FORECLOSURE MEDIATION — MOTION FOR PERMISSION TO REQUEST MEDIATION LATER THAN 15 DAYS AFTER RETURN DATE OR TO CHANGE MEDIATION PERIOD JD-CV-96 Rev. 8-09 C.G.S. § 49-31k-n, P.A. 09-209 STATE OF CONNECTICUT SUPERIOR COURT www.jud.ct.gov Instructions to person filing this form 1. Type or print legibly. 2. Fill out section I or II of this form and file it with the court. 3. An appearance form (JD-CL-12) must be filed with this form if an appearance has not already been filed with the court. Name of Case (Plaintiff v. Defendant) Docket Number Judicial District of Return Date PPMP I. Motion for Permission to file a Foreclosure Mediation Certificate later than 15 days after the return date: I request permission to file the attached Foreclosure Mediation Certificate (JD-CV-108) for the following (good cause) reason: FMMOD II. Motion for Modification of Mediation Period: I request that the mediation period be modified, as follows: for the following (good cause) reason: Allow up to 30 more days for the mediation period to (Date) or, for the following (good cause) reason: Shorten the mediation period to FMSHORT (Date) Signature of Person Submitting Motion Print Name of Person Signing Date Signed Telephone Number (with area code) Address (Number, street, town, state, zip code) Certification I certify that a copy of this Foreclosure Mediation Motion was mailed or delivered to all counsel and self-represented (pro se) parties of record on . (Date) Name of each party the Foreclosure Mediation Motion was mailed or delivered to* Address where the Foreclosure Mediation Motion was mailed or delivered Signed Telephone Number (with area code) For Court Use Only Order (For Court Use Only) Granted until: By the Court (Judge/Clerk) File date Denied Date *If needed, attach additional sheet with name of each party the Foreclosure Mediation Motion was mailed or delivered to and the address where it was mailed or delivered. American LegalNet, Inc. www.FormsWorkFlow.com