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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 WEST CENTRAL REGION OFFICE SOUTHWEST REGION OFFICE 450 Columbus Boulevard Rowland State Government Center 350 Fairfield Avenue, 6" Floor Hartford, CT 06103 55 West Main Street, Suite 210 Bridgeport, CT 06604 Waterbury, CT 06702-2004 EASTERN REGION OFFICE HOUSING COMPLAINTS 100 Broadway Housing Discrimination Unit Norwich, CT 06360 450 Columbus Boulevard Hartford, CT 06103 CASE NAME (First Named Complainant v. First Named Respondent) Case No. David Mederios Vv. Connecticut Department of Consumer Pro [2510183 Juris No. PLEASE ENTER THE APPEARANCE OF: Rebecca Quinn, Office of the Attormey ¢ Ne ot Offical, Firm, Professional Cor, Individual Atty or Po S Paty (See Pro So Parties Notice below) Mailing Address (No, Street, P.O. Box) 165CapitolAve. [TelNo. Harford: “to oR Gir 06116. 860-818-5163 City/Town State Zip Code Fax No. Email rebecca.quinn@ct.gov 4 ss Tn the above-entitled case for: (select one) [1 The Complainant [1 All Complainants ~~ # The Respondent [J All Respondents [0 The following Complainants only Ran 0 The following Respondents only: TR 3 Ce ECR SS SD Note: Tf counsel has already appeared for the party or parties indicated above, state whether this appearance is: [1 No other counsel has appeared for the party or parties indicated above. 0 In lieu of appearance of the following named attorney or firm already on file: # In addition to appearance already on file [1 Iam appearing pro hac vice and have permission from superior court to appear in this matter. (Attach {he court's permission to this appearance) Requirement effective as of January 1, 2017.) Siznature (Individual atormey or pro s¢ party) | Name of Person Signing at Left (Print or Type) Date Signed OR AD 1000 [8 g Rebecca Quinn 2120/25 [~~~ CERWFICATION Thereby certify that a copy of the above was mailed/delivered to: & All counsel, including Commission comnsel and pro se parties of record 5 Counsel or the party who appearance is 10 be replaced (For “in lieu of” appearances) J nic ol G1: (0A— 2120125 Signature (Individual Wttorney or pro se party) Date Copies Mailed/Delivered Li below the mame of cach party served and the address at which service was made (attach additional sheet if necessary) David Mederios, 215 Mountain St, Windham, CT 06226 *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.