Free IN THE CIRCUIT COURT FOR THE THIRD JUDICIAL CIRCUIT CLERK - Illinois

Note to Internet User: If you are acting as your own attorney (that is, if you are "Pro Se"), scroll down to find blank forms you may use. The following forms are available below: 1. Motion form (and an instruction form). 2. Answer/Entry form 3. Affidavit and Application to Sue or Defend as an Indigent Person (and instructions)

About the forms: A motion may be filed for a variety of reasons, depending on what type of case you are involved in. For example, you may need to ask the court to change a hearing date if you are put in the hospital unexpectedly. In such an instance, you would request through your motion that the case be continued to a later date. Motions may also ask to vacate a judgment, to modify a child custody arrangement, to dismiss a case, and so on. Some motions have requirements about what they must say. If you are acting as your own attorney, you must follow the law just as an attorney must. An answer is filed in response to a pleading filed by a petitioner. As respondent, you may complete the "Answer/Entry" form and either admit or deny the allegation. An affidavit and application to sue or defend as an indigent person may be completed by a party to a case when the party believes he cannot afford to pay court fees. For instance, if you wish to answer an allegation made against you in a case, there is an $118.00 answer fee. A judge will decide whether to allow you to proceed without paying a fee after you complete the affidavit. You may also be required to provide a tax return, paycheck stub, or other documents or testimony before a judge rules on your request.

IN THE CIRCUIT COURT FOR THE THIRD JUDICIAL CIRCUIT MADISON COUNTY, ILLINOIS CASE NUMBER Plaintiff(s) Name Address Defendant(s) Name Address

Phone

Phone

PRO SE MOTION
Now comes the (Plaintiff/Defendant) Pro Se, and in his/her motion to

states as follows: 1)

2)

3) (etc.)

Therefore, (Plaintiff/Defendant) requests the Court to grant the motion to

Signature
I mailed a copy of this pleading to the other party (or the attorney) on the _______ day of ________________________, 200__ at the post office at ______________________ in a postage-paid envelope. (city/state) Signed: ______________________________________ By person completing this form

--- EXAMPLE FORM --IN THE CIRCUIT COURT FOR THE THIRD JUDICIAL CIRCUIT CLERK MADISON COUNTY, ILLINOIS CASE NUMBER

(This number is mandatory)
Defendant(s) Name (2nd name listed on original case) Address

Plaintiff(s) Name (1st name listed on original case) Address

Phone

Phone

PRO SE MOTION
Now comes the (Plaintiff/Defendant) Pro Se, and in his/her motion to

(Your name here) (State what you are asking the court to do)

states as follows: 1) (List the first reason why the court should grant your motion. If there is more than

one reason, list the second reason after the number 2 below, the third reason after 3)

2)

3) (etc.)

Therefore, (Plaintiff/Defendant) requests the Court to grant the motion to

(Restate what you are asking the court to do)
(Your Signature) Signature

(Note: Once you have mailed a copy as indicated below, return the white copy to the Clerk's office) I mailed a copy of this pleading to the other party (or the attorney) on the _______ day of ________________________, 200__ at the post office at ______________________ in a postage-paid envelope. (city/state) Signed: _______(Your Signature)___________

IN THE CIRCUIT COURT FOR THE THIRD JUDICIAL CIRCUIT MADISON COUNTY, ILLINOIS

, Petitioner(s) vs. Case No. Family Division

,

Respondent(s) ANSWER/ENTRY

I,
(Print your name on above line)

appears and

admits / denies the allegations contained in the petition on file herein.
(circle one of above)

Sign Your Full Name on Line Above

Street Address on Line Above

City, State and Zip Code

(

)

Area Code and Phone Number I mailed a copy of this answer/entry to the other party (or the attorney) on the _______ day of ________________________, 200__ at the post office at ______________________ in a postage-paid envelope. (city/state) Signed: ___________________________________

Instructions for Affidavit & Application To Sue or Defend as an Indigent Person
If you claim you are not financially able to pay filing fees and costs, you may apply to the Court for waiver of those charges as an indigent person. To seek waiver of those fees, you must complete and submit the form "Affidavit & Application to Sue or Defend as an Indigent Person." Please submit the completed form as soon as possible so that the Judge can rule on your request, and you can provide further information if required. You must PRINT all of the information required on the form and sign your signature affirming under penalty of perjury that the information you have given is truthful. Complete all parts of the form. The Judge will review your completed application and either grant or deny it or require additional information. If you are being sued and the Court denies the application, you will have to pay the filing fees before the answer date or extension. If you do not, a default Judgment may be entered against you. In order to qualify as indigent, the Court uses income guidelines based on those established by U.S. Department of Health and Human Services:

2008 GUIDELINES ­ INDIGENT PARTY
(125% of Health & Human Services Poverty Level)

SIZE OF FAMILY 1 2 3 4 5 6 7 8

YEARLY $13,000 $17,500 $22,000 $26,000 $31,000 $35,000 $40,000 $44,400

MONTHLY $1,083 $1,458 $1,833 $2,208 $2,583 $2,958 $3,333 $3,708

For family units with more than 8 members, add $4,350 yearly or $363 monthly for each additional person.

IN THE CIRCUIT COURT FOR THE THIRD JUDICIAL CIRCUIT MADISON COUNTY, ILLINOIS _________________________________________, Plaintiff vs. _________________________________________, Defendant

Case No. __________________

AFFIDAVIT AND APPLICATION TO SUE OR DEFEND AS AN INDIGENT PERSON The undersigned as affiant, under penalty of perjury as provided in Section 735 ILCS 5/1-109, certifies that the statements in this instrument are true and correct, or made on information and belief and believed to be true: 1.) I am familiar with the facts stated herein and this Application to Sue or Defend as an Indigent Person is brought for: myself as Applicant on behalf of a minor or a disabled adult, ________________________________. 2.) The applicant is named as a defendant in a pending action or intends to file a lawsuit. 3.) The applicant receives assistance from the following benefit programs: SSI, AABD, TANF, Food Stamps, General Assistance, State Transitional Assistance, State Children & Family Assistance. (Circle all benefits received.) 4.) The applicant's household income is 125% or less of the current poverty level as established by the United States Department of Health and Human Services.
(Clerk will provide current chart to make this determination.) (You must also provide the following information to confirm your eligibility.)

Number of persons in applicant's household ________ Household income: $_____________ monthly. The applicant's household income includes Social Security Disability Payments. Unemployment compensation benefits. 5.) The applicant is unable to proceed in an action without payment of fees, costs, and charges and the applicant's payment of those fees, costs, and charges would result in substantial hardship to the applicant or the applicant's family. 6.) Applicant is: unemployed, or $ ____________ monthly. 7.) Applicant is married, or $____________ monthly. 8.) Applicant is receiving employed, and the applicant's current income is

unmarried. The applicant's spouse's current income is paying child support in the amount of $___________ monthly.

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9.) The applicant has the following assets: money in banks, credit unions and savings & loans, in the amount of $__________ real estate with equity of $_____________ located at ____________________________ automobiles with equity of $ _____________
(Equity is the value of the property minus any mortgage or debt.)

other financial assets, including retirement accounts, of $___________ other assets____________________________________ in the amount of $___________ 10.) The applicant's total monthly living expenses are $______________ as follows:
(Do not include payments for debts or child support.)

Rent or mortgage payment: ___________ Food: ___________ Clothing: _________ Car payment: _________ Car insurance:_________ Gasoline & maintenance: _________ Utilities: _____________ Telephone: ____________ Child care: _____________ Medical, hospital & prescription: _______________ Insurance: _______________ Other: _____________________________________________________________________ 11.) The affiant, in good faith, believes that the applicant has a meritorious claim or defense. Wherefore, the Affiant seeks permission of this Court for the Applicant to sue or defend as an indigent person.

Affiant ORDER Having reviewed the Application to Sue or Defend as an Indigent Person, the Court now enters its Order: Application ALLOWED. The applicant is allowed to sue or defend as a poor person without payment of fees, costs or charges. Assessment against any other party is reserved pending outcome. Application DENIED for the following reason(s): Applicant is not indigent. Other: ________________________________________________ ________________________________. Applicant granted _____ days to pay filing fees. Application is INCOMPLETE. Default Judgment may be entered if application is not completed by the answer date or extension. Applicant granted _____ day extension to submit completed application. RULING RESERVED. Applicant MUST submit most recent Federal income tax return along with yearto-date paycheck stub or statement within _____ days. Failure to do so may result in entry of Default Judgment. __________________________ Date __________________________________________ Presiding Judge

Clerk to mail copies of this Application and Order to all parties of record.
Rev. 3-2-04

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Case No.