FORECLOSURE MEDIATION — OBJECTION FMOBJ STATE OF CONNECTICUT SUPERIOR COURT www.jud.ct.gov JD-CV-95 New 9-08 P.A. 08-176 Instructions to Person Objecting to Foreclosure Mediation or to a Motion, Pleading or Procedure in the Foreclosure Mediation Program 1. Type or print legibly. 2. Fill out and file the objection with the court. Name of Case (Plaintiff v. Defendant) Docket Number Judicial District of Return Date Objection to Case being included in the Foreclosure Mediation Program: I object to the case named above being included in the Foreclosure Mediation Program for the reason(s) that (check all that apply): It is not a mortgage that is being foreclosed The property is not the primary residence of the mortgagor The property is not a one-to-four family residential property The property is not located in the State of Connecticut The defendant submitting the mediation request is not the borrower Other Objection: I object to the following pleading, request or procedure (specify and provide reason(s)): (If more space is needed, attach a separate sheet of paper.) Signature of Person Submitting Objection Print Name of Person Signing Date Signed Address (Number, street, town, state, zip code) Telephone Number (with area code) Certification I certify that a copy of this Foreclosure Mediation Objection was mailed or delivered to all counsel and self-represented (pro se) parties of record on (Date) . Name of each party the Foreclosure Mediation Objection was mailed or delivered to* Address where the Foreclosure Mediation Objection was mailed or delivered Signed Telephone Number (with area code) For Court Use Only Order (For Court Use Only) Sustained By the Court (Judge/Clerk) File date Overruled Date *If needed, attach additional sheet with name of each party the Foreclosure Mediation Objection was mailed or delivered to and the address where it was mailed or delivered. American LegalNet, Inc. www.FormsWorkflow.com