UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT
, Plaintiff V. , Defendant Case No. [Put case number here]
CONSENT TO ELECTRONIC NOTICE BY PRO SE LITIGANT
A. I, [Complete the first line for electronic notification from the court]
hereby consent to the court (name of pro se litigant) using my email address, as listed below, for the purpose of sending me notification of orders and notices issued by the court.
B.
[Complete the second line for electronic service from opposing counsel; DO NOT COMPLETE THIS LINE IF YOU WANT OPPOSING COUNSEL TO SEND PAPERS BY REGULAR MAIL]
I,
hereby consent to opposing (name of pro se litigant) counsel using my email address, as listed below, for the purpose of sending me papers filed with the court. In the event I change my email provider or discontinue my email service, I will notify the court immediately of the address change so my court records may be updated.
(Name of pro se litigant, typed or printed)
Street Address
City, State, Zip Code
Telephone
email address
Date
Rev. 12/1/04
Signature
Page 1
Certificate of Service
I hereby certify that on ____________ [date], a copy of foregoing "Consent to Electronic Service By Pro Se Litigant," was filed and served by mail on the following: [insert name and address of every person served]
Signature of pro se litigant
Rev. 12/1/04
Page 1