CL012
CL012
CL012
There are instructions and important notices on page 2 (the back) of this form.
Read page 2 before filling out this form. Return date (For Civil/Family cases)
I am filing this appearance to let the court and all attorneys and self-represented Docket Number
parties of record know that I have changed my address. My new address is below.
TBD
Name of case (Full name of first Plaintiff v. Full name of first Defendant) Note: In Criminal/Motor Vehicles cases, the Plaintiff is The State of Connecticut
Other (Specify):
This is a Family Matters case (such as divorce, custody, or child support). My appearance is for: (Select one or both)
matters in the Family Division of the Superior Court Title IV-D Child Support matters
This is a Criminal/Motor Vehicle case, and I am filing this appearance as a Public Defender or Assigned Counsel
This appearance is for the purpose of a bail hearing only. (Special Public Defender)
This appearance is for the purpose of alternative arraignment proceedings only.
If an appearance by other counsel or self-represented party is on file for this party/parties, select one option below:
1. This appearance is in place of the appearance of:
Name and Juris Number (if applicable) to be replaced
2. This appearance is in addition to an appearance already on file.
I agree that documents can be delivered (served) to me electronically in this case. (Practice Book Sec. 10-13) ✖ Yes No
Signed (Individual attorney or self-represented party) Name of person signing at left (Print or type) Date signed
Virginia Brown
Certification FOR COURT USE ONLY
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 of record who received or will immediately be receiving electronic delivery.
Name and address of each party and attorney that copy was or will be mailed or delivered to*
*If necessary, attach additional sheet or sheets with name and address which the copy was or will be mailed or delivered to.
Signed (Signature of filer) Print or type name of person signing Date signed
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.