IN THE CIRCUIT COURT OF ROCK ISLAND COUNTY, ILLINOIS FORTEENTH JUDICIAL CIRCUIT SMALL CLAIMS DIVISION
CASE NUMBER________________________________________________________ INDEX BOOK NUMBER_________________________________________________ PLAINTIFF_____________________________________________________________ DEFENDANT___________________________________________________________ DATE JUDGMENT ENTERED_____________________________________________ AMOUNT OF JUDGMENT________________________________________________ COSTS_________________________________________________________________ RELEASE DATE_________________________________________________________
I, LISA L. BIERMAN, Clerk of the Circuit Court, do hereby certify that the foregoing data is true and correct as taken from the records of Rock Island County Circuit Court now in my office remaining. IN WITNESS WHEREOF, I have hereunto set my hand and Affixed the seal at Rock Island, Illinois this __________day Of ____________, A.D. 20___________.
______________________________________ (CLERK OF THE CIRCUIT COURT) BY:_____________________ (DEPUTY)