Order: MB FINANCIAL BANK, N.A. v. STERRY, NANCY A. Et Al

• 
• 
• 
• 

						
                                
Preview
                                STATE OF CONNECTICUT

FORECLOSURE MEDIATION JER

CERTIFICATE SUPERIOR COURT £

JD-CV-108 Rev. 7-15 JUDICIAL BRANCH
www.jud.ct.gov -

C.G.S. §§ 49-31k, 49-31 PLA, 15-124

Instructions to Homeowner Applicant
pp FMREQ

1. Use this form if the return date in your case is on or after July 1, 2009.
2. Fill out this Certificate form and an Appearance form, JD-CL-12 (available at the courthouse or online at www.jud ct.gov) PARAM

and file them with the court not more than 15 days after the return date on the Summons.
3. You must mail or deliver a copy of this completed Certificate form to the plaintiff's attorney, or to the plaintiff if the plaintiff
is not represented by an attorney, and to all parties who have filed an appearance in the case.

This form will be used to determine your eligibility for the Foreclosure Mediation Program.

Type or Print Legibly
Docket number (To be filled in by court staff)

Name of case (Plaintiff on Summons vs. Defendant on Summons} .
Bendett = Uc fool , P» LLEOV IGG zs|

Return date (On upper right portion of Summbns) P Judicial District of (On upper left portion of Summons)

Wplecie | Etehtela
Micheel ¢ Douce Sterry

‘Address (Number, street, town, state, Zip code)

96 Pesmmg cho, Meco LUiGapot, et oGT77G

Telephone number ‘Blo phone Cell phone
(660) 210-1943 (Bo) 355~ 3237 8) 7771- 7o8l
A. If you are an individual, answer the following questions:

4. Do you own the property? Yes ‘L]No

2. Do you live in the property? . . fe Yes [No

3. Is it your primary residence? Yes [JNo

4. 1s ita 1, 2, 3 or 4 family-residential property located in Connecticut? { fecreto all attorneys and self-represented parties of record and that written consent for electronic delivery
was received fram all attorneys and self-represented parties of record who were or will immediately be electronically served.

‘Name and ‘address of each party and attomey that copy was or will immediately be mailed or delivered to”
Ben dett ¢ Mettogh fe.
jbo Forhkin gton .
acpi
Facningle., CR 66032

‘additional sheet or sheets with name and address which the copy was or will immediately be mailed or delivered to.
i

*if necessary, attach,

‘Signed at Print or type name of person signing Date signed
» é l Mieheel 6. Steer : Ul 7 [2abe
Walling addresy/ (Number, street, town, state and zip code) Telephone number

feng pr Deo Lit, & er: ob77b flo vio. JY