GUARDIAN AD LITEM REQUEST FOR STATUS CONFERENCE JD-FM-219 New 2-12 STATE OF CONNECTICUT JUDICIAL BRANCH www.jud.ct.gov Instruction to preparer: Fill out this form and file with the court. Instruction to clerk or caseflow coordinator: Schedule the status conference and notify all appearing attorneys and self-represented parties in the case. Judicial District of At (Town) Docket number Judge's name Date of judgment Plaintiff's name (Last, first, middle initial) Defendant's name (Last, first, middle initial) Plaintiff's address Defendant's address As court-appointed guardian ad litem for the minor child/ren in this matter, I request a status conference be scheduled by the court with all parties and counsel present. I represent to the court that: This is an urgent matter affecting the children: Regarding the safety of the children. Regarding compliance with existing court orders. This is not an urgent matter but requires the court's attention. This matter is about fees. This matter is on appeal. I am requesting the appointment of an attorney under Section 67-13 of the Connecticut Practice Book. Signed Guardian Ad Litem for the minor child/ren Print name of person signing at left Date signed Certification I certify that a copy of this document was mailed or delivered electronically or non-electronically on (date) to all attorneys and self-represented parties of record and that written consent for electronic delivery was received from all attorneys and self-represented parties receiving electronic delivery. 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 (Guardian Ad Litem) Mailing address Print or type name of person signing Telephone number American LegalNet, Inc. www.FormsWorkFlow.com