CLAIM FOR JURY JD-CL-53 Rev. 6-12 C.G.S. §§ 52-215, 52-258 Pr. Bk. §§ 14-4, 14-8, 14-10 STATE OF CONNECTICUT Court Use Only SUPERIOR COURT www.jud.ct.gov CLAIM6 *CLAIM6* Instructions 1. This claim must be accompanied by the appropriate jury fee (Section 52-258 of the Connecticut General Statutes). 2. When pleadings are closed, a Certificate of Closed Pleadings (JD-CV-11) must also be filed. Return date To: The Superior Court Name of case (Full name of Plaintiff v. Full name of Defendant) Docket number Judicial District Housing Session Geographical Area number Address of court (Number, street, town and zip code) This case is claimed for the inventory of jury cases. (A certificate of closed pleadings must be filed before the case named above can be placed on the inventory of jury cases.) Claim filed by ("X" one) Plaintiff's Attorney Plaintiff Defendant's Attorney Defendant Name of Law Firm, Attorney, or Self-Represented Party Mailing address (Number, street, town, state and zip code) Telephone number Certification I certify that this claim is filed in accordance with section 52-215 of the Connecticut General Statutes and 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 For Court Use Only 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* Signed (Signature of filer) Print or type name of person signing Date signed X Mailing address (Number, street, town, state and zip code) Telephone number *If necessary, attach additional sheet or sheets with name and address which the copy was mailed or delivered to. American LegalNet, Inc. www.FormsWorkFlow.com