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
| IN RE THE MATTER OF: | ) |
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| (your name) | ) | No. (get from the clerk at the time |
| ) | you file) |
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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.
Cook County is its own judicial circuit. The rest of the counties in Illinois fall into one of 22
circuits.
First Circuit - The counties of Alexander, Pulaski, Massac, Pope, Johnson, Union, Jackson, Williamson and Saline.
Second Circuit - The counties of Hardin, Gallatin, White, Hamilton, Franklin, Wabash, Edwards, Wayne, Jefferson, Richland, Lawrence and Crawford.
Third Circuit - The counties of Madison and Bond.
Fourth Circuit - The counties of Clinton, Marion, Clay, Fayette, Effingham, Jasper, Montgomery, Shelby and Christian.
Fifth Circuit - The counties of Vermilion, Edgar, Clark, Cumberland and Coles.
Sixth Circuit - The counties of Champaign, Douglas, Moultrie, Macon, DeWitt and Piatt.
Seventh Circuit - The counties of Sangamon, Macoupin, Morgan, Scott, Greene and Jersey.
Eighth Circuit - The counties of Adams, Schuyler, Mason, Cass, Brown, Pike, Calhoun and Menard.
Ninth Circuit - The counties of Knox, Warren, Henderson, Hancock, McDonough andFulton.
Tenth Circuit - The counties of Peoria, Marshall, Putnam, Stark and Tazewell.
Eleventh Circuit - The counties of McLean, Livingston, Logan, Ford and Woodford.
Twelfth Circuit - The county of Will.
Thirteenth Circuit The counties of Bureau, LaSalle and Grundy.
Fourteenth Circuit - The counties of Rock Island, Mercer, Whiteside and Henry.
Fifteenth Circuit - The counties of JoDaviess, Stephenson, Carroll, Ogle and Lee.
Sixteenth Circuit - The counties of Kane, DeKalb and Kendall.
Seventeenth Circuit - The counties of Winnebago and Boone.
Eighteenth Circuit - The county of DuPage.
Nineteenth Circuit - The counties of Lake
Twentieth Circuit - The counties of Randolph, Monroe, St. Clair, Washington and Perry.
Twenty-first Circuit - The counties of Iroquois and Kankakee.
Twenty-Second Circuit- The county of McHenry
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
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| Paragraph 7: | First blank: | total value of your possessions; |
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| Second blank: | year and make of your car; if you do not have a car, simply |
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| | put "none"; |
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| Third blank: | value of your car; |
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*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.
FORM: Motion to Waive Publication Costs (use only if you want to apply for a waiver of the costs of publication) First blank: Your name.
Second blank: Name of county in which you filed your case.
Sign your name on both blank lines next to where it says "Plaintiff" and print your name below each signature.
FORM: Order Waiving Publication Costs (use only if you are submitting the Motion To Waive Publication Costs)
First blank: Name of county in which your case is filed.
DO NOT FILL IN THE DATE OR THE SIGNATURE LINE FOR THE JUDGE.
FORM: Notice of Filing of Petition For Name Change First blank: Put the date on which you will be filing your Petition For Change of Name. Remember that this date must be at least 6 weeks after the date the Notice
appears in the newspaper. Put the day, month, and year. Second blank: Your present full name (first, middle, last) Third blank: The new name you want the court to give you. (first, middle, last) Fourth blank: Name of the city in which the courthouse is located. Sign the form above where it says Plaintiff and put the date you signed the form above where it says DATE.
FORM: Letter to Newspaper First blank: Name and address of newspaper in your town or county. Second blank: Your case name. (for example, In Re The Marriage Of Jones) Third blank: Your case number (for example 96-D-67)
If your Motion To Waive Publication Costs was denied or you did not ask for a waiver then check box 1. If your Motion To Waive Publication Costs was approved, check box 2 and list the name of the county in which your case was filed in the first two blanks and the name of the city in which the courthouse is located in the third blank.
Sign your name and print your name, address, and telephone number where you can be reached. Don't forget to include a self-addressed, stamped envelope.
FORM: Petition For Change of Name
First blank: Your name.
Second blank: Your age in years.
Third blank: Your address including city and state.
Fourth blank: The state in which you were born. If you were not born in the United States, put
the country. Fifth blank: Your present full name (first, middle, last) Sixth blank: The new name you want the court to give you. (first, middle, last) Sign your name on both blank lines next to where it says "Plaintiff" and print your name below each
signature.
FORM: Order For Change of Name First blank: Your present full name (first, middle, last) Second blank: The new name you want the court to give you. (first, middle, last) DO NOT FILL IN THE DATE OR THE SIGNATURE LINE FOR THE JUDGE.
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| IN RE THE MATTER OF: | ) | _____Application granted |
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| ) | _____Application denied |
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| ) | No._______ |
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| ) | _________________________, 20___ |
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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 ________________________________________.
- My income for the preceding year was approximately ______________________________.
- The sources and amounts of income I expect to receive in the future are:
- Person(s) who are dependent on me for support are: ________________________________
- 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 $____________.
- 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.
- I am unable to pay the costs of commencing and prosecuting this action.
- 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 }
} SS.
COUNTY OF _____________ }
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 ___________, 20___.
NOTARY PUBLIC
STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT COUNTY
| IN RE THE MATTER OF: | ) |
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| ) | NO. ________________ |
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MOTION TO WAIVE PUBLICATION COSTS
I, _____________________, state the following facts are true:
- I have filed an Application to Sue as a Poor Person, which lists my income, resources and assets.
- An order was entered by this Court which allowed me to pursue this action without payment of costs.
- Illinois case law recognizes that publication costs of persons like myself are a local obligation and that service by publication is a constitutional right under due process of law. King v. King, 21 Ill. App.3d 1062, 316 N.E.2d 555 (4th Dist. 1974).
WHEREFORE, I ask that the Court waive publication costs and order the ___________________ County Treasurer to pay the costs of publication to the newspaper which publishes the required Notice of Filing of Petition For Change of Name.
______________________, Plaintiff
Under penalties as provided by law pursuant to Section 5/1-109 of the Code of Civil Procedure, the undersigned certifies that the statements set forth in this instrument are true and correct, except as to matters therein stated to be on information and belief and as to such matters the undersigned certifies as aforesaid that she/he verily believes the same to be true.
, Plaintiff
| IN RE THE MATTER OF: | ) |
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| ) | NO._______________________ |
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ORDER WAIVING PUBLICATION COSTS
The Court, having considered the Motion to Waive Publication Costs filed herein by Plaintiff and having previously allowed Plaintiff to pursue this action as a poor person, finds that Plaintiff is indigent.
IT IS HEREBY ORDERED that the Clerk of the Circuit Court shall cause publication to be made on behalf of Plaintiff and the Treasurer of _________________ County pay costs of publication upon presentation of a statement by the newspaper wherein such notice was published and upon filing and allowance of claim. The County Treasurer shall pay for such necessary and proper expenses pursuant to 55 ILCS 5/ 5-1106.
DATE:___________________ ENTER:___________________________________ JUDGE
| IN RE THE MATTER OF: | ) |
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| ) | NO._______________ |
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NOTICE OF FILING OF PETITION FOR CHANGE OF NAME
Notice is given you, the public, that on __________________________, 20 __, I will file a Petition For Change of Name in this Court asking the Court to change my present name of _________________________________________________________________________ to the name of ___________________________________________________________.
DATE_____________________________ PLAINTIFF_____________________________
IN RE THE MATTER OF: ) )
____________________ ) NO. _______________ ) )
PETITION FOR CHANGE OF NAME
I, ________________________________, without the assistance of an attorney, ask this Court to change my name. In support of my Petition, I state the following items are true:
- This Court has jurisdiction over the subject matter and myself
- I am ____ years old.
- My current address is: ________________________________________________________ ____________________________________________________________________________________.
- I have lived in Illinois for at least 6 consecutive months before I filed this Petition.
- The state/country of my birth is: _________________________________________.
- My current full name is: ________________________________________________.
- The new name I would like the court to give me is: ___________________________ ___________________________________________________________________________. WHEREFORE, I request that the Court grant my Petition For A Name Change. ______________________, Plaintiff Under penalties as provided by law pursuant to Section 5/1-109 of the Code of Civil Procedure, the undersigned certifies that the statements set forth in this instrument are true and correct, except as to matters therein stated to be on information and belief and as to such matters the undersigned
certifies as aforesaid that she/he verily believes the same to be true. , Plaintiff
| IN RE THE MATTER OF: | ) |
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| ) | NO._____________________ |
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ORDER FOR CHANGE OF NAME
The Court, having considered the Petition for Change of Name filed herein by Plaintiff, heard the evidence, and being otherwise fully advised in the premises, finds that it should be granted.
IT IS HEREBY ORDERED that the Plaintiff’s name of ____________________________, is hereby changed to: ___________________________________________________________, by which he shall be hereafter known and called.
DATE:___________________________ ENTER:
JUDGE
DATE: ____________________
__________________________ Newspaper
Dear Sir or Madam:
Re: __________________,Case number: _________
Enclosed you will find a Notice to File Petition For Change of Name in the above referenced case. Please run this Notice once a week for 3 weeks. After publication has been completed, please send the Certificate of Publication to me in the enclosed self addressed stamped envelope.
( ) Please bill me for the cost of publication. If you have any questions, please feel free to contact me.
( ) Please bill the office of the Treasurer in __________________ County, ___________________ County Courthouse, _________________________, Illinois for the cost of publication. I have enclosed a court order requiring the Treasurer to pay the cost of publication in my case. If you have any questions, please fell free to contact me.
I thank you for your cooperation
Sincerely,
