Free CCCR 0320 12-15-03 - Illinois

Supplement to Identity Theft Petition IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS PEOPLE OF THE STATE OF ILLINOIS or

(3/28/05) CCCR 0018

________________________________________________________,
A Municipal Corporation, v.

_______________________________________________,
Defendant,

________________________________________________________,
Petitioner.

}

Case No. ____________________________________

SUPPLEMENT TO IDENTITY THEFT PETITION

_______________________________________________________ Charge(s) Against Defendant in Above Case: ________________________________________________________________
Case Number Falsely Containing Petitioner's Identity: Date of Arrest: ________ /________ /________ Arresting Agency/Agencies: ______________________________________________ Defendant's IR/SID #, if any: Petitioner's Date of Birth:

___________________________ Petitioner's IR/SID #, if any: __________________________ ________ /________ /________ Sex: ________ Race: ____________________________

_______________________________________________________ Charge(s) Against Defendant in Above Case: ________________________________________________________________
Case Number Falsely Containing Petitioner's Identity: Date of Arrest: ________ /________ /________ Arresting Agency/Agencies: ______________________________________________ Defendant's IR/SID #, if any: Petitioner's Date of Birth:

___________________________ Petitioner's IR/SID #, if any: __________________________ ________ /________ /________ Sex: ________ Race: ____________________________

_______________________________________________________ Charge(s) Against Defendant in Above Case: ________________________________________________________________
Case Number Falsely Containing Petitioner's Identity: Date of Arrest: ________ /________ /________ Arresting Agency/Agencies: ______________________________________________ Defendant's IR/SID #, if any: Petitioner's Date of Birth:

___________________________ Petitioner's IR/SID #, if any: __________________________ ________ /________ /________ Sex: ________ Race: ____________________________

_______________________________________________________ Charge(s) Against Defendant in Above Case: ________________________________________________________________
Case Number Falsely Containing Petitioner's Identity: Date of Arrest: ________ /________ /________ Arresting Agency/Agencies: ______________________________________________ Defendant's IR/SID #, if any: Petitioner's Date of Birth:

___________________________ Petitioner's IR/SID #, if any: __________________________ ________ /________ /________ Sex: ________ Race: ____________________________
(Attach additional sheets if necessary.) VERIFICATION BY CERTIFICATION

Date:

_________________________________, _________

Atty. No.: _________________ Pro Se 99500 Attorney (or Pro Se Petitioner): Name: ____________________________________________ Address: ___________________________________________ City/State/Zip: ___________________________________________ Telephone: ________________________________________

Under penalties as provided by law pursuant to Section 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 s/he verily believes the same to be true.

__________________________________________
Signature of Petitioner

DOROTHY BROWN, CLERK OF THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS