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STATE OF CONNECTICUT CHRO Regional Offices APPEARANCE FORM DISCRIMINATION CASE Send to CHRO OFFICE WHERE THE CASE IS PENDING USING MAILING ADDRESSES BELOW CAPITOL REGION OFFICE 999 Asylum Avenue Second Floor Hartford CT 06105 EASTERN REGION OFFICE 100 Broadway Norwich CT 06360 WEST CENTRAL REGION OFFICE Rowland State Government Center 55 West Main Street Suite 210 Waterbury CT 06702-2004 SOUTHWEST REGION OFFICE 350 Fairfield Avenue 6th Floor Bridgeport CT 06604 ALL Housing Complaints HOUSING DISCRIMINATION UNIT 25 Sigourney Street 7th Floor CASE NAME - FIRST-NAMED COMPLAINANT vs. FIRST-NAMED RESPONDENT CASE No* v* PLEASE ENTER THE APPEARANCE OF Name Of Official Firm Professional Corp* Individual Atty. or Pro Se Party See Notice to Pro Se Parties at bottom* Juris No* if applicable Mailing Address No* Street P. O. Box Tel* No* City/Town State Zip Code Fax No* Email In the above-entitled case for select one The Complainant All Complainants The following Complainant s only The following Respondent s only The Respondent All Respondents Note If other counsel have already appeared for the party or parties indicated above state whether this appearance is No other counsel has appeared for the party or parties indicated above. In lieu of appearance of the following named attorney or firm already on file -. In addition to appearance already on file. Signature Individual attorney or pro se party Name Of Person Signing At Left Print or Type Date Signed CERTIFICATION I hereby certify that a copy of the above was mailed/delivered to All counsel including Commission counsel and pro se parties of record. Counsel or the party whose appearance is to be replaced* For in lieu of appearances. Date Copies Mailed/Delivered List below the name of each party served and the address at which service was made. Attach additional sheet if necessary. Notice to Pro Se Parties - A pro se party represents himself or herself* It is your responsibility to inform the CHRO if any of your contact information including your address changes. FIRST-NAMED RESPONDENT CASE No* v* PLEASE ENTER THE APPEARANCE OF Name Of Official Firm Professional Corp* Individual Atty. or Pro Se Party See Notice to Pro Se Parties at bottom* Juris No* if applicable Mailing Address No* Street P. or Pro Se Party See Notice to Pro Se Parties at bottom* Juris No* if applicable Mailing Address No* Street P. O. Box Tel* No* City/Town State Zip Code Fax No* Email In the above-entitled case for select one The Complainant All Complainants The following Complainant s only The following Respondent s only The Respondent All Respondents Note If other counsel have already appeared for the party or parties indicated above state whether this appearance is No other counsel has appeared for the party or parties indicated above. O. Box Tel* No* City/Town State Zip Code Fax No* Email In the above-entitled case for select one The Complainant All Complainants The following Complainant s only The following Respondent s only The Respondent All Respondents Note If other counsel have already appeared for the party or parties indicated above state whether this appearance is No other counsel has appeared for the party or parties indicated above. In lieu of appearance of the following named attorney or firm already on file -. In addition to appearance already on file.

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