Signed (Self-represented party or individual attorney)

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ONLINE DISPUTE RESOLUTION REQUEST TO RETURN TO REGULAR DOCKET JD-CV-166 New 12-18

Docket numberName of case (Full name of Plaintiff v. Full name of Defendant)

Address of court (Number, street, town and zip code)Judicial district

Instructions 1. Type or print clearly. 2. If you are filing this form electronically, select Online Dispute Resolution - Request

to Return to Regular Docket as the name of the document you are filing.

The in the above-entitled matter is choosing to opt out of participation in Online Dispute Resolution and is notifying the court and all appearing parties that this case should be returned to the regular docket of the Superior Court.

Mailing address (Number, street, town, state and zip code)

Signed (Self-represented party or individual attorney)

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Certification

Print or type name of person signing

Telephone number

Date signed

(date) to all attorneys and self-represented parties of record and that written consent for electronic delivery was received from all attorneys and self-represented parties of record who received or will immediately be receiving electronic delivery.

I certify that a copy of this document was or will immediately be mailed or delivered electronically or non-electronically on

*If necessary, attach additional sheet or sheets with name and address which the copy was or will be mailed or delivered to.

Name and address of each party and attorney that copy was or will be mailed or delivered to*

Date signedPrint or type name of person signing

Plaintiff Defendant

STATE OF CONNECTICUT SUPERIOR COURT

www.jud.ct.gov

ADA NOTICE The Judicial Branch of the State of Connecticut complies with the Americans with Disabilities Act (ADA). If you need a reasonable accommodation in accordance with the ADA, contact a court clerk or an ADA contact person listed at www.jud.ct.gov/ADA.

Note: This form must be filed within 15 days of the date when the case was referred for Online Dispute Resolution (ODR).