Docket number Name of case (Plaintiff v. Defendant In re John D.) Self-represented party address Self-represented party name 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 , click on the link for 223E-Services,224 then click on the link to 223Enroll224 and follow the instructions on screen. Self-represented party E-Services User IdentificationI. All fields must be completed II. Submit this form using 223A224 or 223B224 below A. Any self-represented party in any appellate matter in which the self-represented party's user identification has not already been provided, other than a family or child protection appellate matter or an appellate matter Signed (Self-represented party)Date signed I certify that a copy of the document(s) that I am filing has been delivered on to each other counsel of record, and I have included their names, addresses, e-mail addresses, and telephone numbers; the document(s) have been redacted or do not contain any names or other personal identifying information that is prohibited from disclosure by rule, statute, court order, or case law; and the document(s) comply with all applicable rules of appellate procedure in accordance with Practice Book Section 62-7. Names, addresses, and telephone numbers are included on a separate page. Signed (Self-represented party) Print name Subscribed and sworn to before me on: Signed (Notary Public or other proper officer) Date American LegalNet, Inc. www.FormsWorkFlow.com