Document for NEW LONDON COUNTY MUTUAL INSURANCE COMPANY A/S/O D v. PRADO-QUIREES, KEVONIE

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                                APPEARANCE                                                                This form is available                              STATE OF CONNECTICUT
JD-CL-12 Rev. 12-21                                                       in other language(s).                                    SUPERIOR COURT
P.B. §§ 3-1 through 3-12, 10-13, 25-6A, 25a-2, 254-3
                                                                                                                                                 www,jud.ct.gov
There are instructions and important notices on page 2 (the back) of this form.
Read page 2 before filling out this form.                                                                                    ito
                                                                                                                               date (Fc       GivilFamily cases)
      ‘| am filing this appearance to let the court and all attorneys and self-represented
                                                                                                                                             2ZOZ2.
                                                                                                                             Docket Olt
      parties of record know that I have changed my address.                 My new address is below.
                                                                                                                             BHD-Cyz2- bibl                                       7S
Name of case (Full name of first Plaintiff v. Full name offirst Defendant) Note: In Criminal/Motor Vehicles cases, the Plaintiffis The State of Connecticut         KeNOrMe.
                           on               ary             Muta\ Tonsourance
                                      ‘Address of colin (Number, Streat, fown and zip code)
                                                                                                         Company
                                                                                                         Cols  OU
                                                                                                                                AlslO_ Dv, Prado Wuirres
                                                                                                                             aad Court date (Criminal/Motor Vehicle cases only)
 Housing Judicial Geographic
   ession. istrict                       GH          Washington S*- Hartford CT
Enter the ‘Appearance of
Name (Your name or name ofof firm, professional corporation, or individual attorney)                                                       Juris number (For attorney/law firm)
         eNOM) ec.
Mailing address:
                                      ada-AuicreS                                                           Post Office box number         Telephor    ‘umber (Area code first)
 14
City/town
             SJenathonP                      State      Zip code               Fax number                   E-mail address
                                                                                                                                          (BloOOVNORSIA
BroomFela                                    CT! ObOOZ                                                     Keyorie                     AR Manual. con
in the case named above for: (Select one of the following parties. See descriptions/notes on page 2 of this form, )
PLAINTIFF
                   (J): The Plaintiff.
                   L) All Plaintiffs
                   LJ The following Plaintiff(s) only:
                                                                                              DEFENDANT           The Defendant. dD
                                                                                                                  All Defendants.
                                                                                                             L] The following Detgfendant(s) only:
                                                                                                                                                  o/
                                                                                                                                                              2
                                                                                                                                                      {3=I

             Other (Specify).                                                                                                                         oe
                                                                                                                                                      3
Oo This is a Family Matters case (such as divorce, custody, or child support). My appearancaiibf
                                                                                              iS                                                 elect one onboth)
   (J matters in the Family Division of the Superior Court      (J Title 1V-D Child Support matters”
                                                                                                                                        Sat
1 This is a Criminal/Motor Vehicle case, and | am filing this appearance as [] a Public Deféndet on Co Aesignfed Counsel
(_] This appearance is for the purpose of a bail hearing only.                                 co      (Special Public Defender)
(J This appearance is for the purpose of alternative arraignment proceedings only.          oar
                                                                                                           =o    oo
If an appearance by other counsel or self-represented party is on file for this party/parties, select one éption‘Bélow:
1. [|] This appearance is in place of the appearance of:
                                                                                   ‘Name and Juris Number (applicable) to be replaced
2.   (      This appearance is in addition to an appearance already on file.

| agree that documents can be delivered (served) to me electronically in this case. (Practice Book Sec. 10-13)                                         {| Yes         LINo
     init
      individu a          heabb=          Kennet.                            ‘Nanpe of person signing ate Pant or re)                                 Date signed
                                                                             Keyonie.                   Prodo-Quirres
                                                                                                         tr                                              NVloz/a2z2
Conti ication                                                                                                                                FOR COURT USE ONLY
| 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 fromall 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

 Co nweuy                   Srougcton                              LLC
     (AL           Faormiratern                  Avense
      Bortord                     CT Ob\05
*If necessary, attach additional sheet or sheets with name and address which the copy was or will be mailed or delivered to.
Signed (Signat:                                     Print or type name of per igning
                                   ante |                    CM OM LS                Th        o-boicres             eek Z
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