REQUEST TO CONFORM CASE INITIATION DATA ENTRY INFORMATION TO SMALL CLAIMS WRIT AND NOTICE OF SUIT STATE OF CONNECTICUT SUPERIOR COURT www.jud.ct.gov JD-CL-116 New 1-11 Instructions to Person Making Request: This form may be used only to request that data incorrectly entered electronically be conformed to the information on the Small Claim Writ and Notice of Suit that was served. Instructions to Court Staff: Bring this form to the Clerk of Centralized Small Claims. Name of Case (First-named Plaintiff vs. First-named Defendant) Docket number Court location Centralized Small Claims, 80 Washington Street, Hartford, CT 06106 The Plaintiff(s) respectfully represent(s) that the case initiation documents in the case named above were served on the defendant(s) on . After service on the defendant(s), the documents were filed with the Court electronically through e-filing. The data entered in the e-filing system does not conform to the data contained on the Small Claims Writ and Notice of Suit served on the defendant(s) as follows: Data entered in the case management system (Check all that apply) Information contained on the summons served Case Type Venue Amount Claimed Party Type Name(s) of Plaintiff(s) Name(s) of Defendant(s) The plaintiff(s) therefore request(s) that the incorrect data contained in the Court's case management system be changed to conform to the information on the Small Claims Writ and Notice of Suit. Print Name of Person Signing Signed Juris Number Date Signed Certification I certify that a copy of this document was mailed or delivered electronically or non-electronically to all attorneys and self-represented parties of record on and that written consent for electronic delivery was received from all attorneys and selfrepresented 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 (Individual attorney or self-represented party) Print or type name of person signing Ξ Acted on as requested No action taken (reasons): Notice sent to parties on (date): By: Date (Clerk/Assistant Clerk) Print Form Reset Form American LegalNet, Inc. www.FormsWorkFlow.com