Fill and Sign the Jd Fm 164a Rev 11 01 Docket No Cgs46b 115s Pb25 Form

NAME OF PLAINTIFF(S) (Print or Type) EXPEDITED PROCESS TRACK CONSENT OF PARTIES JD-CV-56 Rev. 10-06 C.G.S. §52-195b Pr. Bk. Sec. 23-3 DOCKET NO. (If known) CERTIFICATION I hereby certify that a copy of the above was mailed/delivered to all counsel and pro se parties of record on the date shown below. NAME OF CASE The undersigned party(ies) and the attorney(s) for such party(ies): INSTRUCTIONS TO CLERK This form is to be filed with the clerk in accordance with Practice Book Sec. 23-3 to indicate the consent of one or more parties and their attorneys to placement on the expedited process track. When all parties to the action and their attorneys have consented, the plaintiff shall, pursuant to Practice Book Sec. 23-3(d), file with the clerk Form JD-CV-57, "Notice for Placement on the Expedited Process Track". TO: The Superior Court JUDICIAL DISTRICT COURT LOCATION (No., street, town and zip code) 1. state that the above-referenced case is one which may be brought as an expedited process case under C.G.S. §52-195b(b)(2); 2. consent to placement of the case on the expedited process track; 3. waive the right to a trial by jury, the right to a record of the proceedings, and the right to appeal. Additionally, the undersigned plaintiff(s) agree to limit the amount in demand to a maximum of $75,000 exclusive of interest and costs. Pursuant to Practice Book Sec. 23-3(c) the above waivers and limit to the amount in demand apply only if the case is placed on the expedited process track. SIGNATURE OF PLAINTIFF(S) SIGNATURE OF ATTORNEY(S) FOR PLAINTIFF(S) NAME OF DEFENDANT(S) (Print or Type) SIGNATURE OF DEFENDANT(S) SIGNATURE OF ATTORNEY(S) FOR DEFENDANT(S) DATE COPY(IES) MAILED OR DELIVERED SIGNED (Individual attorney or pro se party) X NAME OF EACH PARTY SERVED * ADDRESS AT WHICH SERVICE WAS MADE * If necessary, attach additional sheet