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•
STATE OF ILLINOIS
•
N
THE CIRCUIT COURT OF THE
22
0d
JUDICIAL CIRCUIT
FIL.ED
DEC
22009
McHENRY CQUNTY .
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TliERINE M.
KEEFE
McHENRY
CTY. ClR.
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·NOTICE OF MOTION
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.m., or
as
soon
thereafter
as
COU;lSc!
may
be
heard;
I
shall
appear before the Honorablej
LA
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or any
Judgesitting
in
his/her stead,
in
the
courtroom
usually occupied
by
himlher
in
the
McHenry
County
Government
Center,
2200
N.
Seminary Avenue,
Woodsiock,
Illinois
and
_________________
Signature
Attorney
for
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Address
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\ CV·NOT4: Revised
12/01/06
••
ROOF
OF SERVICE
BY
DELIVERY
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(the attorney, eerlify) (a non-attorney, on oath slale)
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each person
to
whom it
is directed,
(If
nol the attorney)
Signcd
nd
sworn
to
before
me
-#~~~'---,fI4L.,
20
0
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Signature
,-
OFACIAL
SEALCONNIE
R.
TROTIERNotary
Pulitlc
-
State
of
IlIInols
My
Commission
ExpillSFeb
09,2013
PROOF OF SERVICE
BY
MAIL·
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J,
____
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___________
~ - - - - ~ - - ~ - - ~ - - - - - -
(the Dttomey, cerlify)
(0
non-DUomey, on oath
SIDle)'
I
scrved
this
notice
by
mailing
a
copy
to
___________________________
at
________________________
~
___________________________________
__
and
depositing
the
samein
the
U.S.Mailat'
____
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_-"
_
. : : : ~ = = -
_________
_'__~
_____
at
______
on
_______________
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20
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with
proper
postage
prepaid.
Signature
....
--'
(If
nolthe
allomey)
Signed
and
sworn
to
before
me
__________
---!.20
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.
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NOlary
PublicCV-NOT4: Revised
12101106
IN
THE
cIRcm-AtuRT
OF THE
TWENTY-SECONAmCIAL
CIRCUIT
P
fJ
IL
McHENRY COUNTY,
ILLINOIS
Nil
0
DEC
~2
2DD9
I<ATHCRIN.
"''''Ellf/Y
rJ.,
..
m""
.
CIR.
ClJ(.
09
IJ1l 39c;
C~eNumber
______________________________
__
Now
comes
S
A.t:!
g,o.-J
A
f\f',.
.
;V1
t
fL..o>.A...I'
,
pursuant
to
Supreme Court
Rule
298
and
Section
515-105
of
the Code
of
Civil
Procedure
and
on
oath states:I.
My
occupation or
means
of subsistence
is
=t
un!!!)
P
(0"-1
edJ
'[/C(?cu.f;vp.J'eq
r>...b
(Jr<l{:essl
;,.,.,{
2.
My
income
for the
previous
year
was
$.
__
- - : - ~ L " - " : s - : ' - ' i ) ~ ' ' ' ' 1 " . D ' _ ' _ « · ) ' _ : _ _ - V ~ - - - - - - - - - - - - - - _ : _ 7 " - - ; _ - - _ _ ; _ - - - - - - - - - - -
3.
The
source
and
amount
of
income [currently expec!is
rJ
" ,
"C,ome
e.
Kef;!
et
dOo'\c.
-(
I
"..oS
4.
The
nature
and
value
of
property
owned
by
me
is:a)
Real
Property
C?
b)
Personal
Property
t
100
0
5.
During
the preceding year, I
have
petitioned
for
permission
to
sue or defend
as
a
poor person
in
the followingmatters:
CJ
6.
I
am
unable
topay the
costs
of
this suit.
7.
I
have
a meritorious claim or defense.
8.
I
am
indigent
based
on
the following criteria (check
which
applies):
o
(a)
'1
am
receiving assistance
from
the
following
public benefits
programs:.
___
c.V..,'
-
_______________
o
(b)
Mic)
My
available income
is
125%
or
less
ofthe current official
federal poverty
income guidelines; or
?
I
am
unable
to
proceed
in
this
action without the
payment
of
costs
and
if
I
am
required
to
pay
costs,
my
family
or I
will
suffer substantial hardship.
9.
The
names
of
person(
s)
residing
in
my
fami
Iy
unit
are:'_-LK:>..l.f";(J"I".f",f:."""'L..(",---,t!t.o..A,,,,-,d.L-.>..,[L.!'-O
"""",L"---,-,--,-P,.,(,.,,,,,,,,-C--,(Yl.;..!...,,.,12
WHEREFORE, Petitioner prays
this
Court
to
grant
leave
to
sue or defend
as
a poor
person.
VERIFICATION
BY
CERTIFICATION
-Under
penalties
as
provided
by
law
pursuant to Section
1-109
of
he
Code
of
Civil Procedure,
the undersigned certifies that
the
statements set
forth
in
this
instrument are
true and
correct, except
as
to
alters therein stated
to
be
on
information
and
belief
and
as
to
such
malters
the
undersigned certifies
as
aforesaid that
eerily
believes the same
to
e.
Petitioner's Signature
'"
YOUII
p~;rITlON
is
GIIANTEt>,
THE
COUR1' MAY ORDER YOU
TO
PAY
AI,L
OR A PORTION
OFTHE
FEF.s, COSTS. OR GHARGF,s WAIYED
OUTOF
MONIV.s
lU:COV~;R~;D
BY
YOU PURSUANT
TO
ANY SETTLEMEl'oT
OR
JUDGMENT RESULTING
IN
THIS
CASE,
ORDER
Permission
is
hereby
(granted)
(denied)
Petitioner
to
sue or defend
as
a poor
person,andThe
Sheri
fT
of McHemy
County·(ls.)
(is
not)
ordered
to
serve process
upon
defendant witliout
fee.
The County
of
McHenry
(,Js-)
(is not) ordered
to
pay
costs
of
service
by
publication.Other:
__________________________________________________________
_If Petition
is
denied, reason(s) for denial:
______________
-::::::;.,..-fjf-
___
A-:::::::==:;:---7/------------
Dated:
______________________
Entered:c---r-'--_-I
___
,,=:;,-\,.---=-=-
__
+
____
-.,
____
_
CV-APPI: Revised
12101106
_._---<-
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