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1567146
AFFIDAVIT CONCERNING STATE OF CONNECTICUT Court Use Only
MILITARY SERVICE SUPERIOR COURT AE
JD-FM-178 Rev. 11-11
P.B,§ 17-21
IMA
Instructions
Anyone who knows the military status of the defendant may complete the form below. You must swear
that your statement is true and sign it in front of a court clerk, a notary public, or an attorney who will also
sign and date the affidavit. Make one copy for yourself and give the original to the court clerk.
Explanation: A military service affidavit is required in every case where the defendant has not filed an
Appearance form with the court clerk's office by the time of the court hearing. The purpose is to protect
men and women serving in the U.S. military from getting a court judgment against them without first
receiving notice of the lawsuit and a chance to defend the case. The affidavit gives the court the necessary
facts to find that the defendantis not in the U.S military.
Judicial District of ‘At (Town) Return date (Month, day. year) Docket number
HARTFORD J.D. SMALL CLAIMS SESSION AT HAFAT HARTFORD
Piainfiff's name (Last, frst, middle initial) Defendant's name (Last. first, middle initial)
CAPITAL ONE, NA, SUCCESSOR BY MERGER TO CAPITAL ONE BANK (USA), LESSARD,KYMBERLY A
NA
| certify that the following is true (check all that apply and complete):
[-]1. The defendant is in the U.S. Military.
2. The defendant is not in the U.S. Military. | know this because:
{_]the defendant is working at
{_]the defendant currently lives at
[the defendant is years old.
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other (state reasons) Verified by Service Members Civil Relief Act Website wy phlA. p %,
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Signature Print Name.
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M, Bargy, Lepmeart
Clerkistary Public/Cammissioner of Superior Court)
Nicole Pesino/ Kathleen LeBlane/ Hemali al Tanne M Ganger >
‘At(Town, State) Date Signed
East Hartford, CT 6 fablaoay
tC
ADA NOTICE
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 ADA contact person listed at www.jud.ct.gov/ADA
Department of Defense Manpower Data Center Resuts as of : Jun-26-2024 06:47:18 AM
‘SCRA 520
gARYs
s
SS e
x . Status Report
B\
Pursuant to Servicemembers Civil Relief Act
Sar
SSN: XX-XX-XXXX
Birth Date: XXX-XX-XXXX
Last Name: LESSARD
First Name: KYMBERLY
Middle Name A
Status As Of Jun-26-2024
Certificate ID P3W1VVO67Y7FWJ4
‘i Ale Buty On Ase Dal Slats Dae
Adlive Duly Start Dato Active Duty End Date Status ‘Service Component
NA NA Ne. NA
‘This response rellocts the individuals’ active duly status based on the Active uly Status Date
ell Active Duty Wilbin 987 Oays of Active Duly Status Date
‘Active Duly Star Date ‘ative Outy End Date ‘Status ‘Serce Component
NA NA No NA
This response rellects where the individual ieft active daty stalus wahin 367 days preceding the Active Outy Status Date
‘The Member or His/Her Unk Was Notified of a Future Cal-Up to Active Duty on Active Duty Status Date
‘Order Notification Start Date ‘Grder Notiication End Date ‘Status ‘Service Component
NA NA No. NA
Ti etponte etects wheter he ivi oir witha ehh Hy olin o report fr actve ay
Upon searching the data banks of the Department of Defense Manpower Data Center, based on the information that you provided, the above is the status of
the individual on the active duty status date as to all branches of the Uniformed Services (Army, Navy, Marine Corps, Air Force, Space Force, NOAA, Public
Health, and Coast Guard). This status includes information on a Servicemember or his/her unit receiving notification of future orders to report for Active Duty.
San rusespgacteh
Sam Yousefzadeh, Director
Department of Defense - Manpower Data Center
4800 Mark Center Drive, Suite 0425
Alexandria, VA 22350
The Defense Manpower Data Center (DMDC) is an organization of the Department of Defense (DoD) that maintains the Defense Enrollment and Eligibility
Reporting System (DEERS) database which is the official source of data on eiigibility for military medical care and other eligibility systems.
The DoD strongly supports the enforcement of the Servicemembers Civil Relief Act (50 USC App. § 3901 et seq, as amended) (SCRA) (formerly known as
the Soldiers’ and Sailors’ Civil Relief Act of 1940). DMDC has issued hundreds of thousands of "does not possess any information indicating that the
individual is currently on active duty” responses, and has experienced only a small error rate. In the event the individual referenced above, or any family
member, friend, or representative asserts in any manner that the individual was on active duty for the active duty status date, or is otherwise entitled to the
protections of the SCRA, you are strongly encouraged to obtain further verification of the person's status by contacting that person's Service, Service contact
information can be found on the SCRA website's FAQ page (Q35) via this URL: https://scra.dmdc.osd.mil/scra/#/faqs. If you have evidence the person
was on active duty for the active duty status date and you fail to obtain this additional Service verification, punitive provisions of the SCRA may be invoked
against you. See 50 USC App. § 3921(c).
This response reflects the following information: (1) The individual's Active Duty status on the Active Duty Status Date (2) Whether the individual left Active
Duty status within 367 days preceding the Active Duty Status Date (3) Whether the individual or his/her unit received early notification to report for active
duty on the Active Duty Status Date.
More information on "Active Duty Status”
Active duty status as reported in this certificate is defined in accordance with 10 USC § 101(d) (1). Prior to 2010 only some of the active duty periods less
than 30 consecutive days in length were available. In the case of a member of the National Guard, this includes service under a call to active service
authorized by the President or the Secretary of Defense under 32 USC § 502(f) for purposes of responding to a national emergency declared by the
President and supported by Federal funds. All Active Guard Reserve (AGR) members must be assigned against an authorized mobilization position in the
unit they support. This includes Navy Training and Administration of the Reserves (TARs), Marine Corps Active Reserve (ARs) and Coast Guard Reserve
Program Administrator (RPAs). Active Duty status also applies to a Uniformed Service member who is an active duty commissioned officer of the U.S.
Public Health Service or the National Oceanic and Atmospheric Administration (NOAA Commissioned Corps).
Coverage Under the SCRA is Broader in Some Cases
Coverage under the SCRA is broader in some cases and includes some categories of persons on active duty for purposes of the SCRA who would not be
reported as on Active Duty under this certificate. SCRA protections are for Title 10 and Title 14 active duty records for all the Uniformed Services periods.
Title 32 periods of Active Duty are not covered by SCRA, as defined in accordance with 10 USC § 101(4)(1),
Many times orders are amended to extend the period of active duty, which would extend SCRA protections. Persons seeking to rely on this website
cerlification should check to make sure the orders on which SCRA protections are based have not been amended to extend the inclusive dates of service.
Furthermore, some protections of the SCRA may extend to persons who have received orders to report for active duty or to be inducted, but who have not
actually begun active duty or actually reported for induction. The Last Date on Active Duty entry is important because a number of protections of the SCRA.
extend beyond the last dates of active duty.
‘Those who could rely on this certificate are urged to seek qualified legal counsel to ensure that all rights guaranteed to Service members under the SCRA
are protected
WARNING: This certificate was provided based on a last name, SSN/date of birth, and active duty status date provided by the requester. Providing
erroneous information will cause an erroneous certificate to be provided.