APPLICATION FOR REFERRAL OF CASE TO THE COMPLEX LITIGATION DOCKET (CLD) STATE OF CONNECTICUT SUPERIOR COURT - CIVIL DIVISION www.jud.ct.gov JD-CV-39 Rev. 8-11 Pr. Bk. Sec. 23-15, C.G.S. §§ 51-347b, 52-259 Instructions 1. Counsel and self-represented parties seeking to have a case referred to the Complex Litigation Docket (CLD) must supply all of the information requested below. (Failure to supply complete and accurate information may disqualify a case.) 2. This application must be accompanied by the appropriate fee (Section 52-259 of the Connecticut General Statutes). 3. Information that does not fit on this form should be attached on a separate sheet, numbered to correspond to the questions on the form. 4. Attorneys not excluded from efiling must e-file this form and select “Complex Litigation Application" when naming the form in e-filing. Attorneys excluded from efiling and self-represented parties must file the original with the appropriate fee with the Clerk in the judicial district in which the case is pending. COURT USE ONLY COMPLEX *COMPLEX* Note: Any objection to the transfer of this case to the CLD must be filed within 15 calendar days after the filing of this application. Attorneys not excluded from efiling must select "Objection to Transfer to Complex Litigation" when naming the objection in e-filing. Attorneys excluded from efiling and self-represented parties must file the objection with the Clerk in the judicial district in which the case is pending and must title it "Objection to Transfer to the Complex Litigation Docket.” I submit this application for the Court's consideration. 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. Name and address of applicant Juris number Telephone number 1. Case name (Plaintiff v. Defendant) 2. Docket number 3. Judicial District in which case is pending 4. Return date of original complaint 5. List all plaintiffs and their counsel: Plaintiff's name Counsel's name and address Counsel's phone # Counsel's name and address Counsel's phone # 6. List all defendants and their counsel: Defendant's name Yes 7. Indicate whether opposing counsel opposes: No a. referral to the CLD................................................................ b. transfer to the CLD location requested on this application... 8. Briefly describe the nature of the case: (products liability, anti-trust, stockholders' action, UCC, etc.) 9. List any cases with which this case is consolidated: (Note: In order to apply for CLD in unconsolidated but related cases, a separate application with fee is required for each case.) Case name (Plaintiff v. Defendant) Docket number Judicial District 10. Indicate the status of the litigation: Yes No a. pleadings closed..................................................... b. discovery completed............................................... c. file sealed (partial/entire)........................................ d. scheduled for trial — if so, when (Date) e. pretrial held............................................................. f. trial management conference held......................... (Continued...) American LegalNet, Inc. www.FormsWorkFlow.com Yes Not yet determined No g. claimed for jury trial................................................ h. claimed for bench trial............................................ i. class action status sought...................................... 11. Has a request or application to refer this case to the Complex Litigation Docket previously been denied? Yes No 12. What is the estimated length of trial (in days)? 13. Why should this case be referred to the CLD ? 14. Which CLD location is requested? (Enter order of preference.) Hartford Stamford Waterbury Certification I certify that a copy of this document was mailed or delivered electronically or non-electronically to all attorneys and self-represented parties of record on (date) parties receiving electronic delivery. and that written consent for electronic delivery was received from all attorneys and self-represented Name and address of each party and attorney that copy was mailed or delivered to* *If necessary, attach additional sheet or sheets with name and address which the copy was mailed or delivered to. Signed (Individual attorney or self-represented party) Print or type name of person signing X Mailing address JD-CV-39 (Page 2 of 2) Rev. 8-11 Telephone number American LegalNet, Inc. www.FormsWorkFlow.com