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[ ONNECTICNS
State Marshal Kenneth Lombardi
8 Huntington Street Suite 141, Shelton, CT 06484
Office: 203-610-1374 E-mail: kenlombo@gmailcom
STi
MARSHAL
Officer's Return of Service
STATE OF CONNECTICUT
SS: S4ef4on DATE: Varre 7 org
COUNTY OF FAIRFIELD
IN THE MATTER CONCERNING: A, x OS LSet
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Then and by virtue hereof and by the direction of the plaintiffs attorney, | made
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by leaving a true and attested copy abode/in hand to Marco onv vray
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atthe address 36 Abe Ae Aor 22 Sf ee OF
with my doings hereon endorsed
FEE 7R —— ATTEST:
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Kenneth Lombardi
State Marshal Fairfield County
Badge #333
RETURN DATE: JULY 97, 2024 SUPERIOR COURT
AXOS BANK J.D. OF ANSONIA-MILFORD
AT MILFORD
v.
MARCO GJURAJ May 29%, 2024
COMPLAINT
(Breach of Contract)
The plaintiff, Axos Bank. (“Axos”) is a national banking association with an office
located at 9205 W. Russell Road, Suite 400, Las Vegas, NV 89148.
The defendant, Marco Gjuraj, upon information and belief, is a Connecticut resident with
residing at 646 Howe Avenue, Apartment 23, Shelton, CT 06484. (“Gjuraj” or
“Defendant”).
On or about June 27, 2022 the Defendant executed that certain promissory note in
favor
of the Plaintiff (the “Note”) in the original principal amount of $25,000.00 (the “Loan”)
A true and accurate copy of the Note is attached hereto as Exhibit A.
Subsequent to the execution of the Note, the Defendant default on his obligations under
the terms of the Note by failing to make payments thereunder.
As of May 29", 2024, the balance due to Axos is 22,756.64. A true and accurate copy
of
the payoff is attached hereto as Exhibit B.
The failure to tender the Indebtedness to Plaintiff constitutes a breach of the Note
WHEREFORE, the Plaintiff seeks:
Money damages;
Post-Judgment interest pursuant to Conn. Gen. Stat. §37a-3;
Attorney Fees;
Costs, and
Such other and further relief as the Court may deem just and equitable.
Respectfully submitted,
PLAINTIFF
By its attorneys,
/s/Shawn M Masterson
Shawn M Masterson (Juris No. 422888)
Cohn & Dussi, LLC
536 Atwells Avenue, Suite 1
Providence, Rhode Island 02909
(781) 494-0200; (401) 226-4578(cell)
Dated: May 29", 2024 smasterson@cohnanddussi.com
RETURN DATE: JULY 9™, 2024 SUPERIOR COURT
AXOS BANK J.D. OF ANSONIA-MILFORD
AT MILFORD
V.
MARCO GJURAJ May 29%, 2024
STATEMENT OF DEMAND
The amount in controversy is greater than $15,000.00 exclusive of interest and costs.
Respectfully submitted,
PLAINTIFF
By its attomeys,
/s/Shawn M Masterson
Shawn M Masterson (Juris No. 422888)
Cohn & Dussi, LLC
536 Atwells Avenue, Suite 1
Providence, Rhode Island 02909
(781) 494-0200; (401) 226-4578(cell)
Dated: May 29", 2024 smasterson@cohnanddussi.com
EXHIBIT A
Promissory Note
Loan Number: 91012625116 Loan Date: 6/27/2022
Maturity Date: 6/27/2027 Principal: $25,000.00 Interest Rats 79%
Axos Bank® ("Lender") Borrower: Marco Gjuraj
9205 W. Russell Rd., Suite 400 646 Howe ave apt 23
Las Vegas, NV 89148 Shelton, CT 06484
Borrower's Promise to Pay. This Promissory Note (the "Note") is entered into by Borrower and the Lender on the date listed above.
"Borrower" means any person who signs this Note. "Lender" means Axos Bank®, or any assignee of the Lender. By signing this Note,
Borrower agrees to all of the terms and conditions of this Note, In return for a loan (the "Loan") that Borrower has received from Lender,
Borrower promises to pay Lender $25,000.00 ("Principal Amount’), plus interest, to the order of Lender. The principal consists of
$24,625.00 given directly to Borrower, paid on Borrower's behalf, or credited to Borrower's account and a $375.00 nonrefundable
origination fee, if applicable.
TRUTH IN LENDING DISCLOSURE STATEMENT
ANNUAL PERCENTAGE FINANCE CHARGE Amount Financed Total of Payments
The cost of your credit as The dollar amount the The amount of credit The amount | will have paid
a yearly rate. credit will cost me. provided to me or on my after | have made all
behalf. scheduled payments.
10.44% $7,091.00 $24,625.00 $31,716.00
The Military Annual Percentage Rate (MAPR) is 10.44%
Payment Schedule:
No. of Payments Amount of Payments When Payments are Due
59 $528.60 Monthly, beginning July and the 27 day of each month
thereafter until all amounts owed under this Note are paid in
1 $528.60 full.
Late Charge. if a required payment is not paid in full within 15 days after it is due, Borrower will be charged a late charge of
$15.00,
Pre yment. Borrower may prepay all or any portion of the Loan at any time without penalty.
Additional Information. Please see the rest of this document for additional information about nonpayment, default, and any
required repayment in full before the scheduled due date.
ITEMIZATION OF AMOUNT FINANCED
A Principal Amount (amount given to, or paid on behalf of, $25,000.00
Borrower):
1 ‘Amount given to Borrower directly: $24,625.00
B. Origination Fee (Prepaid Finance Charge) $375.00
Cc. Amount Financed (A) - (B): $24,625.00
This Note is the final agreement between Lender and Borrower and may not be changed by prior, current, or future oral
agreements between Lender and Borrower. There are no oral agreements between Lender and Borrower relating to this loan
agreement. Any change to this agreement must be in writing and signed by Lender. BY ACCEPTING ONLINE YOU ARE SIGNING
THIS NOTE and Borrower AGREES WITH AND ACKNOWLEDGES RECEIPT OF THE ABOVE DISCLOSURES AND THE ADDITIONAL
TERMS AND CONDITIONS ON PAGES 2 AND 3.
Loan Number: 91012625116 Acknowledgement Date: 6/27/2022 8:56 AM _IP Address: 172.56.23.236 Ver: 3.1
PROMISSORY NOTE
ADDITIONAL TERMS AND CONDITIONS
1. Nonrefundable Loan Origination Fee and Interest. Borrower agrees to pay Lender a non-refundable loan origination fee which is
withheld from the proceeds of this loan. Borrower promises to pay interest of 9.79% per year (the "Interest Rate"). The simple interest rate
on this Note will be fixed at the per annum interest rate and will accrue on the unpaid principal from the date of this Note until the principal is.
repaid in full. Interest will accrue on the unpaid principal on a daily basis, with the daily rate equal to 1/365th (1/366th in a leap year) of the
yearly Interest Rate. The Interest Rate required by this Section 1 is the rate Borrower will pay both before and after any default described in
this Note, and, the rate Borrower will pay on any unpaid principal before and after the Maturity Date of this loan. The amount of the Finance
Charge, Total of Payments and Payment Schedule shown in the Truth in Lending Disclosure Statement assumes that Borrower will make all
payments in the scheduled amounts and on the scheduled dates. Because Borrowerwill pay interest on the actual balance each day, the
interest Borrower will pay will be higher if payments are made later than scheduled, and lower if payments are made earlier than scheduled.
Borrower agrees to pay the actual amount of interest that accrues on this Loan. Such amount may be more than or less than the Finance
Charge shown in the Truth in Lending Disclosure Statement.
2, Payments. Borrower will make payments as set forth in the payment schedule above. Borrower's payments will be applied first to
accrued, unpaid interest, then to unpaid principal, and then to any other charges that are due. The portion applied to Principal Amount will
be the difference between the total scheduled payment and the actual accrued interest; any excess over accrued interest and principal will
then be applied to charges (such as late fees) and, if such charges are paid, to remaining principal. On the date of Borrower's last
scheduled payment (the "Maturity Date"), Lender, at Lender's option, may demand that Borrower pay in full any and all remaining amounts
owing hereunder or permit Borrower to continue to make monthly payments in the then scheduled amount until all indebtedness hereunder
has been paid in full. Borrower will make all monthly payments at Lender's address set forth above, or at a different place if required by
Lender. Lender may accept late payments, partial payments or items marked "paid in full" or the like without losing any of its rights under.
this Note.
3. Prepayment. Borrower may prepay all or any part of the unpaid principal at any time before payment is due, without penalty. if Borrower
makes a partial prepayment it may reduce the number of payments Borrower must make or the amount of the final payment, but Borrower
must continue to make a full payment each month until Borrower has paid all amounts due. Any prepaid finance charge shown in the
itemization of Amount Financed is fully earned when the Principal Amount of this Note is disbursed and is not subject to rebate or refund if
principal is prepaid or accelerated.
4. Loan Charges. Lender intends to charge only interest, fees and charges permitted by law. If a law, which applies to this loan and which
‘sets maximum loan charges, is finally interpreted so that the interest or other loan charges collected or to be collected in connection with
this Note exceed the perrmitted limits, then: (a) any such loan charge will be reduced by the amount necessary to reduce the charge to the
permitted limit; and (b) any sums already collected from Borrower which exceeded permitted limits will be refunded to Borrower. Lender may
choose to make this refund by reducing the principal Borrower owes under this Note or by making a direct payment to Borrower. if a refund
reduces principal, the reduction will be treated as a partial prepayment.
5. Late Fees and Returned Item Fees. If Borrower does not pay the full amount of each monthly payment within 15 days after it is due,
Borrower promises to pay a late fee of $15.00. Borrower will pay this late fee promptly, but only once on each late payment. Acceptance of a
late payment or late charge does not mean that you can keep making payments later than the due date. If any check, other payment
instrument, or ACH payment Borrower gives Lender is not paid, is dishonored or rejected, Borrower will pay Lender a charge of $25,
provided such a charge is not prohibited by law. Lender may add those fees to the unpaid principal Borrower owes or collect them
separately.
6. Default. Borrower will be in default under this Note if (1) Borrower does not pay the full amount of each monthly payment on the date it is
due; or (2) Lender's prospect of payment is significantly impaired, which may include (a) if Borrower fails to keep all other prorises in this
Note or in any other obligation Borrower owes to Lender, (b) if any information furnished in connection with this Note proves to have been
false or materially misleading; (c) if Borrower becomes subject to a bankruptcy or an insolvency proceeding, (d) if the last remaining obligor
on this Note and Borrower dies; or (e) if Borrower experiences any financial change that Lender considers adverse and material.
7. Rights and Remedies upon Default. Upon default, Borrower agrees that Lender will have all rights, options, and remedies of a creditor
under applicable law, and under this Note, subject to any rightto cure Borrower may have under applicable law, including without limitation,
the right to demand immediate payment in full of all amounts outstanding under this Note (following any applicable notice and waiting period
if and as required by law). Borrower also agrees to pay the actual and reasonable attorneys’ fees incurred by Lender in payment of the
services of external counsel ("“Attorneys' Fees , to the extent allowed by applicable law, whether or not suit is brought, including any
attorneys’ fees relating to any insolvency, liquidation, receivership or bankruptcy proceedings.
8. Waivers. Lender may accept late payments or partial payments, even though marked "paid in full," without losing any rights under this
Note, and Lender may delay enforcing any of its rights under this Note without losing them. Lender does not have to (a) demand payment of
amounts due (known as "presentment"), (b) give notice that amounts due have not been paid (known as "notice of dishonor"), or (c) obtain
an official certification of nonpayment (known as "protest"). Borrower hereby waives presentment, notice of dishonor and protest. Even if, at
a time when Borrower is in default, Lender does not exercise its default remedies as described above, Lender will still have the right to do so
if Borrower is in default at a later time. The Lender's failure to exercise any of its rights under this Note, or delay in exercising any of its
rights, will not act as a waiver of those rights or prevent Lender from strictly enforcing those rights in the future. Waiver of any default shall
not constitute a waiver of subsequent default.
9. Lenders Right to Contact Borrower. Lender reserves the right to contact Borrower regarding Borrower's account status and changes
to subscriber agreements, privacy notices, or any other policies or agreements relevant to Borrower and/or the Note. Borrower also agrees
that Lender may contact Borrower in any manner (including text message or auto dialer) at any telephone number provided on Borrower's
credit application, including Borrower's cell phone or any other mobile device. Borrower may be charged by Borrowers wireless provider in
order to receive text messages. Borrower may change Borrowers contact preferences by calling our toll free number or contacting Lender
via e-mail at personalloans@axosbank.com.
10. Obligations of Persons under This Note. If more than one person signs this Note, each person is fully and personally obligated to
keep alll of the promises made in this Note, including the promise to pay the full amount owed. Any person who is a guarantor, surety or
endorser of this Note is also obligated to do these things. Any person who takes over these obligations, including the obligations of a
guarantor, surety or endorser of this Note, is also obligated to keep all of the promises made in this Note. Lender may enforce its rights
under this Note against each person individually or against all of them together. This means that any Borrower may be required to pay all of
the amounts owed under this Note.
Loan Number: 91012625116 Acknowledgement Date: 6/27/2022 8:56 AM _IP Address: 172.56.23.236 Ver: 3.1
.
11. Transferable Record. Borrower expressly agrees that this Note is a "transferable record” as defined in applicable law relating to
electronic transactions and that it may be created, authenticated, stored, transmitted, and transferred in a manner consistent with and
permitted by such applicable law.
12. Applicable Law; General. Lender is a federally-chartered savings association with a branch office in Nevada and has the right under
federal law to export interest rates, fees, and other types of charges based upon the laws applicable to a Nevada state-chartered bank. As
such, this Note is governed by and construed in accordance with Nevada law (excluding Nevada choice of lawor conflict of law) and Federal
law pursuant to 12 USC Ag 85. Any provision hereof held by a court to be invalid shall not affect the remainder of this Note. Borrower may
not assign this Note except with Lender's prior written consent, and subject to the foregoing this Note shall be binding upon the heirs,
personal representatives, successors, and assigns of both Borrower and Lender. Unless otherwise required by applicable law, any written
notice that Lender is obligatedto send Borrower hereunder shall be sufficient if sent by regular mail, postage prepaid, to Borrower's
address shown on the first page of this Note (or any more recent address if Borrower has advised Lender of such in writing). Borrower
agrees to give Lender updated financial information any time Lender requests it. Borrower waives demand, presentment, and protest, notice
of dishonorand notice of protest to the extent permitted by law. This Note constitutes the entire agreement between Lender and Borrower
may not be altered or amended except by a writing signed by both Borrower and Lender.
ARBITRATION PROVISION. Upon written request by Borrower or Lender submitted according to the rules for arbitration, any Claim, except
those specified below, shall be resolved by binding arbitration in accordance with: (i) the Federal Arbitration Act, (ii) the Rules of the chosen
Administrator, and (iii) this Arbitration Provision.
‘a) Claims Covered. "Claim" means any claim, dispute, or controversy now or hereafter existing between Borrower and Lender, including
without fit itation, any claims arising out of, in connection with, or relating to this Note, and any modification, extension, application, or inquiry
of credit or forbearance of payment; any products, goods and/or services, including the installation thereof, purchased in connection with
this Note; any insurance, service contract, extended warranty, or debt cancellation agreement purchased in connection with this Note; the
closing, servicing, collecting or enforcing of this Note; whether the claim or dispute must be arbitrated; the validity of this Arbitration
Provision; any negotiations between Lender and Borrower; any claim or dispute based on an allegation of fraud or misrepresentation,
including without limitation, fraud in the inducement of this or any other agreement; and any claim or dispute based on state or federal law,
or an alleged tort. Lender and Borrower also agree to submit to final, binding arbitration any claim or dispute that Lender or Borrower has
against all persons and /or entities: (i) who are involved with this Note, (ii) who signed or executed any document relating to this Note or any
Claim, and (iii) who may be jointly or severally liable to either Borrower or Lender regarding any Claim.
EXCLUSION FROM ARBITRATION. The following types of matters will not be arbitrated: (1) the exercise of extra-judicial or self-help
repossession under applicable lawor any action seeking to enforce a security interest or any action to effect the sale or transfer of the
property being foreclosed (collectively "Excluded Actions") provided, however, that any claim or dispute arising out of or relating to the
exercise of such Excluded Actions is subject to arbitration in accordance with this Arbitration Provision; or (2) any Claim where alll parties
collectively (including multiple named parties) seek, in the aggregate, $15,000 or less in total monetary relief, including but not limited to
compensatory, statutory and punitive damages, restitution, disgorgement, and costs and fees (including attorney's fees); or any Claims
brought and maintained as an individual (as opposed to class) action in a small claims court. If Borrower attempts to assert any Claim on
behalf of a putative class of persons, in violation of other terms in this Arbitration Provision, the value of such Claim will, for purposes of this
exclusion, be deemed to exceed $15,000. if any party fails to specify the amount being sought for any relief, or any form or component of
relief, the amount being sought shall, for purposes of this exclusion, be deemed to exceed $15,000. Participation in a lawsuit or seeking
enforcement of this section by a court shall not waive the right to arbitrate.
(b) Commencing Arbitration. The party initiating arbitration must choose one of the following arbitration Administrators and follow the rules
and procedures that govern disputes established by the Administrator ("Rules"). The Administrator shall be the American Arbitration
Association, 335 Madison Avenue, New York, NY 10017-4605, www.adr.org, or any other organization that Borrower may choose provided
Lender approves of my choice in writing. The Rules and a form of demand for arbitration are available from the Administrator. Lender or
Borrower may bring an action, including a summary or expedited proceeding, to compel arbitration of any Claim, and/or to stay the litigation
of any Claim pending arbitration, in any court having jurisdiction. Such action may be brought at any time, even if a Claim is part of a lawsuit,
up until the entry of a final judgment.
(c) Place of Arbitration. Arbitration shall be conducted in the county of Borrower's residence, unless all parties agree to another location.
id) No Class Actions/No Joinder of Parties. Claims and disputes by or on behalf of other persons not a party to this Note will not be
arbitrated in any proceeding considering Borrower's Claims. BORROWER MAY NOT SERVE AS A CLASS REPRESENTATIVE OR
PARTICIPATE AS A MEMBER OF A CLASS OF CLAIMANTS OR ACT AS A PRIVATE ATTORNEY GENERAL WITH RESPECT TO ANY
CLAIM AGAINST ANY PARTY ENTITLED TO COMPEL ARBITRATION UNDER THIS ARBITRATION PROVISION. This is referred to in this
Note as the "class action waiver."
(2) Governing Law for Arbitration. The Federal Arbitration Act, 9 U.S.C. A§A§ 1 et seq., shall govern this Arbitration Provision. The arbitrator
shall make his or her decision in accordance with applicable substantive law consistent with the Federal Arbitration Act and applicable
statutes of limitations, and shall be empowered to award any damages or other relief provided for under applicable law. Judgment upon any
arbitration award may be entered in any court having jurisdiction.
(f) Costs of Arbitration. Lender will advance my filing, administration, service or case management fees and my arbitrator or hearing fee all
up to $2,500, which may be reimbursed by the decision of the arbitrator at the arbitrator's discretion. Each party shall be responsible for its
own attorney, expert and other fees, unless awarded by the arbitrator under applicable law.
(g) Other Important Agreements. This Arbitration Provision applies even if this Note has been paid in full, charged-off by Lender, or
discharged in bankruptcy. In the event of a conflict or inconsistency between this Arbitration Provision and the arbitration Rules or the other
provisions of this Note, this Arbitration Provision shall govern.
If the class action waiver above is determined to be unenforceable, void, illegal or otherwise against applicable law, then the remainder of
this Arbitration Provision shall be unenforceable.
You may opt out of Arbitration by sending us by certified mail your request to do so, signed by all parties who signed the
Obligation. To be effective, we must receive the request within 10 business days of the date of this Agreement.
This Arbitration Provision does not apply to "covered borrowers" as defined by the Military Lending Act.
13. Military Lending Act - Federal law provides important protections to members of the Armed Forces and their dependents relating to
extensions of consumer credit. In general, the cost of consumer credit to a member of the Armed Forces and his or her dependent may not
exceed an annual percentage rate of 36 percent. This rate must include, as applicable to the credit transaction or account: The costs
Loan Number: 91012625116 Acknowledgement Date: 6/27/2022 8:56 AM _ IP Address: 172.56.23.236 Ver: 3.1
.
associated with credit insurance premiums; fees for ancillary products sold in connection with the credit transaction; any application fee
charged (other than certain application fees for specified credit transactions or accounts); and any participation fee charged (other than
certain participation fees for a credit card account).
Loan Number: 91012625116 Acknowledgement Date: 6/27/2022 8:56 AM _ IP Address: 172.56.23.236 Ver: 3.1
EXHIBIT B
Payoff 91012625116 - MARCO GJURAJ - CONSUMER 1/22/2024
UNSECURED
Description Amounts Payoffs
Current Balance $21,279.35 $21,279.35
Accrued Interest $313.58 $21,592.93
Secondary Accrued Interest $1,055.71 $22,648.64
Late Charge Due Amount $105.00 $22,753.64
Total Payoff
a $22,753.64
Axos Bank
Page 1
SUMMONS - CIVIL For information on
€ oy
JD-CV-1_ Rev, 2-22 STATE OF CONNECTICUT
ADA accommodations,
C.G.S. §§ 51-346, 51-347, 51-349, 51-350, 52-45a, 52-48, 52-259; contact a court clerk or SUPERIOR COURT
P.B. §§ 3-1 through 3-21, 4, 10-1 www jud.ct.gov
go to: www,jud.ct.gov/ADA.
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.
-] Select if amount, legal interest, or property in demand, not including interest and costs,
is $2,500 or MORE.
LJ 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 le gal
service of this summons and attached complaint.
‘Address of court clerk (Number, street, town and zip code) Telephone number of clerk Retum Date (Must be a Tuesday)
14 West River Street, Milford CT 06460 (203 ) 877 - 4293 07/09/2024
[x] Judicial District GA. At (City/Town) Case type code (See list on page 2)
(1 Housing Session C1 Number: Milford
Major: C Minor: 40
For the plaintiff(s) enter the appearance of:
Name and address of attomey, law firm or plaintiff self represented (Number, street, town and zip code)
Juris number (if attorney or law firm)
Shawn M. Masterson, 536 Atwells Avenue, Suite 1, Providence, RI 02909
422888
Telephone number ‘Signature of plaintiff (if selFrepresented)
(781) 494 — 0200
The attorney or law firm appearing for the plaintiff, or the plaintiff if E-mail address for delivery of papers under Section 10-13 of the
self-represented, agrees to accept papers (service) electronically Connecticut Practice Book (if agreed)
in this case under Section 10-13 of the Connecticut Practice Book. [¥] Yes [] No smasterson@cohnanddussi.com
Parties Name (Last, First, Middle Initial) and address of each party (Number; street; P.O. Box; town; state; zip; country, ifnot USA)
First Name: Axos Bank
plaintiff Address: 9205 W. Russell Road, Suite 400, Las Vegas NV 89148 P-01
Additional Name:
plaintiff Address: P-02
First Name: Marco Gjuraj
defendant Address: : 646 Howe Avenue, Apartment 23, Shelton CT 06484 D-01
Additional Name:
defendant Address: D-02
Additional Name:
defendant Address: D-03
Additional Name:
defendant Address: D-04
Total number of plaintiffs: 1 Total number of defendants: 1 [1] Form JD-CV-2 attached for additional parties
Notice to each defendant
4 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 ni jot 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.
lf you or your attorney do not file an Appearance on time, a default judgment may y 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 bein ig made against you in this lawsuit, you should immediately contact
your insurance representative. Other actions you may take are descr ribed in the Connecticut Practice Book, which may be found ina
superior court law library or on-line at https://www.jud.ct.gov/pb.htm.
if you have questions about the summons and complaint, you should talk to an attorney.
The court staff is not allowed to give advice on legal matters.
Date Signed (Sigrvand’selectproper box) [x] Commissioner of Superior Court_| Name of person signing
05/29/2024
NL oO Clerk Shawn M. Masterson
If this summons is signed by a Clerk: For Court Use Only
a. The signing has been done so that the plaintiff(s) will not be denied access to the courts. File Date
b. itis 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 legal advice in connection with any lawsuit.
d. The Clerk signing this summons at the request 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.
I certify | have read and Signed (SelF- represented plaintify Date Docket Number
understand the above:
Page 1 of 2
|. 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 co, py of the summons for each additional defendant. Each defendant
must receive a copy of
this summons. Each copy of the summons mu: st show who signed the summons and when it was signed.
If there are more than tw
plaintiffs or more than four defendants, compl lete 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 ct opy 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
(d) Probate appeals
(i) Housing Code Enforcement actions
Case Type Codes
MAJOR CODE
Major MAJOR CODE
DESCRIPTION MINOR DESCRIPTION Major! MINOR DESCRIPTION
Minor DESCRIPTION Minor
Contracts coo ‘Construction - All other Property Poo Foreclosure
c10 Construction - State and Local P10 Partition
c20 Insurance Policy P20 Quiet Title/Discharge of Mortgage or Lien
C30 Specific Performance P30 Asset Forfeiture
c40 Collections P90 All other
c50 Uninsured/Underinsured Motorist Coverage
ceo Uniform Limited Liability Company Act—C.G.S. 34-243
C30 All other Torts (Other T02 Defective Premises - Private - Snow or Ice
than Vehicular) TO3 Defective Premises - Private - Other
Eminent E00 State Highway Condemnation Tit Defective Premises - Public - Snow or Ice
Domain E10 Redevelopment Condemnation T12 Defective Premises - Public - Other
E20 Other State or Municipal Agencies T20 Products Liability - Other than Vehicular
E30 Public Utilities & Gas Transmission Companies T2383 Malpractice - Medical
E90 All other T29 Malpractice - Legal
T30 Malpractice
- All other
Housing H10 Housing - Retum of Security Deposit T40 Assault and Battery
H12 Housing - Rent and/or Damages T50 Defamation
H40 Housing - Housing - Audita Querela/Injunction Tél Animals - Dog
H5O Housing - Administrative Appeal Té69 Animals - Other
H60 Housing - Municipal Enforcement T70 False Arrest
H 90 Housing- All Other TH Fire Damage
T90 All other
Miscellaneous Moo Injurtction
M10 Recéivership Vehicular Torts vot Motor Vehicles* - Driver and/or Passenger(s) vs. Driver(s)
M15 Receivership for Abandoned/Blighted Property Vv04 Motor Vehicles* - Pedestrian vs. Driver
M20 Mandamus: V05 Motor Vehicles* - Property Damage only
M30 Habeas Corpus (extradition, release from Penal Institution) vos Motor Vehicle* - Products Liability Including Warranty
M40 Atbitration voo Motor Vehicle* - All other
M50 Declaratory Judgment V10 Boats
M63 Bar Discipline v20 Airplanes
M66 Department of Labor Unemployment Compensation v30 Railroads
Enforcement V40 Snowmobiles
M68 Bar Discipline - Inactive Status vo All other
M70 Municipal Ordinance and Regulation Enforcement *Motor Vehicles include cars, trucks,
M80 Foreign Civil Judgments - C.G.S. 52-604 & C.G.S. 504-30 motorcycles, and motor scooters.
M83 ‘Small Claims Transfer to Regular Docket
M 84 Foreign Protective Order Wills, Estates wid Construction of Wills and Trusts
Mag CHRO Action in the Public Interest - PA. 19-93 and Trusts ws30 All other
M90 All other
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