REQUEST FOR EXCLUSION FROM ELECTRONIC SERVICES REQUIREMENTS JD-CL-92 Rev. 8-18STATE OF CONNECTICUT SUPERIOR COURT JUDICIAL BRANCH www.jud.ct.govE-Services Exclusion Requests Court Operations 225 Spring Street, 2nd Floor Wethersfield, CT 06109Instructions 1. Type or print clearly. 2. Send the exclusion request form to Superior Court Operations at the address below. 3. Keep a copy of this form for your records. Reason for Exclusion RequestI request an exclusion from electronic services requirements for me or on behalf of the firm named above for the following reason(s): Signed (Attorney or self-represented party) Do not write below this lineThe request is hereby ordered:Granted.Denied. FILE DATE Signed Name/Title of Person Signing Date From (Name of Attorney, Law Firm, or self-represented party) Juris Number or User ID Mailing address Telephone Number (area code first) E-mail address I do not have internet access, and I cannot access a court service center, law library or public library with internet access because (explanation required): Other (explanation required): Name of person signing at left Date signed Juris Number or User IDTo: ADA NOTICE 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. American LegalNet, Inc. www.FormsWorkFlow.com