions you may take are described in the Connecticut Practice Book, which may be found in a ‘superior court law library or 6n-line‘at https:/Awww.jud.ct.gov/pb.htm. If you have questions about the sami ns and complaint, you should talk to an attorney. The court staff is not all ed jiv@\advice on legal matters. Date ‘Signed (Sign ct Ipebiox) De] Commissioner of Superior Court | Name of person signing oO Clerk | Mark F. Griffin Vv For Court Use Only If this summons is signed by a Oerk: File Date a. The signing has been done so that the plaintiff(s) will not be denied access to the courts. b. It is the responsibility of the plaintiff(s) to ensure that service is made in the manner provided by law. c. The court staff is not permitted to give any le vice in connection with any lawsuit. d. The Clerk signing this summons at the requést of the plaintiff(s) is not responsible in any way for any errors or omissions in the summons, any“allegations contained in the complaint, or the service of the summons or complaint. A_/ I certify | have read and | Signed (Seif Date Docket Number understand the above: v [Print Fora jf Page 1 of 2 I Reset Form | Instructions 1. Type or print legibly. If you are a self-represented party, this summons must be signed by a clerk of the court. 2. If there is more than one defendant, make a copy of the summons for each additional defendant. Each defendant must receive a copy of this summons. Each copy of the summons must show who signed the summons and when it was signed. If there are more than two plaintiffs or more than four defendants, complete the Civil Summons Continuation of Parties (form JD-CV-2) and attach it to the original and all copies of the summons. Attach the summons to the complaint, and attach a copy of the summons to each copy of the complaint. Include a copy of the Civil Summons Continuation of Parties form, if applicable. After service has been made by a proper officer, file the original papers and the officer's return of service with the clerk of the court. Use this summons for the case type codes shown below. Do not use this summons for the following actions: (a) Family matters (for example divorce, child support, (e) Administrative appeals custody, parentage, and visitation matters) (f) Proceedings pertaining to arbitration (b) Any actions or proceedings in which an attachment, (g) Summary Process (Eviction) actions gamishment or replevy is sought (h) Entry and Detainer proceedings (c) Applications for change of name (i) Housing Code Enforcement actions (d) Probate appeals Case Type Codes MAJOR CODE MAJOR CODE Major! MINOR DESCRIPTION Major! MINOR DESCRIPTION DESCRIPTION Minor DESCRIPTION Minor Contracts coo Construction - All other Property Poo Foreclosure c10 Construction - State and Local P10 Partition c20 Insurance Poticy P20 Quist Tite/Dischargo of Mortgage or Lien cs Specific Performance P30 Assot Forfeiture c40 Collections: Po All other cso Uninsured/Underinsured Moterist Coverage cé Uniform Limited Liabilty Company Act —C.G.S. 34-243 cso Allother Torts (Other T02 Defective Premises - Private - Snow or Ice than Vehicular) TOS Defective Premises - Private - Other Eminent Eco ‘State Highway Condemnation TW Defective Premises - Public - Snow or Ice Domain E10 Redevelopment Condemnation T12 Defective Premises - Public - Other E20 Other State or Municipal Agencios T20 Products Liability - Other than Vehicular E30 Public Utilities & Gas Transmission Companies T28 Malpractice - Medical E80 Allother T29 Malpractice - T30 Malpractice - All other Housing - Retum of Security Deposit T40 Assault and Battery Housing H10 T50 Defamaticn H12 Housing - Rent and/or Damages Te Animals - Dog H40 Housing - Housing - Auclta Querela/injunction 768 Animals - Other H50 Housing - Administrative Appeal T70 False Arrest H60 Housing - Municipal Enforcement Hm Fire Damago Ho Housing.Al Other T80 All other Miscellaneous M00 Injunetion M10 Recelvership Vehicular Torts vor Motor Vehicles' - Driver and/or Passenger(s) vs. Driver(s) M15 Receivership for Abandoned/Blighted Property vo4 Motor Vehiclos® - Pedestrianvs. Driver M20 Mandamus vos Motor Vehiclos* - Proparty Damage only M30 Habeas Corpus (extradition, reloase from Penal institution) vos Motor Vehicle* - Products Liabilty including Warranty veo Motor Vehicle’ - All other M40 Asbitration vi0 Boats M50 Declaratory Judgment v20 Airplanes M63 Bar Disciptine v30 Raitroads M66 Department of Labor Unemployment Compensation va Snowmobiles Enforcement M68 Bar Discipline - Inactive Status v80 All other *Motor Vehicles include cars, trucks, M70 Municipal Ordinance and Regulation Enforcement motorcycles, and moter scooters. M80 Foreign Civil Judgments - C.G.S. 62-604 & C.G.S. 50-30 M83 ‘Small Claims Transferto Regular Docket Wills, Estates wi0 Construction of Wills and Trusts. Med Foreign Protective Order and Trusts weso All other Meo CHRO Action in the Public Interest - PA. 19-93 M80 All other Page 2 of 2