APPEARANCE JUVENILE MATTERS JD-JM-13 Rev. 8-16 C.G.S. § 46b-120 P.B. §§ 3-2(b); 3-3; 3-4(c); 3-5; 3-6(b); 3-8, 26-3 STATE OF CONNECTICUT Instructions SUPERIOR COURT 1. Type or print clearly with ball point pen. www.jud.ct.gov 2. File a separate appearance for each child. 3. If this form is e-filed, pursuant to Section 51-193c of the Connecticut General Statutes the document shall have the same validity and status as a paper document that was signed, subscribed, or verified by the filer. Docket number JUVENILE MATTERS To: The Superior Court For Juvenile Matters In re: (Name of child/youth) Address of court (Number, street, town and zip code) o Mailing address (Number, street, P.O. Box) City/town Please Enter the Appearance of o Juris number of attorney or firm Telephone number Name of official, firm, professional corporation, individual attorney, or self-represented party (See "Notice to self-represented Parties" at bottom) State Zip code Fax number In the above-entitled case as counsel for the: E-mail address ("X" appropriate box) child father (name): mother parents child and parents other (name and interest, legal status or relationship): Type of case ("X" all that apply) Neglect / Uncared-for / Abuse Termination Probate Transfer Emancipation Appointment as guardian ad litem for If other counsel or a self-represented party have already appeared for the party or parties indicated above, state whether this appearance is: In place of the appearance of attorney or firm In addition to appearance already on file. (Name) Delinquency Family w/Service Needs Administrative Appeal Appeal from Probate Decision Other (specify): already on file or NOTE: If other court appointed counsel has already appeared for the party or parties indicated above, an appearance in place of the court appointed counsel must be authorized by the Judicial Authority. Signed (Individual attorney or self-represented party) Print of type name of person signing at left Date signed Certification I certify that a copy of the above was mailed or delivered in accordance with Practice Book Sections 3-4(c) and 3-5 of the Connecticut Practice Book. Name and address of each party and attorney that copy was mailed or delivered to* Signed (Individual attorney or self-represented party) Date copy(ies) mailed/delivered For Court Use Only * If necessary, attach an additional sheet or sheets with the name of each party and the address which the copy was mailed or delivered to Notice to Self-represented Parties A self-represented party is a person who represents himself or herself. It is your responsibility to inform the Clerk's Office if you have a change of address. 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. Appearance American LegalNet, Inc. www.FormsWorkFlow.com