Docket number
Name of case (Plaintiff v. Defendant In re John D.)
Self-represented party address
Self-represented party name
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.
Notice
All self-represented parties must have an account with E-Services unless exempt
from electronic filing. All nonexempt self-represented parties in family matters, child
protection matters, matters involving protected information and in all other matters in
which the self-represented party's user identification has not already been provided
must submit this form. This form must be filed within ten days of the filing of the
appeal. Failure to comply with this rule may result in the dismissal of the appeal or
the imposition of sanctions pursuant to Practice Book Section 85-1.
To register for E-Services, please visit http://www.jud.ct.gov/
, click on the link for
“E-Services,” then click on the link to “Enroll” and follow the instructions on screen.
CONNECTICUT JUDICIAL BRANCH
APPELLATE CLERK
231 Capitol Avenue
Hartford, CT 06106
APPELLATE ELECTRONIC ACCESS
(SELF-REPRESENTED PARTY REGISTRATION)
JD-AC-15 Rev. 1-19
P.B. 60-7(c)
Self-represented party E-Services User Identification
I. All fields must be completed
II. Submit this form using “A” or “B” below
A. Any self-represented party in any appellate matter in which the self-represented party's user identification
has not already been provided, other than a family or child protection appellate matter or an appellate matter
that involves protected information, must file this form through Appellate E-Filing. The form does not need to
be notarized when you submit it through Appellate E-Filing.
E-filing instructions:
Notice: Any self-represented party in a family or child protection appellate matter, or an appellate matter involving
protected information must submit this form on paper, and the instructions in "B" below must be used.
1. If you are filing this form in an appeal: Search for your case by docket number. On the summary screen for your
case, select “E-file a preliminary paper/appeal document” from the drop-down menu at the top of the screen, and
then select “Appellate Electronic Access” from the list.
2. If you are filing this form in a petition for certification or in a motion or application before filing an appeal: Search for
the petition, motion, or application by docket number, using the six (6) digit number assigned to the filing. On the
summary screen for the petition, motion, or application, select “Other Document” from the drop-down menu at the
top of the screen, and then select “Appellate Electronic Access” from the list.
B. Any self-represented party in a family or child protection appellate matter, or an appellate matter that involves
protected information must submit this form on paper in one of the following two ways:
1. Bring this completed form and photo ID to the Office of the Appellate Clerk at 231 Capitol Avenue, Hartford, CT
06106. The name on the photo ID must match the name of the party in the case file. If the name on the photo ID
is different than the party's name, proof of name change must also be delivered to the Office of the Appellate Clerk.
DO NOT SIGN THE FORM BEFORE BRINGING IT TO THE OFFICE OF THE APPELLATE CLERK.
2. Mail this completed form that is signed and sworn to under oath before a notary public or other proper officer to the
Office of the Appellate Clerk, 231 Capitol Avenue, Hartford, CT 06106.
DO NOT SIGN THE FORM BEFORE BRINGING IT TO THE NOTARY PUBLIC OR OTHER PROPER OFFICER.
Signed (Self-represented party)
u
Date signed
I certify that a copy of the document(s) that I am filing has been delivered on to each other counsel of record,
and I have included their names, addresses, e-mail addresses, and telephone numbers; the document(s) have been redacted or do not
contain any names or other personal identifying information that is prohibited from disclosure by rule, statute, court order, or case law; and
the document(s) comply with all applicable rules of appellate procedure in accordance with Practice Book Section 62-7.
Names, addresses, and telephone numbers are included on a separate page.
Date signed
Signed (Self-represented party)
Print name
Subscribed and sworn
to before me on:
Signed (Notary Public or other proper officer)
Date
Print name
