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How to Sue as a Poor Person
This supplement includes a forms guide as well as forms. The forms guide is for use only in filling out the forms. For more information about what these forms mean or are used for, consult the appropriate Self Help packet. ©Board of Trustees, Southern Illinois University

FORMS GUIDE

ALL FORMS: At the top of each form is the "caption". It is completed as follows:

STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE (number of circuit) JUDICIAL CIRCUIT (name of county) COUNTY

(your name) Plaintiff, and (your spouse's name) Defendant.

) ) ) ) ) ) ) ) ) ) )

No. (get from Clerk at the time you file)

Determine the number of the "Circuit" according to the chart on the next page. If your county does not appear in the chart, call the Circuit Clerk in the county in which you will be filing your case and ask for the number of the Circuit.

Circuit Courts in Illinois
Cook County is its own judicial circuit. The rest of the counties in Illinois fall into one of 21 circuits. First Circuit The counties of Alexander, Pulaski, Massac, Pope, Johnson, Union, Jackson, Williamson and Saline. The counties of Hardin, Gallatin, White, Hamilton, Franklin, Wabash, Edwards, Wayne, Jefferson, Richland, Lawrence and Crawford. The counties of Madison and Bond. The counties of Clinton, Marion, Clay, Fayette, Effingham, Jasper, Montgomery, Shelby and Christian. The counties of Vermilion, Edgar, Clark, Cumberland and Coles. The counties of Champaign, Douglas, Moultrie, Macon, DeWitt and Piatt. The counties of Sangamon, Macoupin, Morgan, Scott, Greene and Jersey. The counties of Adams, Schuyler, Mason, Cass, Brown, Pike, Calhoun and Menard. The counties of Knox, Warren, Henderson, Hancock, McDonough and Fulton. The counties of Peoria, Marshall, Putnam, Stark and Tazewell. The counties of McLean, Livingston, Logan, Ford and Woodford. The county of Will. The counties of Bureau, LaSalle and Grundy. The counties of Rock Island, Mercer, Whiteside and Henry. The counties of JoDaviess, Stephenson, Carroll, Ogle and Lee. The counties of Kane, DeKalb and Kendall. The counties of Winnebago and Boone. The county of DuPage. The county of Lake The counties of Randolph, Monroe, St. Clair, Washington and Perry. The counties of Iroquois and Kankakee. The County of McHenry

Second Circuit -

Third Circuit Fourth Circuit -

Fifth Circuit Sixth Circuit Seventh Circuit Eighth Circuit Ninth Circuit Tenth Circuit Eleventh Circuit Twelfth Circuit Thirteenth Circuit Fourteenth Circuit Fifteenth Circuit Sixteenth Circuit Seventeenth Circuit Eighteenth Circuit Nineteenth Circuit Twentieth Circuit Twenty-first Circuit Twenty-second Circuit-

Instructions for Individual Forms
FORM: Application to Sue as a Poor Person

Introduction: Your name Paragraph 1: Your address, include street and city. Paragraph 2: The amount and source of your income, for example, $339.00 per month in AFDC, supplemented by Food Stamps. Paragraph 3:. List other sources of income not listed in 2. Paragraph 4: The amount of income you had in the last year. Paragraph 5: Should be the same as 2, unless you expect your income to go up or down, in which case you should list what you expect your income to be. Paragraph 6: List the names and birthdates of your children and/or others you support financially. Paragraph 7: First blank: total value of your possessions; Second blank: year and make of your car; if you do not have a car, simply put "none"; Third blank: value of your car; *Before you sign your name on the blank line where it says "Plaintiff" you will need to locate a notary public to watch you sign the form. Notary publics can probably be found at the Circuit Clerk's Office or at your local bank. Make sure you bring identification with you so that the notary can verify that you are the person you claim to be in the document.

STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE ______________ JUDICIAL CIRCUIT ________________COUNTY ) ) ) ) ) ) ) ) ) ) )

______________________ Plaintiff, vs. ______________________ Defendant.

_____ Application granted _____ Application denied

No. _______ ______________________,20___ ________________________ JUDGE

APPLICATION TO SUE AS A POOR PERSON I, _________________________________, on my own behalf, on oath state: 1. My current address is _________________________________________________ ____________________________________________________________________. 2. My occupation, source of income, amount of public benefits is __________________ ____________________________________________________________________. 3. My other sources of income or support are ________________________________. 4. My income for the preceding year was approximately ________________________. 5. The sources and amounts of income I expect to receive in the future are: _____________________________________________________________________. 6. Person(s) who are dependent on me for support are: ________________________ _____________________________________________________________________ _____________________________________________________________________.

7. I own no real estate. The total value of all my personal property does not exceed $___________ in value and consists of clothing and furniture, and other household items, including a 20____, ____________ motor vehicle, valued at $____________. 8. I filed no applications for leave to sue or defend as a poor person during the preceding year, and none were filed on my behalf. 9. I am unable to pay the costs of commencing and prosecuting this action. 10. I have a meritorious claim. WHEREFORE, Applicant prays the Court to permit her/him to commence and prosecute this action as a poor person under 735 ILCS 5/5-105 of the Code of Civil Procedure. ___________________________________ Plaintiff

STATE OF ILLINOIS COUNTY OF ________________

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SS.

I, the undersigned, a Notary Public, in and for said County, in the State aforesaid, do hereby certify that ____________________, personally known to me to be the same person whose name is subscribed to the foregoing instrument, appeared before me this day in person and acknowledged that he/she signed, sealed, and delivered the said instrument as a free and voluntary act, for the uses and purposes therein set forth. Given under my hand and notarial seal this ___ day of ____________, 200__. ______________________________ NOTARY PUBLIC