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2647 APPLICATION AND ORDER FOR AWARD IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, PROBATE DIVISION Estate of ________________________________________________________ Deceased

(Rev. 9/24/01) CCP 0337

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No. ___________________________________________ Docket ________________________________________ Page __________________________________________

APPLICATION FOR AWARD The undersigned representative of this estate applies to the court to allow a surviving spouse's and child's award as follows: 1. 2. 3. For surviving spouse. For _______________________________ minor and adult dependent children of decedent residing with spouse, payable to spouse. For _______________________________ minor and adult dependent children of decedent not residing with spouse, payable to ______________________________ ________________________________________________________________________. For _______________________________ minor and adult dependent children of decedent when decedent leaves no spouse, payable to _______________________ ________________________________________________________________________. TOTAL $ __________________________ $ __________________________

$ __________________________

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$ __________________________ $ __________________________

_____________________________________________________ Representative Signed and sworn to before me on this ___________ day of _____________________________________________, ________ ________________________________________ Notary Public AWARD TO SURVIVING SPOUSE AND CHILDREN It is ordered that the following reasonable award is allowed, to be paid in not more than 3 installments: 1. 2. 3. For surviving spouse. For ____________________________ minor and adult dependent children of decedent residing with spouse, payable to spouse. For ____________________________ minor and adult dependent children of decedent not residing with spouse, payable to ____________________________ _______________________________________________________________________. For ______________________________ minor and adult dependent children of decedent when decedent leaves no spouse, payable to ______________________ _______________________________________________________________________. (4134) TOTAL $ __________________________ $ __________________________

$ __________________________

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$ __________________________ $ __________________________

Atty. No. _______________ Name: ____________________________________ Attorney for: _______________________________ Address: __________________________________ City/State/Zip: _________________________________ Telephone: ________________________________

___________________________________________, ________ ENTER: _________________________________________________ Judge Judge's No.

DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS