Free CCSD 004 11-08-04 - Illinois

Clerk of the Circuit Court of Cook County Record Request Form
Child Support Division
Correspondence Room 200 28 North Clark Street Chicago, Illinois 60602 (312) 345-4045
Your request is subject to approval under the applicable provisions of the constitution and statutes of the state of Illinois, the Illinois Supreme Court Rules, and the local policy and procedures. PLEASE DO NOT SEND ANY PREPAYMENT! After we receive your request you will be notified of the cost. All Government agencies must submit their request on Government Letterhead.

Requestor Information
Name of Requestor: Address: City: Day or Work Phone: Case Number: Petitioner Name(s): Respondent Name(s): Petitioner SS# Respondent SS# Records Requested:

______________________________________________________________ ______________________________________________________________ ______________________ State:____________ Zip Code: _____________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________
Name used when case was filed

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Name used when case was filed

___________-_______-___________ ___________-_______-___________

Check here for list of payment

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Please complete this form as fully as possible and mail to the address above. The requestor will be responsible for statutory fees (see Section 27.2a of the Clerk's Act (705 ILCS 105/27.2a) which can include but are not limited to, the following: search fees; copying charges; certification charges (if necessary); and postage. Prior to processsing the request, the requestor will be notified of the charges and expected to remit advance payment. PLEASE DO NOT SEND ANY PREPAYMENT.

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Signature of requestor

______________________________________
Date

Fee Schedule (See 705 ILCS 105/27.2a)
Record Searches $9.00 per year and division or district Certified Copies $9.00 per certified document Copies First page at $2.00 Next 19 pages at $.50 Remaining pages at $.25

This request may take 4 to 6 weeks for processing.
(11/08/04) CCSD 0004