LIMITED APPEARANCE JD-CL-121 Rev. 2-16 R.P.C. 4.2 P.B. 3-3(b), 3-8(a)(b), 10-13 STATE OF CONNECTICUT (For Court Use Only) SUPERIOR COURT www.jud.ct.gov LTDAPP (Note: Self-represented parties (pro se parties): Do not use this form. Use form JD-CL-12.) Instructions to Attorneys: 1. Fill out the form, including the certification section at the end of the form. File the original paper version of this form with the clerk. Mail or deliver a copy to all attorneys and self-represented parties of record. 2. If this limited appearance is not being filed in place of another limited appearance, check each event or proceeding for which the limited appearance is being filed. Do not complete the "In place of" or the "In addition to" boxes. Name of Case (Full name of Plaintiff v. Full name of Defendant) Address of Court (Number, state, town and zip code) *LTDAPP* 3. If you are filing a limited appearance in place of another attorney with a limited appearance, the event(s) or proceeding(s) on your in place of limited appearance must exactly match the event(s) or proceeding(s) on the limited appearance being replaced. Indicate these events by completing the "In place of" box that corresponds with the event(s) or proceeding(s). Return date Docket number - - - -S Judicial District Small Claims Housing 1. Enter the Limited Appearance of: Attorney Firm Address Phone Email address City State Zip (Juris number) For the following party or parties: Party Address City State Zip Phone Party Address City State Zip Phone 2. The attorney's appearance in this matter is limited to the following event(s) and/or proceeding(s). If necessary, provide a brief additional description of the event and/or proceeding for which the limited appearance is being filed. Event or Proceeding Event or Proceeding Date, if applicable Appearance in place of, if applicable (Name and Juris number) Appearance in addition to, if applicable (Name and Juris number) Family - Hearing on Order for Relief from Abuse Civil Protection Order (Additional description, if necessary) (Event or Proceeding information continued on Page 2) ADA NOTICE For Court Use Only 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. (Page 1 of 3) American LegalNet, Inc. www.FormsWorkFlow.com Event or Proceeding Event or Proceeding Date, if applicable Appearance in place of, if applicable (Name and Juris number) Appearance in addition to, if applicable (Name and Juris number) Pre-Judgment Motion(s) / Hearing(s) Entry number(s) (If available) File date(s) (If available) (Additional description, if necessary) Post-Judgment Motion(s) / Hearing(s) Entry number(s) (If available) File date(s) (If available) (Additional description, if necessary) Pretrial Conference (Additional description, if necessary) Status Conference Civil - Discovery/Scheduling Order Conference (Additional description, if necessary) Trial Management Conference (Additional description, if necessary) Family - Special Masters Conference (Additional description, if necessary) Family - Conciliation Session Civil - Case Evaluation Conference (Additional description, if necessary) Mediation Other ADR Process Session Foreclosure Mediation Program - Premediation Foreclosure Mediation Program - Mediation (Additional description, if necessary) JD-CL-121 Rev. 2-16 (Page 2 of 3) American LegalNet, Inc. www.FormsWorkFlow.com Trial Civil - Jury Selection (Additional description, if necessary) Other (Specify): (Additional description, if necessary. Be as specific as possible,for example: entry number(s), file date(s), title(s) of motion(s).) 3. I certify that in addition to this limited appearance, the party/parties I am representing ("x" one): already has a self-represented appearance on file. Is filing a self-represented appearance at the same time as the filing of this limited appearance. 4. The Attorney named below is "Attorney of Record" and is available for service of documents ONLY for those court events described above. All pleadings, motions or other documents served on the limited appearance attorney shall also be served in the same manner on the party/parties for whom the limited appearance was filed. For all other matters, the party/ parties must be served directly, unless otherwise ordered by the Court. Service of process on this attorney for any issue not named above shall not be deemed service on the party/parties. The name and address of the party/parties where service will be accepted and phone number are provided in section one of this form for that purpose. 5. I agree to accept papers (service) electronically in this case under Practice Book Section 10-13. Yes No 6. Other parties and their attorneys may directly communicate with the party/parties represented by the undersigned attorney regarding matters outside the scope of this limited representation without first consulting the undersigned attorney. 7. Upon completion of the representation as defined in this Limited Appearance, the attorney will file a Certificate of Completion of Limited Appearance form, JD-CL-122. Copies of the Certificate must be served in accordance with Sections 10-12 through 10-17 on the party/parties, and all attorneys and self-represented parties of record. Signed (Individual attorney) Name of person signing at left (Print or type) Date signed Certification I certify that a copy of this document was or will immediately be 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 (Signature of filer) Print or type name of person signing Date signed Telephone number u Mailing address (Number, street, town, state and zip code) JD-CL-121 Rev. 2-16 (Page 3 of 3) American LegalNet, Inc. www.FormsWorkFlow.com