Free REQUEST FOR EXCLUSION FROM ELECTRONIC SERVICES REQUIREMENTS - Connecticut

REQUEST FOR EXCLUSION FROM ELECTRONIC SERVICES REQUIREMENTS
JD-CL-92 New 6-08

STATE OF CONNECTICUT

SUPERIOR COURT JUDICIAL BRANCH www.jud.ct.gov

Instructions
1. Type or print clearly. 2. File the exclusion request form with the Statewide Grievance Committee at the below address. 3. Keep a copy of this form for your records.

To: Statewide Grievance Committee, 287 Main Street, 2nd Floor, Suite 2, East Hartford, CT 06118-1885
Telephone (860) 568-5157

From (Name of Attorney/Law Firm requesting exclusion) Address of Attorney/Law Firm E-mail address

Juris Number Telephone Number (with area code)

Reason for Exclusion Request
I request an exclusion from electronic services requirements for me or on behalf of the firm named above for the following reason(s): I do not have Internet Access The firm does not have Internet Access Other (explanation required)

Signed (Attorney making request)

Name of Attorney Signing at left

Date

Juris Number of Attorney

Do not write below this line The request is hereby ordered: Granted. Denied. FILE DATE

Signed

Name/Title of Person Signing

Date

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