Last updated: 6/9/2021
Appearance Form Discrimination Case (Office Of Public Hearings)
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Description
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 ALL Housing Complaints: HOUSING DISCRIMINATION UNIT 25 Sigourney Street, 7th Floor Hartford, CT 06106 SOUTHWEST REGION OFFICE 350 Fairfield Avenue, 6th Floor Bridgeport, CT 06604 CASE NAME - (FIRST-NAMED COMPLAINANT vs. FIRST-NAMED RESPONDENT): v. PLEASE ENTER THE APPEARANCE OF: CASE No. 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 Email State Zip Code Fax No. 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.) Signature (Individual attorney or pro se party) 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. (Revised 11/28/2012)
